Dr. Kevin Most: Coronavirus and Pediatric Viruses — What To Look For & What To Do
The world is concerned again as we hear about a new virus that was noted in China in December and has now spread to numerous countries across the world. Three cases have been identified in the United States, all three US patients appear to be doing well and are being held in isolation, not so much for treatment but to limit them from exposing others. We heard last week that O’Hare has begun screening individuals who are arriving from China and the number of cases continues to rise, as does the worldwide exposure and unfortunately deaths.
Let’s take a couple of minutes to understand the virus, what we are seeing and how concerned should we be.
The virus we are talking about comes from the family of Coronaviruses. These viruses are found in many animals, the virus is considered zoonotic as it predominantly impacts animals. The virus however has been known to mutate to a point where it can now infect humans. When this occurs we have big concerns as our immune system is set to fight off the common coronaviruses but not the novel strains. Think of it as a flu virus that mutates and we have no vaccine to protect us, the body is then exposed to a virus that the immune system
There are now 7 know types of Human Coronavirus noted around the world. Of the 7 we consider four of them as “Common”, these 4 are viruses we have all been exposed to, and cause the “common cold”. With the Common Coronavirus, the illness is often mild respiratory symptoms. Cough, fever, runny nose. We have no vaccines for Coronavirus as the symptoms really don’t dictate a need for this illness. The antiviral influenza medications that we use to treat flu are not effective or necessary for Common Coronavirus.
The other 3 types of Coronavirus that have impacted humans but are not common are known as novel viruses. The novel virus is often one that has mutated from an animal virus to a virus that can now infect humans. This has probably occurred thru history but we had not had the capabilities to track and identify until somewhat recently. Looking at the history of novel Coronavirus the 3 we have seen show us the power of a unique new virus.
The 3 Novel Viruses are:
1. The SARS Virus- Severe Acute Respiratory Syndrome- this virus first appeared in 2003 in Asia. This virus was found in many animals, many of which were killed in order to limit spread of the virus. The virus spread to 25 countries but the virus was contained and within a few years the cases of SARS had disappeared and we have not seen any cases of SARS since 2004
2. The MERS Virus- Middle East Respiratory Syndrome- This virus first appeared in Saudi Arabia in 2012. It is felt this virus had its source from a camel. The virus had spread around the world. The US has seen only 2 cases since 2014. Both of these cases were seen in healthcare providers that had worked in Saudi Arabia.
3. The 2019 nCOV- this is the current Coronavirus that has been identified in China in December of last year.
We will spend some time on the new novel Virus and what they are doing to identify patients and mitigate the risk of spread.
2019 n COV
What we know so far is that this virus was first identified in late December a city in China, it has caused hundreds of cases locally and some of those individuals have unfortunately traveled outside of China. Recently the city has been placed in complete shutdown to restrict any travel in or out of the city. The city has 7-11 million inhabitants and it is thought to be one of the biggest cities in the world. Could you imagine if we totally restricted travel in and out of Chicago. The bigger question is how long do they keep the complete quarantine? We know there is a 7-10 incubation period so lifting the quarantine could easily allow for widespread infections.
There have been some deaths as well from respiratory complications of the virus. The goal with these unique and novel viruses has been to identify the patients earl, and isolate the patient. This limits the chance of spread. This is important as we have no vaccine, no medication and our treatment options are just to support the patient and hope their immune system is strong enough to fight the virus. In most cases they can but in some cases this is not the case and the patient dies.
It would take some time to develop a vaccine and we know that the chance of developing any medication to treat this virus is not possible for a long time.
Should we be concerned?
Identification and isolation is key, that being said, identifying the patients is difficult as the symptoms are the same as influenza, and it appears that many patients may have non life threatening symptoms so they may not be seeking treatment. Couple that with the limited number of open isolation beds in most hospitals and the concern rises. We may also see a shortage of protective equipment as the concern has been raised worldwide.
If we knew we were getting the correct numbers from China we would have a better idea of our level of concern. It appears that they are quickly building a large quarantine center in Wuhan. Many are concerned that we are not getting the true number of cases. With the cases we have seen in the US we know many of these cases are not life threatening and therefore may not be recorded or identified.
We also don’t know how this virus will survive, or how easily it is spread. The SARS virus hung around for 8 months and then essentially disappeared and we have not seen cases since 2003. That Coronavirus killed about 10 % of those infected. Early numbers here show this virus with a 3% mortality rate, if we are getting the correct numbers.
If we put it in perspective each year in the United States we see 10 Million influenza infections, that end up with 200,000 severe cases and about 40,000 deaths in the US each year. We know this virus is coming each year and many prepare for it with vaccines, others don’t. At the time of this writing there were just over 2,000 cases worldwide and 3 in the US and those individuals have been isolated with non severe symptoms. The concern for rampant worldwide spread is a concern but identification and isolation will hopefully allow this virus to disappear as we have seen with SARS. At this point I would not be overly concerned but knowing that brilliant scientists around the world are watching this is reassuring.
Viruses in Children this season- tough to be a kid
This has been an unusual season for pediatric viral infections. We discussed the impact that Influenza B has had on children this season, this strain had an impact on Children more strongly than adults and unfortunately we saw an increase in pediatric deaths so far this year due to this strain.
We also have seen very high levels on 2 viruses that mainly impact pediatric cases that have names that may get your attention. The most common one is RSV or Respiratory Syncytial Virus. This year we have seen high numbers of cases than we had seen in years, we are hoping that it has peaked as we have seen the peak noted by the CDC down this past 2 week period.
RSV is a virus all new parents should be aware of. This virus places infants under 6 months, premature infants and children under 2 years old with lung or heart disease at high risk. This virus starts with something as simple as a runny nose and a decrease appetite and then can progress over a few days to a picture of cough and wheezing. In many cases these compromised and young patients may end up hospitalized for treatment and monitoring. We do have some medications that can be used in the hospital setting to help fight this virus.
There is a medication that can be given prophylactically to high risk patients, parents with premature or who are asthmatics should be aware of this medication and discussing with their physician may be appropriate. Medication is Synagis
RSV although often thought of as a disease of infants is also seen in adults over the age of 65, especially those with chronic lung and heart disease. This is important that patients know to look for the cough and wheezing that are unusual. Seeking assessment early can be helpful.
This is a virus that was identified in 2001 and has been seen as mainly hitting children under the age of 5 or over the age of 75. When we see a pattern like this many will assume that those older and middle aged have either already been exposed to this virus and can fight it off or it is a virus that our immune system can fight.
Symptoms include nasal congestion, cough, sore throat and fever. In healthy individuals the symptoms will resolve after a few days. In compromised individuals symptoms will linger and can become more severe.
Treatment of viruses/colds in Children
What can I give my child for their cold? This is a very common question that doctors are asked frequently. There are a few key responses, the first is that children under the age of 2 should not be given any OTC Cold and Cough medications, this has led to many manufactures to place a warning on the label to not use under the age of 4. Studies have shown that for the most part these medications do little if anything to help and may pose some risk of harm.
Why is this? Well cold medications were for the most part studied in adults and not children. Many companies took the adult results and applied them to children, yet we do not know how children and adults may react differently to many medications. We also have the concern that a patient may receive an OTC medication that is based on age not weight, we know that medications should be given based on the weight of a child not the age, yet some parents may be unsure of a weight but they are sure of an age and thus may use the wrong dose.
Also using the appropriate measuring device is key to overdosing. In reality parents need to know that the act of giving a child OTC meds may help the parent feel better knowing they are doing something but is doing little to help the child fight the cold.
Some basics that can be helpful.
1. Keep the child’s fever down with appropriate dosing of fever medications. A few key points, no Advil until the child is over 6 months, and aspirin should not be used in Children. Tylenol and Advil, are safe for children over the age of 6 months, prior to 6 months use Tylenol alone. For over 6 months, You can use both of these medications as they are completely different and will often help keep a child from spiking a fever at the timing of the next dose. Tylenol dosed every 4 hours where Advil is dosed every 6-8 hours for extended coverage.
2. Cool Humidifier in a child’s room will help offset the dry air we see at this time of the year
3. Children may lose their appetite with these illnesses but keeping their hydration up is key. This is a time to let children drink whatever they would like. Also popsicles and jello are great ways to get some fluids in children that are easy on a sore throat and enjoyed by kids.
4. Children under the age of 3 months who are ill should be seen by your doctor as they are at higher risk for more serious illnesses as their immune system develops.
If you have any concern you should see your pediatrician or family doctor.