Changing recommendations about COVID19 are frustrating. That’s true for the experts as well as the public in general.
I don’t want the changing recommendations and the many difficulties of staying away from others to lead us to give up and just ignore the fact that we’re in a pandemic.
We can’t simply gather in large groups of people and expect that no consequences will come from our actions.
Even if you don’t feel sick, you could become infected and share it with an unsuspecting person who gets seriously sick.
You might not ever know you were the person who caused their illness (or even death).
How would you feel if you do find out that you’re responsible for someone you know being hospitalized or dying?
I live close enough to the Lake of the Ozarks to worry that within a few weeks of Memorial Day I will see many of my friends and their family members sick.
New information means new recommendations
No one had heard of COVID19 just a relatively short time ago, despite the fact that it seems like we’ve been living with it for so long. Even experts in epidemiology, infectious disease and related fields didn’t know anything about COVID19 when this started.
Early recommendations were made based on generalizations. They’re fine tuning recommendations as more is learned.
We still don’t know quite a bit that would help us better manage this infection.
Actual infection rates, fatality rates, modes of transmission, best treatment courses and more are still to be determined.
It will be a long time before we know how long immunity lasts – if infection provides immunity at all.
Will COVID19 infections lead to any long term consequences and how will this change recommendations for prevention and treatment?
We all should learn as information changes so we can change our personal habits and behaviors – but we need to be careful where we get our information.
Recognize that what we think we know today may change as new findings are reported.
Opening up doesn’t mean the risk is gone
As states are lifting restrictions, we need to be cautious. We’ve had time to learn and prepare, but not to eradicate the virus.
The more interactions we have with others, the more the virus can spread.
If we are careful to clean our hands properly as often as necessary, not touch our face, and wear face coverings appropriately, we can make a difference. These simple things can make it possible to continue to participate in more public gatherings.
Information released early is more likely to change
The press is eager to share information as soon as it is released, but this means that the public is seeing results of studies before they have been through the typical peer review process. This makes it more likely that information will change again.
One example of this is the early reports of treatments for COVID19.
When it was thought that hydroxychloroquine might be a beneficial treatment, the news reported it widely. Many physicians were vocal in their concerns, but this treatment was shared widely as if it was a proven and safe treatment. Many people were convinced that this was going to be the cure.
Hydroxychloroquine has many risks and studies have not shown benefit in treating COVID19 infections.
Yet there are many people who still promote it despite the study findings.
I’ll talk about some of the more common sources of confusion and frustrations, but realize that even this information can change as we learn more.
Masks were initially not recommended for the public and now they are.
- We have a shortage of medical grade masks, so we don’t want the public to use those. The CDC initially came out strongly stating that people should not buy medical masks. That position hasn’t changed. It is now recommended to wear a cloth face covering.
- People without symptoms can spread infection. This was initially unknown.
- Masks except high-grade fitted medical masks have not been shown to protect the wearer from infection. This remains true, but isn’t the point of the new recommendation. The mask can help prevent the wearer from spreading respiratory droplets, preventing spread of infection to others.
- The vulnerable depend on others to wear masks.
- Multiple studies suggest that if 80% of people wear masks, we can significantly stop the spread of COVID19.
- Children under 2 years of age should not wear masks.
Surfaces were once thought to be a potentially significant source of infection, but now they’re not.
- Respiratory droplets from person to person are thought to be the main source of transmission.
- Surfaces may harbor the virus for hours or days, depending on the surface, but proper hand cleaning can reduce the spread from surfaces.
- It is still very important to avoid touching your eyes, nose and mouth and clean your hands properly and frequently.
- It is not necessary to wipe down all of your groceries and mail.
Risks for kids – initially really low, now higher – but still generally lower than for adults
Older age is one of the strongest predictors of significant infection.
Symptoms and treatment for most young people
Kids and young adults seem to get only mild symptoms, if any symptoms at all, with COVID19 infections.
The symptoms they may have include fever, cough, sore throat, vomiting, diarrhea, body aches, headache, loss of taste or smell, and rash.
Most children with COVID19 infection do not require hospitalization for these symptoms and home care and isolation are the recommendations.
Testing remains limited in many areas, but you can always call your child’s physician to see what is recommended locally.
What about this inflammatory problem?
Now that there are reports of kids getting a serious inflammatory condition, parents are worried about the risk to their children.
This inflammation affects different parts of the body, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs.
Many children with this require hospitalization, but most thankfully seem to recover.
This condition has changed it’s name as we’ve learned more about it. It’s now called multisystem inflammatory syndrome in children, or MIS-C. Previously it was known as pediatric inflammatory multisystem syndrome (PIMS), Kawasaki disease, inflammation syndrome, severe inflammation from COVID-19 and probably other names I’ve not heard.
What we know about MIS-C
- It’s not common. This is important. We all need to think of relative risks. Out of the thousands of kids who have had COVID19, most do very well with the illness and fully recover. This doesn’t guarantee that any individual child will fare well, but it still means that very few kids will have this serious condition.
- It happens after the infection. It is not thought that kids with MIS-C are still contagious at the time of this inflammation. It is thought to be an overreaction of the body’s immune system.
- Previously healthy children can be affected by MIS-C. Most of the children with MIS-C do not have underlying medical conditions.
- Since children can have COVID19 infection without symptoms, a child who is not known to have been infected could develop MIS-C. If your child has symptoms of MIS-C you should contact your child’s physician even if they never were known to have COVID19.
Symptoms of MIS-C
If your child has a fever for 4 days and any of the following, it is important to talk to your child’s physician about getting evaluated for MIS-C:
- Abdominal pain
- Red or pink eyes (the white part of the eye, not the eyelid)
- Swollen glands in the neck (lymph nodes) or neck pain – Note: these are very common in kids and if it’s unchanged from their usual bump in the neck and there are no other symptoms, it is not likely from COVID19.
- Red, swollen, or cracked lips
- Red tongue that looks like a strawberry
- Rash – several different rashes are associated with COVID19
- Swollen hands or feet
- Fatigue (tired)
Important: Kids will not have all of these symptoms. If they have the fever and one or more of the symptoms, call your child’s physician. Not all clinics are equipped to see these children in their office. Speak to your own physician to learn where your child should go.
As always, if your child has difficulty breathing, dehydration, significant pain, or confusion/mental status changes, it is important that your child be evaluated as quickly as possible. These can be symptoms of many illnesses or injury and need prompt medical attention.
If a child is suspected to have MIS-C, they will undergo a series of tests, including blood work, heart tests, and x-rays as indicated by symptoms.
The nose swabs that are used to diagnose active COVID19 infection are NOT helpful at diagnosing MIS-C.
Coronavirus Resource Center (Johns Hopkins)
Coronavirus Resource Center (Harvard)