Happy Mother’s Day (and the Weekly Update)!!!!!
Happy Mother’s Day!!!!
Lots to cover, so sorry in advance for the length of the post and contributing to your likely excessive COVID-19 related increase in daily screen time.
Will start today with a little bit about the reports of a Kawasaki Like Syndrome and concerns that it may be caused by COVID-19. Kawasaki Syndrome classically refers to folks that meet several clinical criteria including fevers longer than five days, rashes, bloodshot eyes, swollen lymph nodes, inflammation/cracking of lips and tongue. Affected individuals tend to be young children. No specific cause for Kawasaki Syndrome has been identified, and it has typically been presumed to be an inflammatory condition brought on from an immune response to an infection (https://en.wikipedia.org/wiki/Kawasaki_disease). Children with Kawasaki are quite ill, often require hospitalization, and are treated with intravenous immuglobulins (IVIG) and aspirin. IVIG is presumed to work for affected individuals by saturating (blocking) the sites the offending antibodies made by the patient usually bind to and thus prevent them from contributing to further inflammation. Aspirin is given to help prevent blood clot risk. PLEASE NOTE: DO NOT GIVE CHILDREN ASPIRIN without being prescribed such therapy. There is risk for Reye Syndrome which causes liver failure when children take aspirin.
Over the last couple of weeks, there have been numerous children admitted for conditions that appear consistent with Kawasaki Syndrome. Some of these children have been positive for COVID. While presumed to be related at this time, no causal link has been demonstrated. The number of children with the concern may still represent what is typically seen, and the severity of illness in these children may be a factor of seeking medical attention later than typical. In any event, a couple of key points for everyone to take home. First, Kawasaki Syndrome is VERY RARE. Second, while there have now been reported fatalities, they represent a small subset of the children with the condition. More obviously to come on this topic as more data is available, but please do not be preoccupied with worrying about this condition at this time. To read a bit more about what is known already (and where you will likely find nice updates going forward), Boston Children’s Hospital has been covering the topic (https://discoveries.childrenshospital.org/covid-19-inflammatory-syndrome-children).
One last bit as food for thought before moving on to the next topic is that should it be found that COVID-19 does in fact cause a Kawasaki like illness it has implications for vaccine development. Specifically, since Kawasaki like illnesses are presumed to be caused by the body’s response to an infection, simulating an infection may well cause the same issue. Being that it appears to be a VERY RARE complication at this time, it emphasizes the need for appropriately sized trials and study prior to using a vaccine on children if developed. Lest you think we have gone “Plandemic,” we truly are rooting for the development of a safe vaccine for COVID-19. We would also like to take a second to remind you to keep your children up-to-date with the current array of vaccines that are recommended and already demonstrated to be safe before we start having to write weekly columns on how to avoid getting Measles or Polio. Regarding “Plandemic,” since it has been asked a couple of times this weekend – it is not grounded in science. To get an idea of the nature of the individual interviewed in the film, we invite you to read up a bit on her for comic relief purposes only (https://vaxopedia.org/2018/12/08/who-is-judy-mikovits/). If you do watch Plandemic, and find it amusing, you may also enjoy Paul McCartney Really is Dead: The Last Testament of George Harrison (https://www.imdb.com/title/tt1683472/).
Next topic for the day is to provide a bit of update on antibody testing and advice as to how to proceed with such. There are now a couple of tests that have been validated (Roche and Abbott make them). Simply speaking, a validated test means that it is capable of telling you that you were in fact exposed to COVID-19 with a high degree of accuracy. There is a lot more to it, but we do not wish this to devolve into a class on statistics. They have Common Core for that variety of torture. As has been mentioned previously, the tests, as of today, DO NOT tell you that you are immune to the virus. Our advice? Do not antagonize your children (or yourselves) and run up a bill for a test that does not provide you with any meaningful information. If at some point it is demonstrated that a positive test is indicative of immunity, that’s another story entirely. There is a lot of direct marketing to do these tests. At this point, aside from those conducting research on the topic (something we strongly encourage), they are attempting to profit by playing into your fears. Some are offering it “because everyone else is.” Again, don’t waste your time and money yet. We will continue to update and let you know if that recommendation should change. If you insist on getting tested despite this recommendation, please at least get the testing done using a validated test so that your efforts do not amount to palm reading.
Antigen testing is imminently available! Quidel Corporation received Emergency Authorization for its Rapid Antigen COVID-19 Diagnostic Assay this weekend. Per the data the company has set forth, it is extremely specific, though not the most sensitive. In plain English, if it gives a positive result you have COVID-19. If it gives a negative result, you may still have COVID-19. Not perfect, but a big step forward at this time. Antigen testing is something that could be done in an outpatient office and give results in a matter of minutes. It is the same technology that is currently used for the rapid influenza and strep tests. Anticipating more companies beginning to manufacture similar products. Full vetting of these tests should also be accomplished over the near term as well as formal recommendations as to whom to test and under what circumstances. Remember, with all tests, there is no reason to seek answers that do not change outcomes.
Moving forward both literally and figuratively. Governor Cuomo has released the plan to reopen New York. The program, New York Forward, is a multistep plan analogous to that the federal government set forth with specifics on criteria. There are seven criteria that must be met by a region to move from one step to the next. The criteria have to do with prevalence of illness, capacity to manage those who are ill, and capacity to test and track those exposed to COVID-19. Currently, Suffolk County has met only 2 of the 7 criteria which likely indicates we have at least a couple of weeks before we will move onto the first step reopening businesses. To monitor the “scorecard” for reopening, it is available on the governor’s website (https://www.governor.ny.gov/programs/new-york-forward). The “New York State on PAUSE” order has been extended as of this weekend through June 7, though if the criteria are met for a given region, they may start to reopen prior to that time.
Much of the country (40/50 states as of late in the week) have already begun the reopening process. Many WITHOUT meeting the federal guidelines that were set forth. How this will impact their rates of infection, hospitalization, and ability to continue to stay open is as yet unknown. It will take 2-3 weeks to start gauging the effect of those heading back to work and the social scene. We continue to feel bad for those making decisions on this topic. Reopening is going to lead to infections and in some cases death. That being said, not opening has serious consequences aside from financial as well. With unemployment at record numbers, it is worth noting that unemployment has been linked with increased mortality in many studies. Try Googling unemployment and effects on health or mortality to find a lot on the topic (one such study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4677456/).
Whether schools will be open on time in September is another question for which there is no clear answer. It is also possible that they will start on time and have to return back to online schooling if there is a “second wave” early in the year. We are starting to get requests for school forms to be completed. These require well visits. We again urge you to maintain your visits on time as we currently have the ability to strictly conduct them in a space where we are not seeing sick patients. As this is a time of year that children are generally in school and not coming in for visits, it is also quite a bit quieter here. Most insurances permit one visit per calendar year. You may choose to come in over the next month rather than try to get in during August when COVID-19 will still be circulating and the office will definitely be more populated. We are looking into ways to permanently segregate ill patients in a completely separate office space, more details on that as we are able to acquire and convert office space to do so.
Last topic for the day is related to well visits. We push a lot of developmental forms to your patient portal to be completed prior to a well visit. Many have assumed they were complete when in fact they had never logged into their portal. The confusion seems to be coming from the pre-visit check in you complete using Phreesia. They are separate entities and require separate attention. Sorry for the confusion with these. Still waiting on the upgraded patient portal. Its launch has been delayed by the manufacturer as they are also dealing with trying to develop a product in a challenging environment.
Have a great week all. Stay safe. We are as always here to help you do such!