** Update: July 2020 **
While the majority of the information below remains true today, wearing facemasks in public and practicing social distancing (6+ feet away from others) is highly recommended by public health experts across the country.
Given that recommendations continue to change rapidly, we recommend that families consult the CDC’s website for the most up-to-date guidance.
What is COVID-19?
Despite the scary name, COVID-19 is an infection caused by a member of a well known family of viruses, called coronaviridae, which means crown in latin. They are given this name because they all share a structure which looks a bit like a crown when viewed through a powerful electron microscope.
Another feature this family shares is that while they are extremely common in animals, they occasionally mutate into forms which also infect humans. The current virus is being referred to as the “novel coronavirus” because prior to December 2019 it had never been diagnosed in humans. It has, however, likely been present in animals for thousands, or even millions, of years.
What are the symptoms?
The information coming from China suggests the most common symptom is no symptom at all. In fact, approximately 80% of people with the infection will have no symptoms or mild symptoms such as fever, cough, muscle aches, or feeling very tired.
Overall, when people do show symptoms, the virus is more likely to affect the lower respiratory tract (cough, labored breathing), rather than the upper respiratory tract (sore throat, runny nose, laryngitis, sinus infection). Therefore, if a person has these upper respiratory tract symptoms, it is unlikely to be from coronavirus.
How does the infection spread?
Like most cold viruses, coronavirus is spread through respiratory secretions, also known as droplets. Respiratory droplets are present in the surrounding air for a short while after a sick person coughs or sneezes. More commonly, they are passed after a sick person touches their nose or mouth then touches something else. Depending on what they touched, the virus can live on that surface for up to a few days. If a healthy person touches that same surface, and then touches their own mouth, nose, or eyes, the virus can then infect that new person.
As I mentioned, 80% of people will have no symptoms or only mild symptoms. Those who do show symptoms may not do so until 2 weeks after they get the infection. Both groups of people, however, can spread the virus during this important 2 week period.
Who is at risk for getting this infection?
The simple answer is everyone. The better question to ask is who is at risk of developing dangerous symptoms, such as respiratory distress or labored breathing? The good news for parents and pediatricians is that for reasons we don’t completely understand yet most children are unlikely to develop dangerous or life-threatening symptoms. They are probably just as likely to get the infection, but much less likely to wind up in the hospital or worse.
The exception is in children with other chronic medical problems such as lung and heart disease, poorly controlled diabetes, or immune system diseases. These children have “low reserves,” which is another way of saying their ability to fight infections is lower than normal.
How can I protect my family?
- Wash your and your child’s hands with soap and water for at least 20 seconds when you get home, after using the toilet, and before preparing or eating food.
- If soap and water are not available, use hand sanitizer which contains at least 60% alcohol.
- Stay away from children and adults who are obviously sick.
- Keep members of your family home if they are sick as well.
- Keep your family members up to date on their vaccines, especially influenza and pneumococcus. Although there is no vaccine against coronavirus, if a person has these vaccine-preventable infections, the coronavirus is more likely to cause a dangerous, life-threatening infection.
What about wearing facemasks?
There are two types of facemasks, and the country's leading experts on infectious diseases do not recommend buying either one. The first is surgical, the common kind of mask you see that ties behind the head or loops around the ears. These single-use, loose-fitting masks are intended to prevent large-droplets from entering a patient’s open wound during surgery and to prevent splashes of bodily fluids from entering the doctor’s body while they are operating on a patient. They were not designed to prevent transmission of small/microscopic droplets (the way viruses are usually spread), and are therefore not effective in preventing the spread of this viral infection.
The second is the N95 respirator mask. These masks are also single-use, but are designed to have a tight fit around the nose and mouth. By design, they require experience and testing to ensure the fitting is correct, and are not effective in children or people with beards. When used correctly, they make it difficult for the wearer to breathe well or participate in normal activities.
Can I travel with my family?
The CDC does not currently recommend against travel within the U.S. On Sunday, however, the state department did recommend against travel on cruise ships. Regarding international travel, I recommend consulting the CDC’s website frequently to obtain the most updated information on traveling to specific countries. As coronavirus spreads to different countries, these recommendations will change, and you should check this website frequently. Remember to count layovers in these countries as well.
Fun fact about air travel: Airlines filter and recirculate the cabin air every 2-4 minutes on average. Studies show the air you breathe in commercial airlines is more sterile than that of a typical bus or train.
Is there a treatment for this infection? What about a vaccine?
There is no antiviral medicine for this infection. Tamiflu has not yet been shown to treat this infection, and antibiotics for bacteria (amoxicillin, z-pack, etc) do not work against viral infections. Infectious disease experts do not anticipate a vaccine for COVID-19 for at least 12-18 months from now.
When should I be worried?
If you or your child has a fever with cough or difficulty breathing, you should call your doctor right away to discuss your concerns.
Other questions about coronavirus? Please email me at dr.tim@modernpediatrics.co if you would like to see answers to other questions on this blog post. Feedback is always appreciated!
