[Health] The Infectious Diseases Thread

[LawBeefaroni]

Doubt that has anything to do with COVID.

[Unagi]

And really... Londoners?

[stessier]

I don't think that's real, but I am amused.

[Daehawk]

Florida

Bad news - 15,000 new cases in 1 day.

Good news - Disney reopens.

Me - *Bonks forehead*

Also in the news the White House is actively trying to discredit Fauci.

https://www.nbcnews.com/politics/white- ... e-n1233612

[hitbyambulance]

I am having questions about the effiectiveness of the covid 19 test as administered by the ZoomCare clinic I went to tonight (one of those 'urgent care' kinda setups). i was brought into the exam room and handed what looked like a normal double-ended cotton swab (the kind that you [don't] clean your ears with) and was told I would be 'self-administering' the collection. at no point was I told to sanitize my hands for this procedure. i was told to insert the swab about an inch into each nostril and swirl it two or three times. i stuck it up my nose about that much and asked if that really was far enough (i have had nasal subsection surgery twice and the upper inside of my left nostril is very raw and sensitive to this day) and i was assured it was.

my question is, is this really effective? if so, why were the procurement of the longer (six inch) swabs such a big deal in the early days of the covid 19 pandemic? it was mentioned in many news outlets that normal sized cotton swabs would _not_ work.

it's been seven days, no results yet. EDIT- they got here just as i wrote that. result is 'not found'

[Defiant]

The doctor who helped defeat smallpox explains what's coming

Here's a follow up interview

[Kraken]

Florida

Bad news - 15,000 new cases in 1 day.

Good news - Disney reopens.

Me - *Bonks forehead*

Also in the news the White House is actively trying to discredit Fauci.

https://www.nbcnews.com/politics/white- ... e-n1233612

I talked to my BIL in FL a couple of hours ago. He says mask compliance is a little better but still under 50%. Floridians just plain don't care.

[Isgrimnur]

A significant portion of them did move there to die, after all.

[Ralph-Wiggum]

In Charleston, masks are now mandatory in indoor public places. From what I’ve seen over the last week, people are taking it pretty seriously; at my last grocery store run, I didn’t see anyone without a mask. Of course, a few people were wearing their masks below their noses. Irrationally, sewing that almost makes me angrier than people not wearing masks at all.

[YellowKing]

The kids' test came back negative. Round 1 bullet dodged. Guess we'll be going through this every time they catch a cold for awhile. Nice to know we don't have to go through another week of quarantine.

[Zaxxon]

The kids' test came back negative. Round 1 bullet dodged. Guess we'll be going through this every time they catch a cold for awhile. Nice to know we don't have to go through another week of quarantine.

Whew. That's a point that my wife and I were just talking about, though. Assume schools do reopen, and that things go 'well' such that they are not forced to re-close. Every single instance of any kiddo having pretty much any symptom is going to be an immediate COVID-19 test and self-quarantine of the whole family, right? It pretty much has to be.

[stessier]

You would think, but people won't. And I don't blame them given the different work situations that are out there - it's going to be a mess.

[Lorini]

The doctor who helped defeat smallpox explains what's coming

Here's a follow up interview

Great article, thanks for the link!

[YellowKing]

The rumor mill is that we are heading for Option B in the fall school program. That would mean schools at 50% capacity with students rotating every 3 weeks.

To Zaxxon's point, I don't know you do even that. With tests taking 4-6 days now, what happens while the school is waiting on the test results for the kid who just got sick in Mrs. Crabtree's class? Does the whole class and the teacher now have to self-isolate? What if a kid turns up positive? Now do you have to have the whole school tested and self-isolate while they wait a week for their results?

Even at 50% capacity in my son's school, for example, you're talking 300 kids. Which is probably small compared to a lot of cities.

I just have a feeling we're going to start with plan B and be right back to 100% remote learning the first time a teacher or kid tests positive.

[Zaxxon]

And just to take it a step further, in any elementary school (really, any class), someone has the sniffles or worse every single day and is sent to school with it. Since schools are not doing screening at the door, those kids will for the most part make it to the classroom. At which point any sane quarantining protocol that's fit for COVID-19 will send the whole class home for 2 weeks.

The more I think about it, there is no chance that this isn't a disaster.

[Ralph-Wiggum]

Another member of the team I'm part of at work tested positive. He hadn't felt well around July 4 weekend and so self isolated, worked from home after that date, and got tested. Unfortunately, it took five days for his positive test to come back. So everyone he had been working with prior to feeling badly have now gone 1+ weeks after being exposed without realizing and have, over that time, working with others. So now they're self isolating and getting tested, but if one of them comes back positive then there will be a whole suite of other people that will need to self isolate and get tested. The slow turn-around between testing and getting results really makes managing this thing almost impossible.

[Jeff V]

You would think, but people won't. And I don't blame them given the different work situations that are out there - it's going to be a mess.

How many keep their kids home if they have the cold or even mild flu? When I was kid, the only excuse for missing school was if you were on your deathbed getting last rights. There was also those "perfect attendance" awards that encouraged going to school while ill.

I do think that the necessity of it will will drive better virtual learning experiences. My son's tolerance for even "fun" learning programs starts to wear thin after 30 minutes though, and he's completely done after about an hour. Zoom classes do seem to hold his attention pretty well, and I'd be interested to see if these might be extended to more than the 30 minutes per day he gets now (summer school...it was 30 minutes every other day before the end of the school year).

What I'd like to see tried at the moment would be a half-day of Zoom class (morning), and programmed instruction for the afternoon. Teachers, meanwhile, could schedule one-on-one meetings with kids to review progress.

The biggest problem remains that all truly safe solutions require a lot of participation and effort on the part of the parents, and this is not practical for every family.

[stessier]

The biggest problem remains that all truly safe solutions require a lot of participation and effort on the part of the parents, and this is not practical for every family.

In theory, getting the best results from school have always involved a lot of participation and effort on the part of the parents.

[YellowKing]

Since schools are not doing screening at the door, those kids will for the most part make it to the classroom. At which point any sane quarantining protocol that's fit for COVID-19 will send the whole class home for 2 weeks.

My kids daycare is doing screening at the door and it's a zero-tolerance symptom policy. Not only is there a temperature check at the door, but kids aren't allowed in if they have any symptoms of anything whatsoever. Parents are also not allowed in the building.

You'd almost have to have something like that at the school level for this to have a chance in hell of working, but I don't know you'd scale it. There's a big difference between parents dropping young kids off at the door one or two at a time between 6am and 9am, and hundreds of elementary school kids showing up at the same time.

[Zaxxon]

Yeah, agreed. At first I was a little annoyed that my school isn't doing any screening at the door, but quickly realized that doing it in an accurate way isn't feasible in a school of more than, say, 50 kids.

[Anonymous Bosch]

Since schools are not doing screening at the door, those kids will for the most part make it to the classroom. At which point any sane quarantining protocol that's fit for COVID-19 will send the whole class home for 2 weeks.

My kids daycare is doing screening at the door and it's a zero-tolerance symptom policy. Not only is there a temperature check at the door, but kids aren't allowed in if they have any symptoms of anything whatsoever. Parents are also not allowed in the building.

You'd almost have to have something like that at the school level for this to have a chance in hell of working, but I don't know you'd scale it. There's a big difference between parents dropping young kids off at the door one or two at a time between 6am and 9am, and hundreds of elementary school kids showing up at the same time.

Or we could follow the guidelines from a pediatrics infectious disease specialist and the American Academy of Pediatrics he represents:

Dr. Sean O’Leary, a pediatrics infectious disease specialist at the University of Colorado Anschutz Medical Campus, helped write the academy’s guidelines. He is a father of two children, 12 and 16, and a survivor of Covid-19 who is still experiencing some symptoms after he and his wife contracted the coronavirus in March.

“I absolutely take this seriously,” Dr. O’Leary said. “I’m still sick.” But he explained why the academy was emphasizing the need to get students back in classrooms.

The academy guidelines place a big emphasis on the importance of physical school over remote learning. Can you summarize why?

As pediatricians, many of us have recognized already the impact that having schools closed even for a couple months had on children. At the same time, a lot of us are parents. We experienced our own kids doing online learning. There really wasn’t a lot of learning happening. Now we’re seeing studies documenting this. Kids being home led to increases in behavioral health problems. There were reports of increased rates of abuse.

Of course, the reason they were at home was to help control the pandemic. But we know a lot more now than we did then, when schools first closed. We’re still learning more every day.

This virus is different from most of the respiratory viruses we deal with every year. School-age kids clearly play a role in driving influenza rates within communities. That doesn’t seem to be the case with Covid-19. And it seems like in countries where they have reopened schools, it plays a much smaller role in driving spread of disease than we would expect.

Back in March, there was this idea of children as silent superspreaders who put older adults and other vulnerable people at immense risk. Has that picture changed?

What we have seen so far in the literature — and anecdotally, as well — is that kids really do seem to be both less likely to catch the infection and less likely to spread the infection. It seems to be even more true for younger kids, under 10 or under 12. And older kids seem to play less of a role than adults.

Here in Colorado, I’ve been following our state health department website very closely. They update data every day and include the outbreaks in the state they are investigating. As you can imagine, there are lots and lots in long-term care facilities and skilled nursing homes, some in restaurants and grocery stores. There have been a total of four in child care centers, and we do have a lot of child care centers open. In almost every one of those cases, transmission was between two adults. The kids in the centers are not spreading Covid-19. I’m hearing the same thing from other states, as well.

The academy’s guidelines talk about balancing the need for physical distance with children’s educational and developmental needs, such as the need for hands-on play. They suggest that if older students are masked, three feet of distance between desks might be sufficient, compared to the six feet recommended by the C.D.C. Why is your advice different?

I don’t know that we’re different. The C.D.C. said six feet if “feasible.” The point we are trying to make is, that’s really not feasible. When you consider the overall health of children and really the community at large, adhering to a six-foot rule, which would mean having a lot of kids at home, may not be in the best interest of overall health. Something has to give.

From our perspective as pediatricians, the downsides of having kids at home versus in school are outweighed by the small incremental gain you would get from having kids six feet apart as opposed to five, four or three. When you add into that other mitigation measures like mask wearing, particularly for older kids, and frequent hand washing, you can bring the risk down.

I do think it’s a balance. I’m not going to come out here and say on June 30 that everything is going to be perfect in the coming school year. There will be cases of Covid-19 in schools even where they make their best efforts. But we have to balance that with the overall health of children.

As I talk to school administrators, most are planning temperature checks. The academy guidelines warn this could be impractical and take away instructional time. Can you say more about why you’re skeptical that this is the right strategy?

Do the harms outweigh the benefits? In this case, if it means students are congregating, it could increase the risk of spread. And we don’t have great evidence that temperature screening is helpful. That’s for a couple reasons. One, a lot of kids who have Covid-19, perhaps the majority, never get a fever. To use fever as a screen and assume that’s going to be good enough? You will miss a kid. And many fevers are not going to be Covid-19. Kids should not go to a school with a fever, period.

[Jeff V]

In theory, getting the best results from school have always involved a lot of participation and effort on the part of the parents.

Yeah, but generally an hour or two in the evening, not having to run their entire school day. It was difficult for us because I was working days and my wife sleeps during the day and a 6-year old is just very self-starting when it comes to things. Now that I am not working, there's more time to spend, I just have a hard time remembering his 30 minute Zoom meetings...was 15 minutes late today because I was helping my 3-year old learn to ride a scooter and last week missed a day because we were out biking and I forgot Wednesdays are an hour earlier than the rest of the week.

[stessier]

That would be the same academy that today came out and backtracked from their previous position and said it should be left to the localities to make the decision based on the individual situations.

Edit: Wasn't today - was Friday. Sorry - time is a square circle.

[dbt1949]

I don't know what to say about sending kids to school.
I believe everybody is going to get covid sooner or later until we can get a cure.
I just hope kids are less susceptible than the rest of us.

[Zaxxon]

Edit: Wasn't today - was Friday. Sorry - time is a square circle.

Excuse me, it's a flat circle.

[stessier]

Edit: Wasn't today - was Friday. Sorry - time is a square circle.

Excuse me, it's a flat circle.

That's what I get for using memes I haven't seen the source material for. I knew it sounded not quite right but didn't bother to look it up.

[Jeff V]

I just hope kids are less susceptible than the rest of us.

It's more a function of their traditional role as disease vectors. While the chance of young kids having serious outcomes from Covid are rather low, bringing it home to mommy and daddy would not be a good thing, especially when daddy is elevated risk for very bad things.

[LordMortis]

time is a square circle.

I thought lucha libre is a square circle. Wait is Wrestling really time?

[Isgrimnur]

[Anonymous Bosch]

That would be the same academy that today came out and backtracked from their previous position and said it should be left to the localities to make the decision based on the individual situations.

Edit: Wasn't today - was Friday. Sorry - time is a square circle.

Indeed, but that's a result of adverse political pressure in reaction to their original guidelines. It is a controversial topic, after all. Realistically, the science behind what the pediatrics infectious disease specialist specifically pointed out above has likely not changed significantly just over the weekend.

[Daehawk]

time is a square circle.

I thought lucha libre is a square circle. Wait is Wrestling really time?

[naednek]

Well, were just about shut down again in California. Governor just shut down indoor places (dining, bars, movies\bowling etc) barbers\salons. In May he gave in to pressure like most governors did, and while our numbers were starting to go down, we did it too soon. So, now we take 2 steps back.

[Blackhawk]

I just hope kids are less susceptible than the rest of us.

Kids absolutely are less susceptible than the rest of us. There are also 56 million of them. They don't have to be very susceptible to have a massive impact.

[hitbyambulance]

I believe everybody is going to get covid sooner or later until we can get a cure.

that's super unfortunate for everybody, given the unnervingly high percentage of covid-19 survivors that incurred permanent disability from the virus.

[naednek]

I just hope kids are less susceptible than the rest of us.

Kids absolutely are less susceptible than the rest of us. There are also 56 million of them. They don't have to be very susceptible to have a massive impact.

We also don't really know... I mean they were one of the first to be quarantined and more than likely stayed home. Now we're putting them back into school where the cases are higher than they were when it first started. Guess we will see the real numbers soon

Sent from my SM-G975U using Tapatalk

[Daehawk]

I wouldn't send a kid back to school. Id use my own judgement though.

[Paingod]

My son's tolerance for even "fun" learning programs starts to wear thin after 30 minutes though, and he's completely done after about an hour.

I suspect this is a battle teachers work with in-person all school year and isn't unique to online learning. At home we've taken to deliberate breaks between tasks so the kids get a lot of little moments to decompress and get back to learning again. It seems to work. We might go 30-45 minutes, 10 minute break, 30-45 minutes, 10 minute break...

[RunningMn9]

We also don't really know... I mean they were one of the first to be quarantined and more than likely stayed home. Now we're putting them back into school where the cases are higher than they were when it first started. Guess we will see the real numbers soon

Yeah, I’m with you in that I don’t know if I’m willing to say “absolutely” at this point. Not only where they one of the first groups to be isolated, I don’t know how much to rely on other countries, where they’ve done a much better job of reducing the amount of circulating virus in the community.

Like going to school in NJ might be a lot safer than going to school in Florida for instance.

I think my daughter’s high school is likely going with some kind of split schedule with some in school and some at home instruction.

My son’s county college is still trying to figure it out, but one of his professors already contacted him and told him that class is 100% online because the professor isn’t coming to campus.

[LordMortis]

My son's tolerance for even "fun" learning programs starts to wear thin after 30 minutes though, and he's completely done after about an hour.

I suspect this is a battle teachers work with in-person all school year and isn't unique to online learning. At home we've taken to deliberate breaks between tasks so the kids get a lot of little moments to decompress and get back to learning again. It seems to work. We might go 30-45 minutes, 10 minute break, 30-45 minutes, 10 minute break...

As you should. A typical adults ability to stay on task in classroom environment is about 40 minutes. There are no typical children. That break should involve some physical activity.

WRT children susceptibility. I can only assume they are less susceptible. AKA they are more asymptomatic or less likely to get laid low without having a lifetime to have their immune systems worn down and they organs degenerate but... that doesn't mean damage won't be done and not revealed and sure doesn't mean they won't act as carriers (which is my personal and selfish concern). If I were an adult in school I'd be terrified. I can't speak for nationally, but as I stated in the political thread, Michigan's first wave started with three distinct groups: Teachers, Prisons, high air travel professionals. So many teachers being diagnosed at the outset combined with having been victim to many young parents during cold seasons is likely to shade my viewpoint until some very strong evidence can enlighten me.

[stessier]

That would be the same academy that today came out and backtracked from their previous position and said it should be left to the localities to make the decision based on the individual situations.

Edit: Wasn't today - was Friday. Sorry - time is a square circle.

Indeed, but that's a result of adverse political pressure in reaction to their original guidelines. It is a controversial topic, after all. Realistically, the science behind what the pediatrics infectious disease specialist specifically pointed out above has likely not changed significantly just over the weekend.

I would contend that the science is in it's infancy and because of poor testing, we have little understanding of the opportunity of spread. Where I live we have some of the higher rates in the country so thinking that the small initial studies cover my situation seems unwise. Additionally, the emotional harm they posit is very family dependent and the thought that we should give a one size fits all recommendation in these uncertain times is incomprehensible to me. Pulling back and saying it should be left to localities is simply acknowledging the complexity of the issue.