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COVID-19 UPDATE for Patients of the Children’s Clinic System

COVID-19 UPDATE for Patients of the Children’s Clinic System

COVID-19 Update March 27, 2020

NEW INFORMATION

Yesterday evening the CDC published its first report on COVID-19 infections in the United States. The data is reported from a total of 4226 positive cases, 2449 of which included the age. Thus, the number of patients who have been studied is still extremely small even though as of this update the United States now leads the world in cases with 82,400. The next CDC report will likely provide significantly better data.

Here is what we know from the 2249 infected patients on whom we have age data:

  1. 6% of patients were 85 years old or greater
  2. 25% were aged 65 to 84 years
  3. 18% were aged 55 to 64 years
  4. 18% were aged 45 to 54 years
  5. 29% were aged 20 to 44 years
  6. Less than 5% of cases occurred in people 0 to 19 years of age.

Among 508 patients known to have been hospitalized:

  1. 9% of patients were 85 years old or greater
  2. 36% were aged 65 to 84 years
  3. 17% were aged 55 to 64 years
  4. 18% were aged 45 to 54 years
  5. 20% were aged 20 to 44 years
  6. Less than 1% of hospitalizations were among persons 0 to 19 years of age.

Infected patients who were less than or equal to 19 years of age were only hospitalized 2% to 3% of time, whereas those equal to or greater than 85 years of age required hospitalization 31% of the time.

The case fatality rate (the number of deaths per 100 cases) increases significantly with age. Particularly at risk are those 85 years of age and older. There were no deaths in people less than or equal to 19 years. However younger healthy people are at risk of severe disease and death as well. Persons aged 20-54 have a case fatality rate of 0.1% - 0.8% (1/1000 - 8/1000).

Based on this very limited and early data those at highest risk must avoid potential exposure to COVID-19. Measures to do so include social distancing, minimize gatherings when at all possible, practicing excellent hygiene such as washing your hands with 60 to 95% alcohol or soap and water, coughing into your elbow, the back of your forearm or a cloth, avoiding touching your face particularly after contact with another person, and disinfecting frequently touched surfaces such as sinks, counter tops, and toilets.

Caregivers of those in the high-risk categories must ensure that they have at least a 30 day supply of all necessary medications and that they continue to take those medications as prescribed. To the extent possible, they should shelter in place. Asthmatics and persons with known lung disease must make sure that they take their medications as prescribed, particularly if they are on daily medication.

The imperatives in the report are to protect the healthcare system and to protect vulnerable older adults. Avoid travel. Avoid crowds and stay home as much as possible to reduce the risk of being exposed. The entire community must work together to slow the spread of COVID-19.

LOCAL IMPACT

The second COVID-19 case in the area has been confirmed. We fully anticipate many more cases as the weeks go by. Local health authorities in partnership with hospital administrations and medical personnel are managing contacts of all cases.

At this moment in the pandemic we are learning who our enemy is. Our knowledge is growing daily. We will get on top of this infection in time. Until then we all must be smart, aware, engaged and caring. The best information is typically not on the inflammatory 24-hour news cycle of the television. The CDC, NIH and WHO are the organizations collecting and interpreting the data with greatest accuracy. Our team of practitioners will continue to post updates as information becomes available.

Our clinics remain open for well checks, pre-participation evaluations, behavioral health care, and all sick patients with non-COVID symptoms. Please share any comments or thoughts on The Children’s Clinic of Lufkin Facebook page.

HOPE IN THE FIGHT

The first doses of the COVID-19 vaccine were administered March 16 to small group of individuals. The study is designed to test three dosage strengths. A second dose will be administered one month after the first. Two weeks afterward blood will be drawn from the subjects and analyzed for results. The manufactures of the vaccine are hopeful to have a commercial product available for healthcare professionals in the fall of this year. A vaccine for the general public may be available mid next year.

The World Health Organization announced the launch of SOLIDARITY, an unprecedented coordinated push to study thousands of patience in dozens of countries with at least four different regimens of medications. The study design is open label which means everybody knows which drug combination they’re getting. The study is extremely simple in design and should yield answers quickly.

Chloroquine and Zithromax remain a medication combination under evaluation. While some results are preliminary encouraging, particularly one study in France, there are no formal controlled studies to date. Thus, all data is anecdotal.

Testing availability is increasing daily as manufacturers produce thousands of tests.

COVID-19 UPDATE MARCH 22, 2020

The physicians and nurse practitioners within the Children’s Clinic System are committed to the health of your child and our community. During this difficult time of the COVID-19 Pandemic, we want to assure you that we are here to help you understand the virus and the impact it may have on the health of your child and family. To ensure the continued well-being of our patients, the Children’s Clinics will remain open to see patients for well appointments and illnesses that do not include flu-like or COVID-19 symptoms. If your child has symptoms of runny nose, cough, congestion, sore throat, fever, or chest discomfort, we are offering tele-visits seven days a week.

WHAT YOU SHOULD BE DOING NOW

  • Continue to follow federal, state and local health official recommendations and mandates as issued particularly as it relates to quarantine.
  • Avoid contact with persons with known or suspected COVID-19 infection.
  • Practice safe hygiene by washing with alcohol-based hand wash, preferably 60% to 90% alcohol.
  • If you’re coughing, do so into the fold of your elbow, the back of your forearm, or a cloth to prevent spread of droplets to those around you.
  • Practice social distancing as currently recommended.
  • If you have any symptoms of COVID-19, contact your healthcare provider or the Angelina County and Cities Health District at 630-8500, and stay at home unless otherwise instructed by a healthcare professional.

UPDATED STATUS OF COVID-19

LOCAL IMPACT

As of this update, there has been one confirmed COVID-19 positive adult from out of state who had returned home to Lufkin briefly to visit family. Shortly after leaving Lufkin he became ill with flu-like symptoms and was tested and found to be positive for COVID-19. He was well after approximately three days of mild illness. Appropriate precautions including quarantining were instituted immediately. The ACCHD is managing the local contacts.

GENERAL CLINICAL UPDATE

As new information becomes available, our understanding of COVID-19 and its clinical impact is certainly going to change. Thus, we recognize that the information that we are providing will likely be modified perhaps significantly as our understanding of the virus expands. Below is a summary of the latest data available from multiple reliable sources.

With expanding testing updated information is revealing the following:

1) The most prepared country investigating the pandemic remains South Korea, a country of 50 million people. As of March 20, they had tested more than 310,000 people. In contrast, the United States, a nation with six times the population of South Korea, had tested only 103,000 people.

2) Those at greatest risk of suffering serious or critical illness or death remain persons with immunocompromising conditions, diabetes, heart, liver or kidney disease, hypertension, and the elderly particularly those over 80 years of age.

3) The World Health Organization in conjunction with the Chinese Center for Disease Control have published their death rate data stratified by age and underlying illness. The Chinese data reveals that healthy individuals under the age of 40 have an overall risk of mortality from infection with COVID-19 of 0.2% or less. Patients over the age of 80 years particularly those with pre-existing underlying conditions listed above have a death rate of 14.8%-21.9%.

The data from South Korea continues to mature as they expand testing, a critical component to assessing the true variance of the clinical impact of COVID-19 infections. Most of the infected individuals had either no or mild cold symptoms, particularly among the young. Currently, they are estimating that the risk of serious illness or death in individuals less than 40 years with no underlying serious medical conditions will be less than 2 out of every 1000 infected.

The importance of widespread testing for COVID-19 cannot be overstated. For reference, in 2009 the pandemic H1N1 Influenza with limited testing was initially reported to have a mortality rate of 1%. With expanded testing the mortality rate fell 50-fold to .02%. Indeed, Dr. Anthony Fauci of the NIH stated a few weeks ago that the coronavirus may have a death rate 10 times greater than seasonal influenza. One week later, on February 28, after reviewing available data across the globe he re-estimated the death rate to be akin to that of severe seasonal flu, approximately 1%.

Put into context with this year’s flu, to date an estimated 22,000-50,000 Americans have died from influenza. Moreover, in a typical season, approximately 27 million Americans will contract influenza and 55,000 will die. (Interestingly, only 55% of eligible recipients will receive a flu vaccine.) Of the four modern flu pandemics the Spanish flu pandemic of 1918 had the highest death rate, 2.5%, and was particularly severe in healthy young adults. Thus, the earliest COVID-19 data available, again based on extremely limited testing, is revealing that the risk of serious illness or death is likely to be far less than originally broadcast (4% - 14%).

Clinical symptoms of infection include:

1) fever

2) cough, particularly dry cough

3) runny nose

4) sore throat

5) headache and achiness

6) occasionally vomiting and diarrhea

7) difficulty breathing

8) chest pain and tightness

HOPE ON THE HORIZON

1) A vaccine for COVID-19 was given to 45 healthy adults aged 18 – 55 in the Seattle area. A second dose will be administered in approximately a month. The limited trial will last six weeks. A vaccine in the Middle East is also being deployed. More to come.

2) Chloroquine, an old antimalarial medication, has shown efficacy in blunting disease severity. The government has now restricted the prescribing of this medication in the event it is proven to be truly effective against COVID-19.

3) A few antivirals medications are being investigated. Data is pending.

Nobel prize winning author Daniel Kahneman in his book, “Thinking, Fast and Slow,” notes the tendency of humans to overweight fear particularly of the unknown compared to everyday events that often have a greater negative impact. While extremely preliminary, the data regarding severe disease and risk of death is trending toward that of severe flu. We encourage our patients and their parents in the community to seek information from reliable sources including the Center for Disease Control, the National Institute of Health and to some extent the World Health Organization. We will continue to update our website as we commit to keeping you up-to-date and all on the same page.

Preventing further spread of the virus

1) Using an alcohol-based hand wash or washing your hands with soap and water after every encounter with people with the above symptoms or anyone who has proven or suspected contact with an infected person is currently believed to be the most important intervention that reduces the likelihood of spread of the virus to you.

2) When coughing or sneezing do so into your elbow area, the back of your forearm or into a tissue or cloth to prevent spread of droplets to those close by you.

3) If you are at risk of having disease or have been told that you are indeed infected with this virus Self Quarantine is mandatory. Currently, recommendation is for 14 days if asymptomatic. The incubation period, that is, the time between virus exposure and when you become ill is between 2 and 14 days. Your local health department will be managing your care if you are proven to have the virus.

The Children’s Clinic System is working with the ACCHD, local hospitals, schools, pharmacies, and other healthcare providers to ensure the safety of everyone in our 4 county service areas. Our team of board-certified physicians and nurse practitioners will be reviewing medical information from dozens of professional organizations on a continual basis and reporting to you any significant changes based on the new information available. Our commitment to you, our patients and our parents, is to fulfill our mission, “Healthy Children, Healthy Communities”.

Telemedicine Instructions

If your child has fever, cough, runny nose, sore throat and/or body aches please schedule a telemedicine appointment with our doctors. In order to protect our patients and staff, we will NOT be seeing patients with these symptoms in the office.

Telemedicine visits can be performed on your computer, tablet, or phone.

Availability:

Weekdays: 8:00 am - 4:00 pm and as needed

Saturday: 8:00 - 11:30 am, 2:00 - 4:00 pm, and 6:00 - 8:00 pm and as needed

Sunday: 10:00 am - 2:00 pm and 4:00 - 6:00 pm and as needed

To make a telemedicine appointment:

  1. Please go to www.medisprout.com or download the V2MD app. Please allow notifications or you won't know when to connect with us. Ensure your child is registered as a patient, or if that is not possible please make sure your child's name and DOB are in the message.
  2. After creating an account, click the "Request a New Video Visit" button. You will then be asked to select a provider. If you are a patient of Angelina Pediatrics or the Children's Clinic of Jasper, Woodville, or Rusk, please select the appropriate clinic as your provider. If your pediatrician is at the Children's Clinic of Lufkin, you may select your specific doctor; there is not a general Children's Clinic of Lufkin icon. On weekends search for "The Children's Clinic of Lufkin Weekend Doctor".
  3. Follow the instructions as given. You can also upload pictures if needed.
  4. After clicking the "Submit Information" button, your request will be sent. On weekdays you will be messaged and appointed for a specific time, and one of our staff members will call you to get background information. On weekends the doctor on call will contact you for availability. Please stay close to your phone. Upon receiving the notification or email follow the instructions to join the appointment and the doctor or nurse practitioner will connect with you.

If your telemedicine visit results in a diagnosis and treatment plan, your insurance will be billed as usual and you will be responsible for your portion. If the visit results in an appointment being scheduled in person you will not be charged.

Preparing for your telemedicine visit:

1. Please check your child's temperature, check or estimate their weight, and prepare a list of medications that your child has taken over the last few weeks, as this information with be very helpful to the doctors. If you have a preferred pharmacy please have their phone number available to share.

2. Ensure you are in a location that is well lit and quiet, and that you have an additional light source to assist the doctor in examining your child. Having good wifi service will enhance the quality of the visit.

3. Stay near your phone or computer so that when you receive a notice that the doctor is ready you will be able to log on quickly. And don't forget to have your child nearby so we can examine them!

4. When the visit starts share your biggest concern first, convey all important information, and ensure all of your questions are answered before the end of the visit. If a prescription is required make sure the doctor knows your preferred pharmacy and their phone number.

If your telemedicine visit results in a diagnosis and treatment plan, your insurance will be billed as usual and you will be responsible for your portion. If the visit results in an appointment being scheduled in person you will not be charged.



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Appointments for well and sick visits can be made Monday – Friday, 8 am – 5 pm.

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George Fidone, M.D., FAAP

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George Fidone, M.D., FAAP

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