Waiting on the World to Change

We at Peds First Pediatrics hope everyone enjoyed their Thanksgiving weekend.  We wish all a happy and healthy upcoming holiday season and are looking forward to a new year that should bring with it a return to normalcy.

“Now we see everything that’s going wrong

With the world and those who lead it

We just feel like we don’t have the means

To rise above and beat it

So we keep waiting (waiting)

Waiting on the world to change

We keep on waiting (waiting)

Waiting on the world to change”

– John Mayer, Waiting on the World to Change (2006)

Pandemic Tolls

Most weeks we begin with a look at the numbers, but today I wanted to begin with a discussion about the pervasiveness of the effects of the pandemic.  Much of it is disheartening, and as the lyrical quote above states, many of us are tired and frustrated with what we see and feel helpless to assist.  We have been rendered isolated and waiting for the world to change.  Today’s positive message is that the wait is almost over.  I emphasize almost over.

This pandemic has taken our nation from a position in which we had our lowest unemployment rate on record to one in which initial jobless claims remain higher than during any recession on record.  The effects of businesses in nearly every category has been negative.  Sure there are some success stories, such as health insurance companies posting record profits, but they are the anomaly rather than the rule.  You don’t need to see many studies on the effects because you can see them when you drive though any town and see more windows of local businesses shuttered than any time of recent recollection.  One review from early in the pandemic which provides some structured discussion on the topic can be found here.   

Our collective mental health has been adversely impacted due to stress and isolation.  Humans are social creatures.  FaceTime and Zoom are not a proxy for direct contact.  Worse yet is that while our mental health is declining, our access to services to assist is diminished.  Ironically, it is for the same reasons that are exacerbating the issue in the first place – the need to distance.  Not surprisingly, substance use concerns are on the rise as well.  

A final review to share today identified seven types of social consequences of mass quarantine.    The list includes psychological stress, heightened communication inequalities, food insecurity, economic challenges, diminished access to health care, disruption of education, and gender inequity.   There was one positive consequence identified – increased altruism.  Again, we show as humans that we can rise up to the challenge.

A little G. Love today.  A band from Philly that started out in the mid-90’s while I resided there.  Entitled “Numbers,” it seemed to fit here nicely.

Fun With Numbers

Will run through the numbers quickly today.  Overall, the numbers are bleak.  There are some positives to be gleaned by looking at European data.

The United States

The numbers nationally continue to have a disturbing trend as you can see below.  We continue to see significant weekly increases in the number of cases.  This has been every week now since the beginning of October.  As expected, the death tolls are starting to significantly increase as well.   We are now experiencing double the number of deaths each week relative to the beginning of October.  This is going to get much worse before it gets better.  Extrapolation of recent case rate data has us on pace to be seeing approximately 27,500 deaths in this country during the week leading up to Christmas.  If Thanksgiving and Black Friday festivities were as well attended as suspected based on travel data, that number may exceed 35,000+ deaths.  That’s 6,000 deaths per day using the merrier of extrapolated outcomes.  We are currently at 2,000.  This is already committed to.  How we proceed from this point is still in our power to influence.

The View From Your Backyard

I hesitate to use the word fortunate, but we appear to be a couple of weeks still behind the rest of the nation with respect to severity of disease burden.  I have cautioned in the past, as I am again now – we don’t live in a bubble.  Unless we act differently than others, our fate will be in lockstep with the rest of our nation.  Looking at the graphs below, you can see that since the beginning of October, daily case rates are up 7-fold (with over 700 cases reported on the 26th).   Hospitalizations are up similarly with over 200 currently admitted in Suffolk County with COVID.  There were four deaths in Suffolk County the first two weeks of November.  Since the 15th of the month, there have been 21 deaths.  Based on how crowded the parking lots appeared yesterday at the local shopping centers, I don’t have a good feeling about where this is heading around here.

A Glimmer of Hope from Across the Pond

How are we deriving hope from Europe?  Simply because they reinforced the positive impact of temporary restrictions on mobility with respect to disease spread.  That sounded nicer than saying “lockdown,” didn’t it.  Many weeks ago I had advised all that when the people don’t collectively act accordingly, the government eventually comes in to enforce it.  In Europe that occurred over one month ago.  They have again reduced their caseload and are beginning to see a flattening of the curve with respect to deaths.

**Keep in mind looking at the short bar to the right of both graphs – they are not reflecting a complete week.

Entitled “Homeward Through the Haze,”  this song appears on the Crosby and Nash album Wind on the Water.

What Now?

The Immediate Term

As discussed at the beginning of today’s blog, we as a nation have suffered tremendously in nearly all facets of life during this pandemic.  It has been ongoing for nine months straight at this point.  We have suffered through an extended period with stay-at-home orders in place.  We have seen numerous government programs put in effect that leveraged our collective futures to assist us through the present.  We appear to have a way out of this situation in the next month or two.  We can choose to waste our efforts to date and continue doing what we are doing.  We can choose to stay home and chill for another month or two in order to be in position to exit this winter in an environment that will be far more recognizable to all.   As many as 200,000 lives can be spared.  If this was Harold and Kumar, it would be like not using the hang glider at the end to get their White Castle.  Seriously though.  200,000 lives.  Suffered 9 months.  One, maybe two to go.

To be clear, I am not simply advocating a “lockdown.”  What I am advocating for all is that you think twice when you are leaving your house.  Do you need to shop for food three times in a week or could you go once every week?  Do you need to physically enter Target to look at what video game to buy a kid for the holidays or can you have it delivered using their curbside offering?  Do you need to have parties?  When you are out and about, are you wearing a mask properly?  Are you steering clear from others?

Why I am not advocating a “lockdown?”  Because the issue is far more convoluted than just a health issue.  As was discussed at the beginning of the blog, there are pervasive costs from implementing such.  I am not opposed to a “lockdown” from the perspective of saving lives.  To issue such has to be for dire reasons and needs to address the needs of those who are affected by such an order.  We cannot allow all businesses to fail, unemployment to escalate, people to become homeless or hungry.  This is for our politicians to deal with.  And they need to learn to play nice in the sandbox or they will fail us all.  Again, there is the “gray” area.  Please be cognizant of your own actions.  Much can be accomplished if everyone does that much.

The Short Term

Short term goals are primarily predicated on the various vaccines that have been developed.  If they do function as well as trial results indicate, they are our best way out of this situation.  These vaccine trials are not truly complete as yet, and it is true that you won’t know long term effects for awhile.  The track record for not having long term effects from vaccination is well established.  If only folks considered long term effects as seriously when they choose to start vaping.  Or choose to eat fast food three times a week.

When the vaccines become available, they will invariably attempt to rapidly vaccinate the highest risk individuals.  If you are 75 years old and by definition high risk for poor outcome from contracting COVID, the choice to take the vaccine should be fairly simple.  If you spend your life caring for individuals with COVID such as a member of the ICU staff, the choice is nearly as straightforward.    By the time you are done immunizing this population, data for several additional months will be available with which to base the rest of immunization recommendations.   Just getting this high risk group immunized may be sufficient enough for the rest of us to go about our daily lives with some continued mild irritations such as masks for awhile longer.

Since it has been asked often, what about mandatory vaccines for schools?  I don’t see this being an issue for awhile, if ever, however there is a condition in which I can see it being reasonable.  Specifically, if trials are performed to assess safety in children AND those at high risk along with lower risk adults have taken it AND we still are unable to control the spread of this illness where this is the last stand so to speak, yes I would advocate we go that direction.

The Long Term

There is much work left to address when viewing the pandemic from this timeline.  First, we have a lot of individuals who will need assistance due to the damage this pandemic has inflicted upon them.  Second, we need to build a proper infrastructure in this nation to prepare for similar challenges in the future.   It is not just about pandemics, though you can bet there will be another one in the future.  Catastrophes happen.  We need better plans for infectious concerns.  We need to more completely understand and plan to address all the collateral damages that occur.  It is not simple to address issues of food insecurity, housing insecurity, financial insolvency, general and mental health issues, resource management, just to name a few.  But we have a ton of smart folks in this country.  We just have to decide to prepare and actually implement rather than just postulate.

Last track for you today is by the Moody Blues.  One of their more popular tunes circa 1970.  If you have an hour to kill, would recommend listening to the album On the Threshold of a Dream.  Classic.

Some FAQ

I have been exposed.  How long do I have to quarantine?

This question may have a different answer shortly as there has been continual reassessment of data for the purpose of offering proper advice.  As it stands today, the answer is 14 days from last exposure.  This means if the person exposing you lives with you, and continues to expose you, your quarantine is 24 days as the 14 days from last exposure would be from the 10th day of the ill persons symptoms (the point at which they are no longer deemed contagious).

A nice pictorial demonstration of the various nuances of the protocol can be found on the CDC website.

I am going to be visiting with grandma, can I get swabbed to make sure I don’t have COVID before I go?

Sure you can.  But do not misunderstand that you can test falsely negative if you were exposed a couple of days ago, yet be contagious when you visit.  A negative test should not be a security blanket or means to decide to go someplace.   Please base your decisions over the short term to truly minimize spread.

I was exposed yesterday, can I get tested?

You can, but it is a waste of your time.  There is virtually no chance you will be positive the first couple of days post exposure if tested.  It is best to wait a few days post exposure assuming you are symptom free to be tested.  And if your exposure was legitimate (such as non-masked hanging out all day), you should remain in quarantine until testing is appropriately done. If you were legitimately exposed and continue to go to anywhere, you are acting selfish and irresponsibly.  Sorry, no way to sugarcoat that.

If I have to get a COVID test, can I get the antigen test or do I need the PCR test?

The answer to this lies primarily in the prevalence rate in the community and the index of suspicion for actually having COVID.  At this time the prevalence on Long Island is high enough that a negative antigen test in an individual with symptoms of COVID is not necessarily sufficient, and a back up test by PCR should be pursued.  The purpose of still antigen testing at the time of visit is to be quicker to identify a positive and mitigate the damage through quarantine of contacts.  The PCR test takes several days at minimum to get results.  For those with significant symptoms and a negative antigen test, the current recommendation will be quarantine for the individual until the PCR results are negative as well.

Is it OK to travel [insert any place but here] for [insert nearly any reason here]?

[insert favorite sarcastic response here]

I have COVID.  Can I have my in-laws watch the kids while I recover?

Depends.  Do you like your in-laws?  Looking forward to spending next Thanksgiving with them?

My two year old has COVID.  Can I run into Stop & Shop for some brownie mix to make them feel better?

No.  Nor can you go into Target.  You must stay home.  Have them delivered to your doorstep.

What vitamin can I take to protect me from COVID?

Better you should click your heels three times, as there is no place like home currently.  But otherwise, take the blue pill.  There is no COVID in the Matrix.

Post authored by Jason Halegoua PhD, MD, MBA, FAAP.  Jason is the founder of Peds First Pediatrics in 2009, and has been a practicing general pediatrician since completing residency at Schneider Children’s Hospital in 2004.  In addition to earning his medical degree from the Medical College of Pennsylvania, Jason earned a PhD in Molecular Pathobiology for his work contributing to the understanding of the genetic regulation of immune responses to murine leukemia viruses from Hahnemann University in Philadelphia and an MBA in Finance from Hofstra University.