Coronavirus (COVID-19): What You Need to Know – PediaCast 455
- Everything you need to know about the novel coronavirus and COVID-19 disease. We go beyond the headlines and dive deep, exploring the cause, transmission, symptoms, treatment, risks, complications and prevention of this rapidly evolving pandemic. We hope you can join us!
- Coronavirus Disease 2019 (COVID-19)
Announcer 1: This is PediaCast.
Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.
Dr. Mike Patrick: Hello, everyone. And welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from the campus of Nationwide Children's Hospital. We are in Columbus, Ohio.
It's Episode 455 for March 11th, 2020. We're calling this one "Coronavirus (COVID-19): What You Need to Know". I want to welcome all of you to the program.
So this is our 14th year of bringing you pediatric podcasts and you can tell that's true by the number of episodes we've produced, 455 now to be exact, with hundreds of topics in the archive related to health and wellness of children, in addition, lots of parenting topics and books reviews.
And for those of you who are long-time listeners, you know I often preface an episode by saying we have a really important topic for you this week. And they are all important topics, especially for families impacted by a particular condition and for raising awareness for the rest of us who should know about that topic as we strive to identify the condition when it occurs and support those who are dealing with it at home.
This week is different. When I say this is an important topic, I really really mean it. And I do believe that this is the most important and timely episode that we have covered in 14 years of podcast episodes. And the reason is that we have a real and significant pandemic on our hands.
Now, that word in and of itself does not necessarily need to cause alarm. So let's define what we mean by pandemic. And first, I actually want to take a step back and define the term 'epidemic'.
What is an epidemic? Well, by definition, an epidemic is the rapid spread of an infectious disease to a large number of people in a given population within a short period of time. And we saw that in January and February in Wuhan, China, right? That was an epidemic.
Now, a pandemic, by definition, is an epidemic that has spread across a much larger region, typically including multiple continents and having a worldwide impact. However, that excludes diseases that spread in a seasonal manner. So seasonal flu, even though it's widespread across multiple continents and has a worldwide impact, that does not constitute a pandemic, unless the flu strain is unique in some sort of way like we saw with the 2009 H1N1 swine flu pandemic.
So pandemics have to be widespread across several continents in relatively short amount of time and unique in some sort of way. We have that now with regard to the COVID-19 coronavirus. So, even though the World Health Organization and the CDC, they've been hesitant to label this outbreak as a pandemic, at least as of today, March 11th, 2020. But by definition, COVID-19 is a significant pandemic.
And I don't want the terminology to catch you by surprise when you start hearing that word used more and more, because you will. And now, the important point I want to make with all of this is the term 'pandemic' simply describes the widespread outbreak of the new or novel disease.
The disease itself does not have to be particularly deadly to be called a pandemic. So when you hear this declared a pandemic, it does not suddenly mean that things are getting more dangerous or more out of control. It's simply a term used to describe the spread.
And I think officials are afraid to use that word because of how it makes people feel. And we have seen the results of how people feel, creating fear and panic in the stock market and elsewhere. So hesitancy in using that term is understandable.
At the same time, it's coming, folks. The term 'pandemic' is coming to a news channel near you. And I don't want you to be surprised or think the situation is suddenly worse in some way when you begin hearing that word used.
So it's I think important to define what is a pandemic, what's an epidemic and hopefully, you have a little better understanding. It's just the spread. It doesn't mean that things are worse. And we have that now, it's happening.
So by way of introduction to this episode, I want to mention that my family visited New York City last week. That's why we didn't have a new podcast for you. It was a trip we have planned many months ago to explore the city. We spent some time in Manhattan and Time Square. We caught a couple of shows on Broadway.
And by the way, Hadestown was terrific and definitely deserving of the Tony for the Best Musical of 2019. Andre De Shields, Patrick Page, Reeve Carney, Eva Noblezada, wow! I've heard and I hope that it's true that when Hadestown goes on tour next year, the original Broadway casts is going with it. And if that is true and I hope it is, get your tickets, folks, if you can when it arrives in the city in your neck of the world.
But I digress, we had a wonderful time. Hadestown was terrific. We also saw Beetlejuice and Hamilton, terrific shows.
And we had a great visit of New York City. We went to the 9/11 site and the observation deck up on Freedom Tower. I put some pictures on Instagram, the PediaCast Instagram page.
So it was a great family spring break getaway. And we had, again, planned this long ago. I think if we had known what we know now maybe we would have held off. But you know, we had the tickets and the hotel and the theater tickets and all that for quite some time.
When we arrived in New York, there was one confirmed case of coronavirus. And when we left three days later, there were 44 confirmed cases. Yesterday, which is when I prepped all of this content for you, so number I gave you are going to be one day old. These are all from March 10th. But yesterday, which was one week from our actual arrival when there was one confirmed case in New York, and now, a week later there are 142 confirmed cases.
So during our time in the city, you could see as that number went up, you could see the tension and anxiety arise among people in the streets, the subways, the theaters. There was growing concern and it continues to grow.
Here in Ohio, we had our first three confirmed cases announced a couple of days ago. My home institution, Nationwide Children's Hospital, announced a work related international and domestic travel ban till the end of April. And the Ohio State University canceled all in-person classes for at least three weeks.
And you can expect our confirmed number of cases here in Ohio to rise, just as it has in New York City, as in the state of New York as we test more people. You're surely going to see these numbers rise. They have to rise. And they're going to rise in your neck of the woods.
There is growing concern. And it will continue to grow as we move forward, which brings me to my next really important point. And that is, it is okay to be scared. It's okay to worry.
You hear a lot on the news, "Oh, don't worry about this, the seasonal flu is much, much worse." And it is, in terms of number of deaths so far. But that doesn't mean that we shouldn't acknowledge our feelings. And it is okay to talk about this plainly with our kids in an age and developmentally appropriate way.
Ask your kids what they're hearing, at school, on the Internet. What information are they coming across? Ask them what fears they have. If you're watching the news together, ask them how they feel about all of this. Gather their questions and arm yourselves with answers.
And that really is the antidote to our fear, right? Answers, facts, the truth, at least as well as we know it here on March 11th, 2020.
And that is my goal today, to get answers, facts, and truth, as well as we know it, today, in your hands to help you and your family as COVID-19 spreads into your community, which it likely will based on what we're seeing in other parts of the world, anyway. I think it will likely spread to your town.
And so, I just want to get information in your hands. And as we do that, there are a few things that I want to avoid. The first, we will keep politics out of this discussion. Now, I realize it's a presidential election year, and you are already hearing COVID-19 coverage through a specific political lens depending on which news outlet you were connecting with. I want to avoid that, no spin here. And I truly mean it. We just want to look at the facts and talk about them.
Second, I do want to keep things in perspective. Since October, seasonal flu in the United States has caused 40 million illnesses, 20 million visits to the doctor, 500,000 hospitalization and more than 20,000 deaths including well over 100 children.
By comparison, in China, where coronavirus has been at its worst, there had been 80,000 confirmed cases of COVID-19. Although, certainly more if mild cases that did not get tested and confirmed are counted, which we can't count because they weren't tested and confirmed.
But we know there are at least 80,000 significant cases of confirmed disease and just over 3,000 deaths. Zero deaths in kids less than 10 years of age that we know about.
So again, 80,000 total cases, 3,000 deaths compared to 40 million cases of seasonal flu and 20,000 flu deaths and over 100 of those in kids from the seasonal flu here in the United States since October of 2019.
And if the news media chronicled every new influenza case and every new flu death every single day as they are doing now for COVID-19, we would likely see the same fear and panic because seasonal flu causes significant disease and death every winter in the United States and around the world.
And the numbers I reported, 40 million cases in over 20,000 influenza deaths, this represents an average flu year for us. Other years have been much more including two years ago.
So this is why doctors are passionate about telling people to get flu shots in the fall. I mean, flu shots are an important defense in our quest to ward off the flu.
And I have to be honest, I have to remind myself of this perspective because as I watch the news and I digest social media, I get anxious inside. And I'm a pediatrician, I'm a scientist, and there's still anxiety that wells up within me as I read and watch and hear news reports.
But you do have to remember that the flu does this every year to a much greater degree. We just don't hear about it, but it's out there. So I do want to remind you and not overstate the impact of COVID-19. At least, for now, seasonal flu is a bigger killer. We need to keep that perspective.
At the same time, I don't want to minimize the concern as some others are doing. The numbers compared to the flu mean nothing if your family is affected. If you lose a loved one because of COVID-19, that is very significant, right? I mean, every life is precious, and we want to save as many people from getting sick or dying from COVID-19 as possible.
So while we can keep it in perspective by thinking about how big and bad the seasonal flu is, COVID-19 is pretty bad, too. And we want to save as many lives as we can and not lose them to this pandemic.
So here's my plan with this episode. First off, right here at the beginning, during the first half of our time together, I want to share the most important facts with you concerning COVID-19. That way, you have the important information in your hands.
And then, if you have other things to attend to, you can move along. After we covered the essentials, we'll take a quick break and then we'll dive into lots more detail and discussion for those who are curious.
In our digital age, you're going to see lots of bullet points in very short two-minute news stories that cover the basics. If you'd like more detailed information, stick around. I'll have that for you as well.
Okay, so what are the most important facts that you need to know about coronavirus and COVID-19 disease? Well, for starters, the reason public health officials are taking this so seriously compared to seasonal flu -- I mean, we don't lock down cities and cancel conferences and tell you you can't travel, don't get on airplanes, don't get on cruise ships, all of those things -- we don't do that every year with seasonal flu. And it's because communities do have natural protection against seasonal flu.
There's protection there because folks get sick with the flu to one degree or another each and every flu season. Yearly flu shots are important because they boost the immunity that we already have at the beginning of flu season for that particular strains of flu that we think are going to go around in a particular season. But the fact of the matter is that most of us do have some immune protection because of previous engagement with the flu virus.
And that is not the case with COVID-19. This is a fairly new, well, this is a new virus. Not fairly new, it is very new. And so our immune systems have to sort of start from scratch to eliminate it and that requires a good working immune system and a healthy body. Which is why we are seeing certain high-risk groups being the ones who do not have healthy immune systems and healthy bodies.
So those over 60 years of age and folks at any age with underlying medical conditions especially immune system problems, high blood pressure, heart disease, lung problems, diabetes, these are the folks who are most at risk from having severe disease from COVID-19. And part of that is because your immune system has to deal with this brand new. You don't have any previous protection.
Now, we don't know that 100%. So we do know that other coronaviruses do go around seasonally. And they do cause colds and coughs and fevers and kids and adults year in and year out. Not this novel coronavirus. And when we get into the deeper discussion, we'll talk a little bit more about how this one differs from other coronaviruses and how it came to be.
But the question becomes does having had a recent infection with a sort of regular coronavirus, not the novel one, does that provide you with some degree of protection against this new one? And could it be that older folks or folks with underlying medical conditions don't make as good of immunity against the regular coronavirus?
And so, maybe they don't have as much protection. And that's maybe why younger adults and especially kids who may have had coronavirus, the regular coronavirus, more recently, maybe they do have some immunity to it. And that is what is protecting them against this coronavirus. That's why we don't see a severe disease in children and young adults.
This is completely hypothetical. This is my own hypothesis. We don't have any idea right now why kids are less affected and why older folks and those with significant underlying conditions are more affected other than their immune system is not quite up to handling it.
So lots to consider but if you are in a high-risk group, so again, if you are over 60 years of age or you have an underlying chronic medical condition, it is really important to prevent yourself from becoming infected with COVID-19 in the first place. How do you do that?
Well, one big thing that public health officials are saying is social isolation. Stay home until we get through this, as much as you can. Avoid crowds, avoid meetings and conferences, avoid grocery stores and shopping centers, avoid attending church.
Check in with one another, Skype, FaceTime to your heart's content. But this is a great time to just stay home for awhile. And if you're able, work from home, if you can.
Don't take any trips, don't ride in the subway, buses, airplanes. By all means, cancel your cruises and don't book a new one until we get through this pandemic.
And these are not just my ideas. These are directives from US public health officials. Stay home if you can especially if you're in a high-risk group. Socially isolate yourself, which is easier to do these days compared to the flu pandemic of 1918 when there was no Internet.
So it is a little easier these days to isolate yourself. You're not really socially isolated, just contact isolated because you can still engage with people online or through FaceTime.
Also, wash your hand frequently with soap and water. Ladder up, scrub for 20 seconds and then rinse and dry with a clean towel or air dry.
Shorter than 20 seconds of scrubbing is not long enough. And much longer than 20 seconds is also potentially problematic because you start to eliminate skin oils and slough off skin cells which are barrier in protecting us.
So 20 seconds is the sweet spot. To get to 20 seconds, you can sing the ABC song in your head. You have to include the "Now, I know my ABCs" first at the end, in order to get to the 20 seconds. But the complete ABC song including that last verse is about 20 seconds long.
Or happy birthday twice through or whatever other song you like. Just time it first and whatever part of the song you're going to sing, aim for about 20 seconds. And time it out and then start when you wash your hands to sing that to yourself.
I do have a list of 20-second handwashing songs to prevent coronavirus in the show notes for you, Episode 455 over at pediacast.org. Some examples, if you just sing the chorus part of "Raspberry Beret" by Prince, "Jolene" by Dolly Parton, "Lose Yourself" by Eminem, "Heaven Is A Place on Earth" by Belinda Carlisle, "Africa" by Toto. I know I'm dating myself with some of these songs.
There's a whole list for you in the show notes or a link to a list in the show notes. And you can find others if you Google. If you don't like any that are provided in the list that I give you, you can find others.
Also, avoid touching your face. Coronavirus gets into the body like other respiratory viruses, like the flu, through your eyes, your nose, and your mouth.
And so, if they're on surfaces that people have touched and then you touched those surfaces and you have not washed your hands, and then you touch your face, you're much more likely to get it. So if you notice yourself touching your face, then stop. Stop doing it, try to be conscious about it.
And I hope others, too, especially your kids, your spouse, folks that you live with. If you see them touching their face, just very politely say, "Hey," and "Please let me know when I'm doing it, too, so we can help other when we see ourselves touching our face." Just really, you want to get out of that habit.
Cover your coughs with the inside of your elbow. And did I mention, wash your hands often. Don't touch your face. Avoid crowds, seriously. And especially, if you're in a high-risk group, these simple actions can save your life.
Face masks, they are not necessary if you are not sick. Think of it this way. Surgeons wears face mask to prevent germs from getting into the sterile operating field. They aren't meant to protect the surgeon from getting sick. They are meant to stop the spread of viruses and bacteria from the wearer's nose and mouth.
In order to protect the wearer of the mask from another person's disease, you need a special mask called an N95 mask and these are in short supply. We need them for healthcare providers who will be caring for people who are critically ill with COVID-19. So please do not use a face mask unless you are the one who is sick.
And even then, just stay home. You don't need a face mask at home unless you live with high-risk people and then, fine, wear a face mask but not an N95 in the house.
And that brings me to my next point. If you are sick, stay home, unless you're having difficulty breathing. If that's the case, seek medical health right away, if you're having any difficulty breathing. That's important.
But if you or your children are sick, including with a fever or cough, which are the primary symptoms of COVID-19, if you're not having difficulty breathing, call your doctor. Explain your symptoms and see what they want you to do.
You do not want to see your doctor for a mild illness and catch COVID-19 in the process, especially if you are in a high-risk group or in close contact with a high-risk group. And if you go to your doctor's office or an urgent care center or a hospital emergency department, there likely is going to be COVID-19 in those places from people who are very sick.
And so, if you have mild illness, it's going to be important to stay home. Touch base with your doctor, absolutely. Let them know what's going on, describe the symptoms to them and let them give you guidance in terms of what to do.
I know it's easier to just go to an urgent care or an emergency room where you don't feel well. Many people do this for mild illnesses and injuries and most of the time, that's fine, it's convenient.
But these are places where you could be exposed to the virus. So check with your doctor to see if it's really necessary. And if it is, what advice did your doctor have for the safest way to accomplish this? Where should you go?
Again, if you're having trouble breathing or chest pain or you're passed out or you're having seizures or serious injury, if you have true medical emergency, get help right away. Call 911 if you have to.
But mild things can wait. Please wait, call your doctor. Get their advice over the phone. I think this is very important.
Okay, what about children? This is after all a pediatric podcast. I have good and bad news for you for kids. The good news is, as I mentioned, healthy children especially under the age of nine appear to only get mild symptoms with COVID-19 or no symptoms at all, which is great. We do not fully understand why, I gave you an idea why I think that might be, but we don't know for sure.
But we will take the fact that kids less than nine do not appear to get severe disease with this virus. But we're not sure about children with chronic underlying diseases.
So if your kids, even if they're under nine, if they have weakened immune systems, heart disease, lung problems, complex medical conditions, diabetes, personally, I would treat them like adults with regard to prevention recommendations.
So we don't really know the effect of COVID-19 in children with underlying medical conditions. We don't know for sure.
And finally, there is some other bad news even for healthy children with mild or no symptoms. And that is they can pass the virus to adults. And that could be a problem, especially for high-risk adults.
So if your children have to be around grandma and grandpa, even if they don't have any symptoms, even if your kids don't have any symptoms, they could be a carrier. So it's a good idea to keep their distance as much as possible, wash their hands frequently using that 20-second rule.
Make sure they're covering their coughs and disinfect any surfaces that they touch. This is the safest practice. And again, I don't say these things to cause panic. They're actually basic hygiene measures we should be practicing anyway.
So again, washing hands frequently, covering coughs, disinfecting surfaces especially when viruses are going around.
And even if your kids, if they have a mild cold, they just have a little runny nose or maybe no symptoms at all, even treat them as if they do, especially for grandparents in their 70s and 80s. I mean, really, I would keep your kids away from them until we get through this. I think that's going to be an important point and the safest practice.
So these are the essential details as we know them on March 11th, 2020. The best places to find additional information is going to be the CDC, the Centers for Disease Control and Prevention. And I'll put a link to their Coronavirus Disease 2019 page, their landing page, where you can then get to tons of additional information. That's going to be good evidence-based information that you can trust from the CDC.
And then, for those in Ohio, I'm also going to put a link to the Ohio Department of Health. They also have a Coronavirus Disease 2019 page with information for the general public, for healthcare providers, for schools, lots of different interest groups. The Ohio Department of Health is going to have great information for you regarding coronavirus disease.
And for those of you who are not in the state of Ohio, just Google your state and type in Department of Health and you'll find it. And I'm absolutely sure that on the landing site of their website, they're going to have a link to get you to their information page on coronavirus disease, COVID-19.
All right, and I'll put a link to both of those places, the Ohio Department of Health and the CDC in the show notes for this episode 455 over at pediacast.org.
All right, we're about halfway through. I got the basic stuff in for you. Let's take a quick break, stick around if you're interested in more detailed and nuance information regarding the current outbreak of the novel coronavirus and COVID-19 disease. I have lots more coming your way. It's happening right after this.
Dr. Mike Patrick: We are back. And before we get started with the second half of today's episode, I want to remind you that information presented in PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your doctor.
So the first half of today's episode, I really wanted to present sort of all packaged up nice and neat for you the most important things that you need to know about coronavirus and COVID-19 disease to keep your family safe and to prevent this from happening in your own family.
The second half, I wanted to take a step back and maybe slow down just a little bit and demystify coronavirus. I think part of the anxiety is just when you hear about something new, you've not really heard the term coronavirus before. It's this new big bad thing that's spreading throughout the world. And that in and of itself causes anxiety.
But when you take a closer look and really try to understand what's going on, at least for me, as a student of science, it helps dial back the anxiety a little bit. Like, okay, we got this, we can figure it out. So that's my hope that this will help with.
So coronaviruses, we've all seen pictures of the virus at this point, right? It's all over the news. It's a sphere shape with spikes coming off of this sphere. Those spikes are proteins and we'll talk exactly why they're there in just a moment.
But coronavirus, corona is the Latin word for crown. And as you look at the picture of a coronavirus, you can understand how it got its name.
We also described the sun as having a corona, which extends in spikes and rays from the spherical surface of the sun. So, again, it all makes sense why this is called a coronavirus.
It's a family of viruses that were discovered in the 1960s and they are a frequent cause of the common cold along with rhinovirus, adenovirus, enteroviruses, human metapneumovirus, respiratory syncytial virus, RSV. These are all things that cause little bit of fever, runny nose, congestion, cough, sneezing in humans.
These viruses also infect other mammals, also some birds. And in cows and pigs, it actually causes significant diarrhea illness. So these viruses have the potential to infect not only the respiratory tract but also the intestine and the GI tract.
And although it's not as common as the big three, fever, cough, and difficulty breathing, we have had reports of diarrhea being associated with the COVID-19 disease as well.
You notice I keep saying the COVID-19 disease because that's the name of the condition. The virus itself has a little bit of a different name, and as we explore through this a little more, I'll tell you what that is. And I think it will make sense to you why it's called what we're calling it.
So the other thing that's important to understand about coronavirus is, is that they are an RNA virus. Now, why does that matter? Why is this important? Well, it's important because RNA viruses tend to mutate much more frequently than DNA viruses.
So DNA kind of has like a spellchecker component to it. And remember, viruses just like cells use genetic material to create new copies of itself by harnessing the mechanics or the factories inside of a cell.
It gets into the cell; it hijacks the factories in the cell to make the cell that it's infecting create more of itself and uses its genetic material to do that.
While RNA, it's a little different than DNA, it doesn't have that spellchecking capability. And so, if things don't go quite right, that mutation is going to stay and the new generation of viruses that get released from that cell are going to be slightly different in terms of their genetic makeup, which in turn changes the proteins that are on the outside of the cell.
So that genetic material codes for what those proteins are going to be like, what their character is. And that's important for couple of reasons. The proteins that are on the surface of the virus affect how the virus engages with other cells. So how easily it can bind to the cell, gain entry into the cell really is dependent on the proteins on the outside of the virus.
Also, our immune system responds to those proteins in specific ways. So you may, if the protein changes a little, you can get some partial immunity, your antibodies may still bind with that new protein. So even though it's a different strain, we may have some partial protection.
If it's a very different protein, your antibodies may not bind to it all and so you don't have any protection against this new strain of the virus.
Another RNA virus is the flu. And that's why the flu mutates every year. It's why we have to have new flu shots every year because those proteins on the outside of the virus are changing. And it's because it's an RNA virus as opposed to a DNA virus is the reason it can mutate so rapidly.
So that's what's happening with the coronavirus. And we've had this happened before. So there have been mutations that have caused new disease caused by coronaviruses in humans even in recent history that many of us can remember.
So one of those is what we call SARS or Severe Acute Respiratory Syndrome. That's what SARS stand for. And the virus itself that causes SARS is called SARS dash CoV or coronavirus, SARS-CoV.
And this arose from an animal host. So it started in an animal in Southern China. We're not sure exactly what animal but it made the leap from being able to infect the animal to being able to infect humans, again, because the proteins changed because they had mutations of that RNA genetic material.
And this occurred around November of 2002 and that outbreak lasted until July of 2003. It caused 774 deaths out of just over 8,000 confirmed cases. So it had a fatality rate of almost 10% and then it disappeared in the summer of 2003. It just went away.
And that's significant maybe for this current outbreak or this current pandemic or maybe not. And we'll get to that in a little bit.
But when viruses mutate in such a way that they cause as much as a 10% fatality rate, they don't spread quite as far and wide because if someone gets really sick quickly and dies, they're not giving that virus to other people.
So the more fatal that a virus is, I guess one good news of that, is it's less likely to become a pandemic. And in fact, this one even though it caused 774 deaths, did fortunately stop before it caused more. And part of that is perhaps explained by the fact that summer got here and another by the very high fatality rate of SARS.
Another virus, another coronavirus that mutated here in recent memory is the MERS which stands for Middle East Respiratory Syndrome. The virus that caused this is what called the MERS-CoV or coronavirus.
This also rose from an animal host, this time in the Middle East. And there's some debate whether it was bats or whether it was camels. We don't know 100% which animal, but it made the leap again from animal to human because those proteins changed.
And this occurred in September 2012. It's still around today sporadically. In fact, there were 212 cases of it in 2019. It's mostly in the Middle East. There's been about 2,000 cases all together since 2012. But it has a really high fatality rate, 30% to 35% of confirmed cases end up with death.
Now, mild cases are likely not diagnosed, not reported. And so, the actual fatality rate might not really be 30% to 35% but it is that high for confirmed cases. So if you get really sick from it, you go beyond than being just a mild illness, the fatality rate goes up to 30% to 35%.
And again, with the high of a fatality rate, you can see why it's not a good candidate really for a pandemic because you're just killing off everybody quickly, and it doesn't spread as easily.
I know we're kind of talking in morbid terms, I understand. But I think it's important in terms of understanding why some of these become pandemic and others don't.
So it happened again. We have another mutation of a coronavirus. It goes from animals to humans, this time in Wuhan, China. And we get what we are calling the virus name is SARS-CoV, just like the first SARS-CoV dash 2. So this is the second SARS virus caused by coronavirus. So SARS-CoV-2, that's the actual name of the virus.
The disease we're calling the Coronavirus Disease 2019 was shortened COVID-19. And again, it rose from an animal host, made the leap to humans.
Our best bet is that it probably came from bats. We've also heard snakes and anteaters. And maybe it went from bats to anteaters in this wet market and then went to humans after that. Again, we don't really know for sure. But it did make the leap from animals, those proteins changed to infect humans. And this was first identified just last December of 2019.
And it is very similar to the SARS-CoV virus that caused SARS back in 2002, except that the proteins are just a little bit different. And that makes the character of the virus and how infectious it is a little different and our immune response to it a little bit different.
Now, this one has caused lots more disease and death than the original SARS or the MERS virus has. So the current confirmed cases and deaths, as we sit here March 11th, 2020, we have 121,000 worldwide confirmed cases. And those have caused 4,368 deaths as of this time right time.
So, that is a 3.6% fatality rate. And you can compare that to the flu, which the seasonal on an average is about a 0.1% fatality rate. So seasonal flu 0.1%, the current COVID-19 disease, that virus is about as 3.6% fatality rate. So in terms of deaths compared to confirmed cases, it's a much higher percentage of death compared to the flu. Now, you noticed I said compared to confirmed cases, we suspect that there are lots and lots more mild cases that are not tested and not confirmed.
And so, we have a little bit of a denominator problem in that if you take the deaths and divide by the number of cases, if you are doing by confirmed cases, you get this 3.6% fatality. But if we knew what the real caseload was, that rate would probably come down.
But maybe not come down quite as much as we would like it to. And the reason I say that is we can look at South Korea as an example of where they probably are actually identifying many more of the mild cases because they've instituted really widespread screening of their population. And if you look at deaths versus confirmed cases in South Korea, if we think that their confirmed cases really represent not only the moderate or severe ones but the mild ones as well, we still see about a 0.7% fatality rate in South Korea.
So that maybe approaching more what we could expect to see here in the United States. And if you compare a 0.7% fatality rate, compare that to the seasonal flu, and we're still seven times higher than the seasonal flu.
So this is still significant concern. Now, you've also heard that this affects folks who are 60 years of age and older more significantly than children and younger adults. And if we stratify the fatality rate by age, this is going to be not in South Korea. We don't have the numbers by age for South Korea, but we do for the world as a whole. And if we look at that, what we find is that for zero to nine years of age, we have no reported deaths, that's fantastic.
Between 10 years of age and 39 years of age, we're at about 0.2%, in the flu 0.1%. So about twice as deadly as the flu. If you are in your 40s, it goes up 0.4%. If you're in 50s, 1.3%. If you're in your 60s, it jumps up to 3.6%. If you're in your 70s, 8%, and if you over 80, nearly 15%.
So that's the sort of stratification of fatality rate versus age. So what you find is you really see the jump up in about 60 and older. But that doesn't tell the whole story. We know that also folks of any age are also at higher risk if you have an underlying chronic medical conditions, and in particular, heart disease, hypertension.
We think that is because if you have a problem with your lungs and oxygen, your heart has to work harder. And if you have an underlying heart disease or high blood pressure, you may not be able to tolerate that increased work. And so, that's one of the reasons that we're seeing increased deaths there.
Also, if you have a problem with your immune system, you need that to fight this off. Diabetes does go along with immune system problems. So that's an issue.
And, of course, lung disease, if you have already had lung disease, so things like asthma, cystic fibrosis, those kinds of things, you're going to have more difficulty with this.
Now, if you'd like to keep up with all these numbers, the best place in my opinion is the Johns Hopkins University Center for Systems Science and Engineering. They keep an up-to-date tally coming in from all of the public health agencies around the world, the CDC. And they really do a great job of keeping that up to date and just lots of numbers and insight in a nice package for you. And I'll have a link to that in the show notes for this episode, 455, over at PediaCast.org.
It is a little hard to look at on a phone screen because of the way that it's laid out. There's another site called Worldometer that also has up-to-date numbers. It's a little bit delayed compared to the Johns Hopkins project. And it does offer some different insights, it looks at what kind of... That's really where I got the stratification by age. It also has stratification by disease, underlying disease processes. It has some interesting information there for you. So I'll put a link for that one, too, COVID-19 numbers from Worldometer.
And then, if you want to compare that to numbers of influenza disease, I'll also put a link to the CDC influenza numbers for this year. So you can really compare those side by side. And see that influenza's killing a lot more Americans this year, just like every other year compared to COVID-19, at least as of today, March 11th.
Okay, that's a little bit of background about coronavirus. We've talked how viruses infect cells and hijacks the cell manufacturing center so the cell's not creating what it's supposed to create, it's creating more viruses. And for these coronaviruses, it's primarily infecting cells of the respiratory system, so upper and lower, and turning them into virus-producing factories and destroying the cell in the process.
And then, your immune system comes in to try to clean up the destruction that the viruses made so you can make new cells, but also to kill the virus. And the immune system response though can sometimes be overdone. So the immune system response itself also starts to kill some cells. And so you can get additional damage.
So poor immune response is going to let the virus go crazy and kill more cells. But too much of an immune response can also kill more cells and cause more problems. So both, you want the sweet spots of immune response. Too little is bad, too much is bad. And both of those extremes will end up causing more lung problems.
And we get what's called an acute respiratory distress syndrome picture, ARDS, which is now when there's so much destruction in the lungs that fluid leaks in from blood vessels, and you get fluid inside the lungs. You can't exchange air. You now have a viral pneumonia and then bacteria from your mouth can migrate down the trachea and cause a bacterial pneumonia on top of that.
Plus, if you have diarrhea, you can have some dehydration. Or you're not eating and drinking well, you have dehydration. So all of these things come together to potentially cause a very serious difficult-to-manage disease.
When do you see this? You know, we've been quarantining people for 14 days. So we know the incubation could, we think that by 14 days out, you should be pretty safe. Although, there have been some case reports of people taking a little longer than that to show signs of the illness. Although you could say, well, maybe they were exposed again a little later. And so, it still really was within 14 days.
The average is about five days. So from exposure to onset of symptoms, can range from a couple of days to 14 days or so. But the average is about five days.
And we do think that, like with many viruses, that you can be contagious for a day or two before symptoms begin. Or if you just have mild symptoms like just a little runny nose and a cough, maybe not even having a fever. And we especially see this in kids, and maybe even no symptoms, potentially you could still be a carrier of that virus. We don't know for sure. But these are hypotheses that are going around.
So, you don't necessarily have to have someone with the high fever, cough, difficulty breathing, who you could catch this from. You could catch it from someone with milder disease and maybe, maybe even without symptoms. So important, that's why the social isolation is important.
Again, primary symptoms fever, cough, shortness of breath. Maybe a little nasal congestion, that's in a far, fewer patients and usually not very significant. A little bit of a scratchy throat can go along with it. And again, some diarrhea. But the big three, fever, cough, shortness of breath.
If you have a lot of nasal congestion and you're sneezing, less likely to be COVID-19. But if you're concerned, call your doctor and talk to them.
In terms of differential diagnosis, what other things cause this set of symptoms? A lot of things to think about. I mean, it can run from the common cold. You're not as likely to have a fever and shortness of breath. Usually, the common cold is more runny nose, congestion, with a bit of a cough, sneezing. But you can have a fever, and if you're prone to asthma and you can have shortness of breath.
Influenza can cause similar symptoms, so if you have symptoms and your concern is COVID-19, you get a flu test and it's positive, that can be reassuring that you have the flu. It's unlikely that you would have COVID-19 and flu at the same time, but it's certainly possible.
And a negative flu test, at least the Rapid flu test does not rule out the flu as a cause because we know that they have a pretty high false negative rate associated with them.
Even allergy symptoms, as we head into spring, can cause a cough. Usually, there would not be a fever with allergies, but that can be associated with a little nasal congestion and a cough as well. So allergies can come into play and confuse the picture a little bit.
So if you have a fever and cough, you have shortness of breath, you need to see someone, absolutely. You're having difficulty breathing, you need to see someone right away. If it's just a fever and a cough, call your doctor, as we mentioned in the first half of our episode, and see what they want you to do.
In order to diagnose, COVID-19, you need a very specific test for that. And in many, many areas, that test is only available through the health department, through the public health department in your area. There are some private labs in different areas of the country that can also run this test that the government has provided these test kits for. And I know they're trying to ramp up production of these.
Again, we don't want to get political in our discussion here but we're trying to ramp up the testing and there's been some talk of letting academic centers develop their own tests for this because it's an emergency situation. The FDA kind of rules over the testing process in conjunction with the CDC. And so, trying to get more availability for tests, but right now, you're unlikely to be able to get a test like from your local hospital lab.
Again, as of March 11th. This is mostly happening through health departments. But your regular doctor, if they feel you need to be tested for COVID-19, they can order that through whatever availability you have in your particular state. And hopefully, this will improve with time.
Now, the good news is testing does not change how we treat these symptoms. So if you have fever, cough, shortness of breath, then you get a viral pneumonia, bacterial pneumonia, it doesn't really matter which virus is causing this. The treatment's going to be the same.
But it does change how we advise on quarantining and finding out who you had contact with and quarantining those people. So there is a good reason to test, to identify, and try to contain. But testing whether you're positive or negative for COVID-19, still going to be very similar treatment regardless of which virus it is that's causing this.
So what does that treatment look like? Well, it's mostly like other viral infections, primarily, supportive care. Unless, you have the pneumonia difficulty breathing part. So if you have the cough and the fever, it's staying home, rest, fluids, acetaminophen or Tylenol, ibuprofen like Advil, Motrin, those kinds. You know, the fever reducers, the things that help with aches and pains and fevers and lots and lots of fluid, so you stay hydrated. And then, stay home.
Now, if we don't know exactly what's wrong with you and you've not been tested, you definitely want to stay home until you've been fever free for 24 hours without needing the medicines that reduce fever.
If you have COVID-19 and that's confirmed, then you're going to want to stay home until you're told otherwise. And your doctor can give you more guidance.
Generally, you stay isolated even after the fever's gone, until you were not shedding that virus anymore. And initially, they thought what would it be two-week period? But it can last longer, and I even saw one study where six weeks later, someone was still shedding the virus. I saw a report of that. Whether it's true or not, again, I don't want to spread misinformation, but we don't know for sure how long someone who has the disease is contagious. And so, you definitely want to talk to your doctor if you've been diagnosed with it, in terms of when it's safe for you to be around other people again.
I didn't mention, if you don't have COVID-19 and it's just a cold or you have the flu, when I say fever free for 24 hours, some people get the idea, well, if I'm taking acetaminophen or ibuprofen and I get that fever down, then I'm not contagious anymore while the fever is down. And then, when the fever comes back up, I'm contagious again. That's not the case. We're saying you want to be fever free for 24 hours without needing any fever reducers, then, you're not as contagious as you were when you had the fever.
I'm not sure I would say that you were 0% contagious but we know you're a lot less contagious once that fever's gone with these other viruses. COVID-19, different animal, talk to your doctor.
If you do have difficulty breathing, that shortness of breath, you want to get help right away. This is definitely a medical emergency. And you're going to need supportive care like oxygen, high flow oxygen, possibly intubation, put on a ventilator, intensive care kind of stuff.
And then, we do know if you have a bacterial pneumonia, you may need an antibiotic. If you developed sepsis, which is really where things go crazy when your immune system has really gone out of whack and you get a little blood pressure and leakage from blood vessels and fluids where it's not supposed to be, and really high mortality rate with sepsis. If those things happen, obviously, you need to be in the hospital in an intensive care unit.
And then, antiviral medications, we talked about this a little bit in the intro as well. We have those for certain viruses but for COVID-19, we really do not have any studies that show us that something will work and be safe.
So there have been some things tried. There may be ongoing trials, but we don't have an approved antiviral medicine that this time that we could use for COVID-19 disease. And certainly, no vaccine at this point, although they are trying to develop one.
In terms of complications of this disorder, we've talked about some of those, the viral pneumonia, bacterial pneumonia, acute respiratory distress syndrome with the fluid filling up in the lungs. And then, the stress that puts on your heart and circulatory system, the bacterial pneumonia on top of the viral pneumonia.
And then, you know, when you have trouble oxygenating, you have what we call hypoxemia, so low oxygen in the blood where your other organs need oxygen in order to survive. And you also need good profusions, so you need good blood flow to all those organs. And so, if your heart and circulatory system is having trouble keeping up because it needs to go faster to deliver less oxygen because your lungs aren't working as well, then you can start to see organ failure, multisystem organ failure.
So kidney failure, you can have congestive heart failure, just multiple organ failure and then that can lead to death very quickly. And that's going to be more common in those with compromised immune system, those over the age of 60, if you have chronic underlying medical conditions, again, heart disease, high blood pressure, diabetes, cancer, chemotherapy, things that are decreasing your immune system. Things can get complicated really quickly.
Also, you don't want to get flu this time of the year. And there's still some flu out there. So if you've not had your flu shot and your doctor has them available or your health department in your area or any place where they offer flu shots, if you haven't had one this year, please do get one. Still very important to protect you from influenza.
And then, in terms of prevention, we really covered this in the beginning of the program. I'll just really quickly say again, stay away from large gatherings and close contact with others, especially when there is known active spread in your community, which really there could be now.
Just because you don't have any confirmed cases in your community does not mean that there is no mild disease out there. And you certainly don't want to be the first one who gets severe disease.
Again, not to cause panic but we want to be prudent about this. And I think it's a good idea just to stay away from large gatherings until this thing blows over, and especially if you're at high risk.
Definitely stay home when you're sick. Again, especially, if you have a fever and a cough, and if you do cough, make sure you do on the inside of your elbow. We know handwashing very important after going to the restroom or touching surfaces, before you eat.
Wash your hands often. Soap and water, scrub for 20 seconds and we had some more information for you on that in Part 1.
Alcohol based hand sanitizers are also great in a pinch, but not quite as good as soap and water for 20 seconds. That's the best. But alcohol-based hand sanitizer will also work if you need it to.
Keep your hands away from your face. Again, you get this stuff through your nose, your mouth, and your eyes.
Masks again are really meant more to protect others from your cough and your respiratory droplets. They do not offer protection for the air that you're breathing in, unless you're an N95 mask. And again, we really want to keep those available for medical providers who are taking care of folks who get very sick with COVID-19 disease.
And by the way, in order for those to work properly, they have to be fitted. Like, I can't just use any N95 mask. For me, personally, I have to use what's called a Duckbill regular. Like the Moldex, small, medium and large, none of those fit my face properly.
So if you just grab an N95 mask without knowing what you're doing, you're going to have a false sense of security. And every single year, I have to do a fit test where I prove that my Duckbill regular is working for me.
And so, if you have not had that done, and you think "Oh, I can go out and about and be around people even though I'm high risk, it's fine if I'm exposed because I'm wearing my N95 mask," if it's not fit properly, it's not going to protect you.
All right, so we're really right here at the tail end now, and the bottom line is how much should you be worried? And you know, for each individual, that's going to be different. In my mind, I worry about the flu every year. Not to the point of anxiety and panic but to the point of being passionate to say "Please, get your flu shot. The flu can kill you." And so this feels like the flu sort of on steroids in terms of having a population that really does not have a lot of protection against this thing.
And so, I am worried. And I think it's natural and normal for you to be worried, too. I'm a pediatrician. I'm a scientist. I'm a medical doctor, an MD and I do have a little anxiety about this especially, as I mentioned before, when I watch the news.
And it's so easy for us to just get bombarded with news stories in our social media feed. And you do have to realize that to some degree, news outlets are there to make money. They are business and they need to sell ads. And they need your eyes, they need you to click, they need you to watch.
And so there are some sensationalism that happens. At the same time, we don't want to minimize this. This is a concern.
But I think the best places to get information is really going to be... I mean, fine, look at the news source, look at your news outlets. It's hard to keep your eyes off of them, right? But also check out the CDC website.
Check out your local health department's website. And as I mentioned before, I will have the links in the show notes to the CDC's COVID-19 site and the Ohio Department of Health. And if you live in a different state, type in your state's name health department, you'll find it. I'm absolutely sure on their landing page, you will find COVID-19 information.
The other thing that I think it is important to do at this point is to have a plan if you get sick. Just think, if I get a fever and a cough, what am I going to do? And really, plot out what that looks like. So even when it does happen, you're not caught by surprise.
I think it's a good idea to stock up on supplies. It's a good idea to have medication on hand. If you can get a 90-day supply of medication from your doctor, I think that would be excellent to have at home.
Stock up on groceries in case you get quarantined. And you're going to have to stay home for 14 days or longer if you actually have COVID-19, but you have mild disease.
Be prepared. Pick groceries that will last for a long time. That way, if this doesn't happen, you got a nice stock. You've not wasted anything. And I don't say that to scare you, just be prepared. So I do think that we need to think about that.
It doesn't mean that you need to buy five huge packs of toilet paper. I mean, some of the things is pretty crazy, the things that are running low. Fine, get your toilet paper, but don't hoard the toilet paper. Your neighbor needs some toilet paper too, all right? And if you did hoard it, please share with your neighbors if they can't find any. You see them on social media. Say okay, I've got some extras if you need some.
And then, you know, the hand sanitizer, the face mask. Leave the face mask with the medical providers. And soap and water work just fine.
And again, stay home if you get sick. Touch base with your doctor, initially by phone. Unless you're having trouble breathing, I really would avoid the medical system as much as you can, so you don't catch COVID-19. But absolutely, call your doctor. Let them know what your symptoms are, get their advice on where you should be seen, where you should go and when.
If not by phone, through whatever mechanism that your doctor has for contacting them. For us, we have this thing called MyChart that I can get on my phone and send my doctor a message. She's very responsive and terrific.
In fact, she's already message all of her patients like "Hey, if you get sick, this is what you do. This is how you get in touch with me. I do want all my patients to have 90 days of medicine. If you don't have that, let me know and I'll get it called in to the pharmacy for you." So some doctors are just being terrific and there's a great opportunity for telemedicine in all of this.
And then, the final thing that I want to mention is summer is coming. Now, we don't know what's going to happen with COVID-19 when summer gets here. But we do know that other coronavirus infections typically diminish in summer, including SARS when it occurred.
And the reason for this, there's several. They probably all come together. One is social isolation. When school is out in the summer, kids aren't together in groups of 20 or 30 and are really close-knit group in the room sharing all their germs.
So you get out and about and you have less spread in schools, which remember when your kids get sick, they give it to adults. And young adults in the workplace give it to older adults in the workplace. So school is a breeding ground for viruses. So when school's out, that helps in the summer.
We also know that respiratory droplets when the air is humid tend to get heavier and drop to the ground. So you're less likely to touch them unless you're down touching the floor. So you're less likely to touch respiratory droplets, get them on your hand, then touch our face and spread it that way in humid conditions.
We also know at least outside, UV light tends to kill bacteria and viruses. And so, when the sun comes out and it's hot and humid, we see less viral illness including coronavirus.
And if you look at the world maps, there's definitely less COVID-19 in South America and Africa right now and in places where it's summer compared to places where it's more winter and early spring. And so, hopefully, when summer gets here, this thing will die out kind of on its own naturally.
But we don't know that for sure and your best bet is to still keep in touch with your doctor and your local health department to figure out exactly what you should do.
And then, my final thing I want to remind you, once again, it's okay to feel afraid, it's okay to worry. Acknowledge those feelings but arm yourself with facts. And that may mean rewinding and just listening to this podcast again. And getting the first time through, you might pick up a few things. The second time through, you pick up some more. Yeah, maybe even a third time through to really start to understand this.
And then, be there for your kids as they ask questions. Ask them what's concerning them. What have they heard at school? What did they hear online? What are they hearing on the news? If you're watching the news with them, talk about it. Really be transparent and answer in age and developmentally appropriate fashion.
All right, we are well over an hour at this point. Where else are you going to get long form in-depth information about COVID-19 aimed to parents? Right here on PediaCast.
So please do share this particular episode with your family and friends. We really want to get this information out there and demystify this thing and just help folks understand and be real with it and present you with facts and not fear.
Let's take a quick break. And then I'll be back to wrap up this program right after this.
Dr. Mike Patrick: We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast a part of it. Really do appreciate that.
Also, once again, please do let other parents know about this program, especially through your social media channels. We really want to get this information into the hands of moms and dads and as quickly as possible.
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Thanks again for stopping by. And until next time, this is Dr. Mike saying stay safe, stay healthy, and stay involved with your kids. So long, everybody.
Announcer 2: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.