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COVID-19 UPDATE March 22, 2020

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%).

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.

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Gerald D. Morris, APRN, CPNP

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Gerald D. Morris, APRN, CPNP

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