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COVID-19 UPDATE April 5, 2020

Angelina County issued a stay-home, stay-safe order effective 11:59 PM April 3 for all county residents. This order will remain in effect until it is rescinded, suspended, or amended or until it expires on May 1. This is not shelter in place.

The order requires any business open to the public to enforce certain safety requirements and to have a written plan in place to enforce those rules, including procedures for maintaining a 6-foot distance between people and for regular cleaning. The number of customers in each store at one time will be limited. The new orders also state that travel in Angelina County is prohibited except for essential activities or going to work in an essential business. Essential activities are defined as performing tasks essential to your health and safety or the health and safety of family and household members, obtaining necessary services and supplies for an individual, family, or household or delivering those supplies to a person in need, outdoor activities provided social distancing requirements are followed, caring for another family member or pet in another household, school-related activities, and engaging in the work of an essential business.

The order can be found here: https://www.angelinacounty.net/files/pdf/order0402.pdf

Please be reassured that the Children’s Clinic and Angelina Pediatrics are following these guidelines, with screening of all employees, patients, and parents at the door, maintenance of social distancing, and constant cleaning. Consistent with the recommendations of the American Academy of Pediatrics we continue to provide well checks and vaccines. We are prioritizing well checks to the morning hours and sick visits to the afternoons, and are not allowing anyone who fails COVID-19 screening into the buildings. We are personally caring for all patients with fever, cough, congestion, or other such symptoms via telemedicine. See our website for more information.

On April 3 City of Lufkin officials recommended that residents over the age of five wear facemasks when in public. The mask should provide coverage of nose and mouth. Examples of masks include allergy masks, homemade masks, scarves, bandannas, or handkerchiefs. They are to be used when engaged in social settings. It is critical that citizens understand that this measure is additive to the social distancing 6 feet or more and not a substitute for social distancing.

LOCAL IMPACT

Officially the ACCHD lists ten cases of COVID-19 in our county as of this update. Due to limited testing the number is likely much higher. Perhaps the most important message of this update for our patients, families and employees is that COVID-19 is here. There is community spread now. We are reminding everyone that this virus cannot come and find you; you must go find it. Restated, travel only when necessary and maintain social distancing.

Keep in mind that SARS-Co V-2 (Severe Acute Respiratory Syndrome CoronaVirus 2), the official name of the virus causing COVID-19, is a novel, or new, virus first appearing in December in China. Thus, to our knowledge 100% of all humans are susceptible to infection. Our strongest and most effective tool against this novel infection is social distancing of six feet or more. Washing your hands with alcohol-based sanitizer or soap and water frequently, avoiding touching your face, mouth, eyes, or nose, and wearing a mask in public are our additional protections against infection.

Pre-symptomatic transmission has now been documented. This means that people who are infected with the virus have been documented to shed the virus before symptoms develop. This is a significant finding in that it means that people with virus in their system can spread it before they themselves know they are ill. Thus again, social distancing and the measures mentioned above are to be strictly observed.

The number of cases in Angelina County is going to climb, perhaps dramatically. The public must know that our county may experience higher numbers of patients with severe disease or death. The reason for this likelihood lies in the general health of our population. According to the 2020 Texas Department of State Health Services website Angelina County ranks number 207 out of 254 Counties in regard to health behaviors. That means we smoke more, drink more, and in general engage in more unhealthy behaviors, many of which increase our risk of severe disease or death if infected with the COVID-19 virus. Specifically, people with chronic lung disease, diabetes, heart disease, kidney disease, immunocompromising conditions, along with people older than 75 are at highest risk of poor outcome. We strongly recommend that those with these risk factors shelter in place.

NEW DEVELOPMENTS

New Challenges

As discussed above, pre-symptomatic transmission has now been documented. People without symptoms may unknowingly transmit the virus. Our best weapon remains social distancing.

Age and Gender Matter

The overall risk of serious illness or death in children remains extremely small. However, there have now been reports of children becoming seriously ill and dying due to COVID-19. Fortunately children, with rare exception, seem to be spared severe disease. This observation has been documented in all countries. Research is underway as to why.

For reasons that are not understood men may be at increased risk of severe disease or death. This trend has been observed consistently across all countries.

Older people are developing more severe symptoms than younger people despite neither having immunity to COVID-19. There is no rational answer at this observation. People over age 60, particularly those with secondary medical conditions, are at greater risk of severe disease. People older than 75 with or without underlying conditions seem to be at risk of severe disease as well. These findings are also consistent across all countries.

Hopeful News

A few medication regimens seem to be gaining traction as treatment options for patients with COVID-19.

1) Remdesivir- The leading candidate to treat this highly infectious disease. The Chinese government in fact has undertaken mass production to synthesize the active pharmaceutical ingredients of Remdesivir.

2)Leronlimab- A medication typically used for patients with HIV and/or metastatic triple negative breast cancer. Its primary benefit is to reduce respiratory symptoms and complications in patients that have impending respiratory failure or are on ventilators by mitigating cytokine storm, an abnormal hyper-inflammatory response some people experience with infection, which if left untreated can cause multi-organ-system failure.

3)Ivermectin – this drug may block the virus’s attachment to our cells.

4)Chloroquine and Zithromax. Multiple studies are currently underway evaluating the efficacy of this combination.

5)Dr. Jacob Glanville reports that he has engineered an antibody that blocks the ability of the virus to attach to human cells. He developed a similar antibody against Ebola virus and reduced its mortality rate from between 50%- 70% to approximately 6%. More to come.

6)The second dose of the experimental vaccine (first dose given March 16) is due to be given April 16. Approximately two weeks afterward serum will be drawn from subjects to determine immune response. If effective, the vaccine should be available for healthcare workers in 4-6 months. The general public would have access to the new vaccine approximately 10 to 12 months later.

Keep in mind there is a global effort, a race, to find a cure as well as a means of preventing infection. The best and the brightest minds in the world are at work night and day. We will win the day.

Know too that the vast majority of all people with COVID-19 experience mild disease (82%). With widespread testing it is almost certainly going to come to light that many people did not even know they were infected. It is our belief that the 82% figure will rise significantly.

A Note on Transmissibility

It has been widely reported and repeated that the virus remains viable on plastic for up to 72 hours. A close look at the data that resulted in this report reveals that only 0.1% of the virus was viable at the 72nd hour. That viral mass is considered too small to lead to infection.

It has also been widely reported and repeated that the virus can linger in air for up to three hours. The aerosol used for that test was far smaller than 5 µm. Unless we are in conditions of extremely low temperatures and low humidity the droplet size in our speech is typically larger than 5 µm. Also, moisture in the air will attach to the virus-containing droplet making it larger and heavier. It will typically fall to the ground within 30 to 45 minutes or sooner. This explains why maintaining a safe distance of six or more feet from each other remains our best defense against infection.

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Amanda Davis, APRN, CPNP

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Amanda Davis, APRN, CPNP

The Children's Clinic
205 Gene Samford
Lufkin, Texas 75904
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