Month: July 2020

Originally published on KevinMD.com on July 27, 2020

Should I send my child back to school? A letter to parents.

This is the million dollar question that I’ve been asked over and over again by distraught parents wanting to do right by their children. 

Parents want to have their children stay home so they can keep them healthy and safe. At the same time they are worried about the far reaching consequences of them not being in school. School is not just about academics but also about social and emotional wellbeing. For some children, school may be the only place where they get a nutritious meal, a safe area to play or a kind word from an adult. But even if the home is ideal, most parents have to put in a lot of time and effort to make sure that their child gets the most out of online school. In spite of all the evidence supporting in-person classes, parents are terrified that they will compromise the safety of their children by sending them to school.

I want to reassure all parents that according to the data, children are about as safe as anyone can be in this pandemic. Does this mean they will be 100% safe? No. But when is your child truly 100% safe? Not when they walk on the road, get into the car, go to the pool or do any number of daily activities that you don’t think twice about.

The American Academy of Pediatrics is encouraging children to get back to physical classrooms. Many doctors I know say they would send their children of any age back to school. 

What is the COVID-19 data on children so far

As of now, there have been ZERO deaths in children in California, Texas and New York despite tens of thousands of cases. Florida has had four deaths with over 23,000 pediatric cases. The total number of US deaths is 31 for children under 15 (the CDC groups older children with adults up to age 24). In comparison, the CDC reports 101 flu deaths for the same age group and time. 

But that’s deaths! I don’t want my child to get seriously sick. 

Of course that is totally understandable. Fortunately, most children are asymptomatic, and the ones who do get sick, mainly end up with mild symptoms similar to that of a cold. 

A rare syndrome called Multi Inflammatory Syndrome in Children (MIS-C) which causes inflammation of multiple parts of the body has been observed. Researchers are still studying this and hopefully we’ll have more information soon. The good news is that only about 200 possible cases have been reported.

To put it all in perspective, there have been a little over 30 deaths and about 200 cases of MIS-C out of about 74 million children in the United States.

Of course when it is your child who is one of those numbers, it’s a wholly different issue. It’s devastating when it’s your child who gets killed in a car wreck or in a pool accident, but you still looked at the odds and made the decision that the risk was acceptable. Hopefully you will feel the same way about COVID-19 as well.

How can I make sure they don’t get COVID-19?

You cannot be sure that they will never get COVID-19, just like you cannot be sure that they won’t get in a car wreck. But you put them in a car-seat or have them wear a seat-belt. The same principle applies to COVID-19. You know what to do and what works – ask them to wash their hands, wear masks and spread out whenever possible. Despite all these precautions, it’s still possible that your child might get COVID-19, but you likely won’t know that they had it or they may just come down with the sniffles. And yes, your child might be the one that gets MIS-C or dies, just like your child might die in a car or pool accident. But you know now that the chances of those happening are miniscule.

It’s terrifying to read reports of surges in cases among kids in daycare and schools…

You can get over that terror by understanding the difference between testing an individual who is sick so you can treat them, and testing people in large groups for public health purposes to see how the virus is spreading in that community. Most of these recent surges in childhood cases are from states’ public health efforts to understand the load of the virus in communities and reduce its spread. Not because all of these kids were seriously sick and needed to be hospitalized. So be more analytical when you read about cases. Dig a little deeper into hospitalization and mortality numbers.

So if children are at such low risk, then why all this controversy over school openings?

The controversy exists because of adults. Adults in the school and at home. Unfortunately, COVID-19 is way, way worse for them than for children. We don’t want the kids to infect high risk teachers and family members. Therein lies the problem. 

Since we can’t leave the kids by themselves at school with no adults to teach or supervise them, nor leave them home alone taking care of themselves, we need to figure out how to protect adults who care for children.  

Most teachers and parents of young children will be 65 years or younger, which means that the highest risk category, those over age 65, don’t enter the equation. The high risk teacher or parent with medical problems will need to be addressed separately. But the majority of adults caring for these children on a daily basis will be in the lower risk group of generally healthy and under 65 years old. 

It is clear that the issue is not really over the safety of children, but over the safety of adults. We adults must figure out ways to reasonably protect ourselves while giving children the opportunity to safely flourish in school again.

Sue Royappa, MD, MPH

Originally published on July 20, 2020 in https://cityofhideaway.org/docs-corner/f/moderna-vaccine-trial-results-in-plain-english

140 vaccines for COVID-19 are now being developed all over the world, with more than 30 in early human trials, and three in large scale, late stage human trials. Moderna in the United States is the first to have its vaccine’s Phase 1 trial published on July 14. Vaccine development is usually very time consuming, often taking 5-10 years to come to market, but the US government’s “Operation Warp Speed” and the billions of dollars invested in it, have resulted in a human vaccine trial just months after the viral genome was first sequenced.

The Moderna COVID-19 vaccine: Phase I trial summary and more

45  healthy adults between 18 and 55 years old were enrolled in the study. So no children, elderly or high risk patients with underlying medical conditions in this round. 

The 45 people were divided into three groups, they either received 25 mcg, 100 mcg or 250 mcg doses of the vaccine.

Each person received TWO shots of the same dose 28 days apart.

28 days after the second dose, 100% of participants had antibodies in their blood, the levels were higher than in those who had antibodies after a natural exposure to COVID-19.

The antibodies produced in the blood by the vaccine were neutralizing antibodies, which means they can bind to the virus in a manner that blocks infection.

Most side effects were mild, including fatigue, chills, headache, muscle aches and pain at the injection site. Side effects were more common after the second dose, especially with the highest dose of 250 mcg. 

Participants will be followed for one year after the second shot with periodic blood collections.

All the above is good news for a Phase 1 trial, which is always small for safety reasons.

What we don’t know at this point:

• How will the most vulnerable people, i.e. the elderly and those with underlying medical problems, react to this vaccine? Will they produce the same level of antibody response that the young and healthy volunteers did or will it be weaker?
• How effective is the vaccine going to be in preventing infection, symptoms, hospitalizations and death? For example, the seasonal flu vaccine is effective 45 -70%  of the time, depending on the year.
• Will it provide complete protection or just enough to keep you out of the hospital?
• If you do get infected despite the vaccine, will you be able to infect others?
• For how long will the antibodies provide protection? Will you need booster shots? And if so, how often? Will the initial dosing consist of a two shot series?
• How many of us will need to be vaccinated to get herd immunity? In other words, what is the minimum percentage of people that need to get vaccinated so they can protect others who can’t or won’t get the vaccine?

Hopefully the above questions will mostly be answered in Phases 2 and 3 of the study. However, some of the answers may not be available until well after the vaccine has been given to the masses.

Later Phases:

Moderna’s Phase 2 is already ongoing with 600 people evenly split between 18-55 year olds, and older than 55 years. Participants will get either a placebo, 50 mcg or 100 mcg doses at both vaccinations, again 28 days apart.

Phase 3 will be significantly larger, and will start enrolling volunteers on July 27 with a goal of 30,000 participants. Half will receive a placebo and the other half will receive 100 mcg doses of the vaccine.

If Phase 3 is successful at the 100 mcg dose, Moderna says it can produce 500 million doses in the first year.

The record time for a new vaccine thus far is 4 years. Less than 10% of drugs in trials are actually approved by the FDA. Let’s see how Moderna performs in the end.

The AstraZeneca/Oxford vaccine Phase 1 trial summary coming soon…

Sue Royappa, MD, MPH

Originally published on July 15, 2020 in https://cityofhideaway.org/docs-corner/f/you-got-tested-for-covid-19-now-what

Once you make the decision to get tested, please isolate yourself at home until you get your results back. Depending on where you got tested, and what type of test was used to check for active coronavirus infection (a.k.a. COVID-19), you may get your test results back in an hour or it may take several days if you’re in a hot spot with a backlog of tests. 

Until you get your results back, behave like you might be positive for the virus and could expose others to it. Please stay home. If your test result is negative, then please read the section “If you test negative for COVID-19” by clicking on the link below https://cityofhideaway.org/docs-corner/f/covid-19-viral-testing-info

If your test result is positive, you may get an email, text or call from the lab or directly from NET Health (the North East Texas Public Health District) if you went to a free testing site that was operated by the Texas Division of Emergency Management. If you went to a private lab or to a local clinic, they report the positive test result to you and to NET Health. You may get asked by the testing lab to isolate yourself according to CDC’s recommendations and inform all your close contacts. If this happens to you, then here are some guidelines to help you do the right thing to reduce further spread of the virus:

● Call your doctor immediately and follow their directions for medical care.

● Isolate yourself at home until at least 72 hours have passed since recovery, which is defined as (A) no fever without the use of fever-reducing medications such as acetaminophen, (B) improvement in respiratory symptoms such as cough and shortness of breath AND (C) at least 10 days have passed since symptoms first appeared.  All three of those situations must occur before you are officially considered to be recovered from COVID-19.

● If you tested positive during a testing drive but never had any symptoms (a.k.a. being asymptomatic), then isolate yourself for 14 days.  

● Make a list of people that came into close contact with you in the 2 days prior to your symptoms of your testing day if you had no symptoms. These are not people you passed by at the golf course or said hi to at the grocery store. These are people that were CLOSER than 6 feet from you for AT LEAST 15 minutes. If you choose to inform your close contacts before NET Health calls you, then here is a link to the CDC close contact information that you can share with them: https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/contact-tracing.html

• Testing is recommended for ALL your close contacts.
• Those contacts who test positive should be managed as a positive case
• Contacts who test negative should self-quarantine for 14 days from their last close encounter with you and monitor for symptoms.
• Those who simply had casual contact with you do not need to quarantine themselves but need to continue to wash hands, use face coverings, and social distance.

NET Health has their own contact tracing program and will connect with you once they are notified by the lab of your positive result.

Do not despair if you test positive. Follow your doctor’s advice and seek prompt care for worsening symptoms. Go to the ER if you have any life threatening symptoms like shortness of breath or confusion. Remember that while most people have mild symptoms and recover without any complications, some individuals may develop severe symptoms that require hospitalization. COVID-19 may not affect you in the same way it may affect someone else.  Continue to encourage your family and friends to wash, distance, and mask.

Sue Royappa, MD, MPH

Originally published on July 3, 2020 in https://cityofhideaway.org/docs-corner/f/main-takeaways-from-the-governor%E2%80%99s-mandate-yesterday

In order to reduce the spread of COVID-19 in Texas, Governor Abbott has mandated the following:

1. No outdoor gatherings larger than 10 people. This is to prevent a whole bunch of us from getting sick at the same time.
2. When around people from other households, stay at least six feet away from them, if at all possible. This is one of the most important things you can do. The primary mode of transmission of the virus is respiratory droplets, so if you stay far away, it’s harder for droplets carrying the virus to reach you.
3. It is now required that you wear a face covering over the nose and mouth in public whenever social distancing is not possible.
4. Businesses can now require you to wear a mask.

Main exceptions to mask requirements:

1. You are younger than 10 years old. This exception was likely made because no children under the age of 10 have been known to transmit the virus to an adult thus far.
2. You are eating or drinking. Unless you have one of those funky masks on YouTube!
3. You are exercising. This is likely because of reports of problems such as low oxygenation, especially in people with compromised heart and lung function.

What does the mandate mean for us?

Of course, we’ve had to reschedule our fireworks to comply with the initial mandate of no gatherings larger than a 100 people. However, we can still celebrate in small groups of 10 or less. Here are some things to consider if you’re having a party at home:

1. Move your party outdoors if possible. Continue to stay 6 feet apart even if outside. Make sure you drink plenty of fluids in the heat. 
2. If your outdoor area such as patio or deck, or your indoor living space is not large enough to allow social distancing, then please wear a mask.
3. High risk people, regardless of age, who are staying at home, but are interacting with people from other households, should wear a mask even if they feel they can social distance most of the time.

How do you know if you are six feet away?

In general, if you and a friend extend arms and come close to touching each other’s fingertips, then step back a little to make sure you’re over six feet away.

A mask is not an impenetrable armor. Just because you have one on, does not mean you should forget about social distancing and get close to people. Stay six feet apart unless you have no other choice. 

Here’s to the quick discovery of a safe, effective, long lasting and affordable vaccine so we can all look forward to a “normal” Fourth in the future!

Sue Royappa, MD, MPH