In a matter of weeks President Trump has declared a national state of emergency, Governor Pritzker announced that all Illinois schools, restaurants, and bars have been closed for 2 weeks, and recommendations for self quarantining have increased dramatically due to concern over the COVID 19 virus. As with any new virus, information on the news and by word of mouth is mixed and very difficult to interpret. Our practice has, therefore, decided we would discuss the virus with Infectious Disease specialists at our local hospitals and the Illinois Department of Public Health as well as interpreting the multitude of articles out there to offer you the best information and advice we possibly can regarding this virus.

YES! We will keep all the offices open at all costs during this difficult time. However, there will be some changes to the office and its flow:

  1. We will schedule well visits only in the morning until 12 PM. If you have any symptoms of fever, cough, or congestion, you will inot be scheduled for a well visit. Sick visits will continue from 12-4 PM.
  2. Please only bring children who have an appointment. If you are bringing your child for a well visit, please do not bring siblings, especially if they have any cold symptoms. If you have a child who is sick and you are concerned, please only bring that child to again minimize the risk of exposure and spread of diseases.
  3. When you check in, if your patient room is not immediately available, we will ask you to wait in your car with your child until the room is ready. We will call your cell phone when the room opens up and is clean in order to minimize sick children from congregating in the waiting room.
  4. We will be recommending non-urgent visits be rescheduled. These include ADHD rechecks, non urgent behavioral visits, and routine asthma rechecks. Please note we encourage well visits as vaccinations are of paramount importance during this time.

COVID 19 stands for “coronavirus disease 2019.” The virus is a strain from the family of coronaviruses, which have been present around the globe for centuries and most often are one of the viruses that cause the common cold. Certain strains of this family of viruses, like the severe acute respiratory syndrome coronavirus (SARS) in 2002, mutate and cause severe lung disease in certain individuals. COVID 19 is the most recent of these more dangerous strains of coronaviruses.

The good news is studies suggest that over 80% of the individuals infected will experience nothing more than a mild flu-like illness needing minimal medical care. However, in about 10-15% of infected individuals, the COVID 19 virus can cause more than just flu-like symptoms of fever and cough. These patients may require hospitalization and anything from oxygen to an ICU stay to help them through the disease.

Unlike influenza (the flu) or other coronaviruses like SARS and MERS, all the current evidence shows COVID 19 is not a life-threatening illness in children and younger, healthy individuals. Less than 1% of patients with severe disease in the 70,000 patients in China were aged less than 19 years of age and none of those patients died. The most at risk population is proving to be older individuals, specifically above the age of 65, individuals with chronic medical conditions (diabetes, heart disease, COPD, etc.), or individuals with compromised immune systems (patients on chemotherapy, HIV infected individuals, etc). While highly unlikely, it is possible that healthy individuals and children can contract severe disease, but this is much more rare given the current studies of global data.

Current studies of the Chinese population show that over 80% of infected individuals will experience nothing more than a very mild cold. However, the over 50 million people in the USA aged 65 and older are at serious risk for severe respiratory disease and being hospitalized, which would put a significant burden on the hospital system and inevitably lead to a number of deaths. More dangerous is the fact that there is no targeted medication for the virus and no vaccine to prevent it. Death rates have been anywhere from 2-8% depending on the country. In the USA, the current death rate is only 1.8%, and we are trying to keep it as low as possible. For this reason, trying to minimize the spread before these at risk individuals are infected is extremely important.

Infected individuals spread the disease in 1 of three ways:
  • Respiratory droplets: This is when someone releases microscopic drops of water in the air by sneezing, coughing, or even breathing without a mask. Estimates say this cloud of infected droplets can be as wide as 6 feet.
  • Direct Inoculation: This is when someone transfers virus directly onto another individual by touching or hugging them.
  • Indirect Inoculation: This is when someone touches an infected surface and then touches their eyes, mouth, or nose before washing their hands and infects themselves. It is important to note that the disease does not spread immediately through the skin after touching an infected surface but only after touching the eyes, nose, and mouth.

Unfortunately, there is growing evidence that patients can transmit the disease a few days before they have symptoms. This is the minority of cases where the disease is spread but is likely the reason why it has been so hard to contain the spread. However, infected individuals are most contagious after they start showing symptoms, which can be anywhere from 2-14 days after being exposed to the virus

  1. WASH YOUR HANDS!! It is the simplest and most important way to prevent the spread. Nothing fancy, just plain old soap and water and washing thoroughly for at least 20 seconds. Touching anything from an infected iphone to an infected door knob and then touching your eye, nose, or mouth is a risk so do not touch your face at all until you have just washed your hands.
  2. Clean surfaces often. The Center for Disease Control (CDC) has some great tips for cleaning here. Briefly, use soap and water at a minimum to wipe down surfaces that are concerning for infection and do not share iphones, ipads, or other objects with individuals whose risk is high for infection or whose risk you do not know.
  3. Avoid large gatherings as much as possible. Because even asymptomatic people may be spreading the disease within a 6 foot radius of their bodies, it is worth avoiding large crowds or going out as much as possible in the next few weeks until we have a better idea of who is infected and how severe the spread is.
  4. Stay home as much as you are able. If you avoid interacting with people you will greatly reduce the risk of exposure from infected individuals.
  5. If you have been exposed to COVID 19 (as defined below), self-quarantine. Explained more below, self-quarantining means to remain in a separate room for 14 days with a closed door to see if you are developing symptoms.

The Illinois Department of Public Health has released information about who should go for testing which we have summarized below or you can check out the following link:

Step 1: Were you exposed?

Concerning methods of exposure:

  • I have had close contact (been within 6 feet for more than 20 minutes) with a patient with laboratory confirmed or laboratory pending COVID 19.
  • I have traveled to at risk countries of China, South Korea, Iran, Japan, and Europe (Austria, Belgium, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Slovakia, Slovenia, Spain, Sweden, Switzerland, Monaco, San Marino, Vatican City)
  • I was in a congregate living facility (a dorm, nursing home, etc.) where multiple patients have been diagnosed or suspected to have COVID 19.
Step 2: Do you have symptoms?
Concerning symptoms are fever and/or lower respiratory symptoms (cough, difficulty breathing, blue skin around the mouth or fingers). It is important to note that sore throat and/or runny nose alone without a fever, deep cough, or difficulty breathing make COVID 19 infection very unlikely.

If you are not having active symptoms as defined above by fever and/or lower respiratory symptoms (cough, difficulty breathing, or blue skin around the mouth or fingers), testing is unlikely to return positive. However, if you get these symptoms and have at least one of the following, you should consider getting tested:

  • Exposure as explained above within 14 days of having symptoms
  • High risk individual with no other source of your symptoms (you did not interact with someone who had the flu, a cold, or pneumonia). High risk means: you are above the age of 65, have chronic medical conditions (patients with diabetes, heart disease, COPD, etc.), or have a compromised immune system (patients on chemotherapy, HIV infected individuals, or immunosuppressive medications, etc).

This is a complicated answer but should be much simpler in the coming days. The national test released to test COVID 19 in February 2020 was not working well so states have only just come up with their own approved testing methods in early March. Because of this, testing centers outside of the ER are only now being set up on a large enough scale to handle patients. Our office is unable to test patients at this time. If you are concerned you or your child may have COVID 19, please call our office or your local county representative of the Illinois Department of Public Health found here for information on where to be tested.

The Center for Disease control has very good guidelines on self-quarantining and how to know if this is the right course of action for you or your child which you can read here. To briefly summarize, self-quarantining is the act of staying home away from any person for at least 14 days after being exposed to this virus. This means staying in a separate room with a door, having a separate bathroom, and having all household members interacting with you only when necessary to give you food or change of clothes. It is not the right move for everyone but maybe a good choice for well appearing children since this disease does not seem to affect them severely. If you are unsure if self-quarantining is right for you or your child, please call the office.

If you believe your child has one of the above exposures to COVID 19, please call the office first to discuss your child. These cases will be handled on a case by case basis after they are discussed with one of our physicians. Keep anyone with COVID 19 exposure away from high risk individuals described above and if they are having difficulty breathing or are ill-appearing, take them to the ER immediately.

We understand this is a stressful time for everyone, and you may have any number of significant questions not addressed here. If you have any concerns, please feel free to call our office or check back for new and important updates as they arrive. We are always here for you, and we wish you what Dr. George always says are the three most important things: Health, Health, and Health.


Helpful links:
https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections
http://dph.illinois.gov/topics-services/diseases-and-conditions/diseases-a-z-list/coronavirus
https://www.cdc.gov/coronavirus/2019-nCoV/index.html

All information was compiled from conversations with specialists, IDPH website, CDC website, AAP website, and select articles published in medical journals.