Pacific Ocean Pediatrics’ response to the Coronavirus (COVID-2019) Outbreak

Pacific Ocean Pediatrics’ response to the Coronavirus (COVID-2019) Outbreak:

The coronavirus epidemic, which is rapidly spreading around the globe, is the topic of conversation of many.  Below are some facts about coronavirus and our thoughts about what should be done and what we at Pacific Ocean Pediatrics are going to do to minimize the spread of this organism.

Historically, coronavirus is an organism that has been associated with the common cold, croup, asthma attacks and bronchiolitis.  Its name is derived from characteristic petal-shaped projections that give the virus a crown (or corona) appearance.

More recently, a handful of “novel” coronaviruses have mutated into more virulent organisms that have cause three significant epidemics: SARS (severe acute respiratory syndrome), MERS (Middle East respiratory syndrome) and now COVID-2019, which is the virus of current concern.

The current epidemic of COVID-2019 began circulating in Wuhan, China in December.  The molecular structure of the COVID-2019 is similar to two known bat coronaviruses and it is likely that this typically, non-human virus has jumped species into humans.

Transmission:

Like influenza, person-to-person transmission occurs through micro-droplets that are created when an infected person sneezes or coughs.  The virus can also be transmitted through fomites (like toys or furniture) when a micro-droplet lands on them and is then unknowingly picked up.  Transmission has been proven between individuals who are asymptomatic, but are found to be COVID-2019 positive.

Incubation Period:

The incubation period (the time between exposure of the virus and the beginning of symptoms) is thought to be up to 14 days, with an average of 5 days.  Family clusters of the disease have shown symptoms occurring between 3 and 6 days after exposure. 

Non-specific Symptoms:

Unfortunately for clinicians, symptoms of COVID-2019 are relatively non-specific and include fever, congestion, cough, runny nose and shortness of breath. Pneumonia is the most severe disease process associated with the infection and is the cause of the majority of deaths that COVID-2019 has caused, but studies from China have shown that most individuals infected with COVID-2019 have mild to moderate disease.

Children are generally handling COVID-2019 infection well:

Thus far into the epidemic, the majority of people who have died from COVID-2019 are elderly individuals, particularly men, who have underlying medical conditions.  Generally, COVID-2019 infection in children has been well tolerated with most cases being mild to moderate in nature.  We are unaware of any children who have succumbed of the disease to date.  This is, of course, good news for parents and pediatricians, but we are concerned that infected children could be a source of infection to other older members of our families. 

Disease Management:

Management of patients with COVID-2019 is early recognition of the disease and immediate isolation of the patient from other healthy individuals.  The diagnosis is suspected more in individuals who have recently travelled from China, South Korea, Italy or Iran, however, the number of countries where COVID-2019 has been found is now well over 60.

Here is the challenge both doctors and parents face with coronavirus.  Unlike influenza, where physicians have the means to rapidly detect the virus (through rapid, bedside testing), treat the infection (with Tamiflu or Xofluza) and prevent it (with the flu vaccine), NONE of these tools are readily available to us with COVID-2019.  Therefore, diagnosing the disease process is a matter of a reasonable guess. 

Yes, it is possible to rule out other common viruses by sending out respiratory panels on children who present with upper and lower respiratory symptoms, but extensive testing is not a great screening option due to the cost of these tests and inability to include all potential viruses.  Our hope and expectation is that specific COVID-2019 rapid testing will soon be available.  We have discussed this with our testing labs and their guess is PCR testing of nasal swabs for COVID-2019 will be available within weeks. 

Until we have these tools to combat COVID-2019, we have decided to implement the following procedures at POP:

THE POP PLAN REGARDING COVID-2019:

1.       When families call for a “sick” appointment, we have instructed our telephone receptionists to ask if you or your child have recently traveled to countries with high rates of coronavirus infection OR if you have been in contact with individuals who have traveled to these countries.

2.      We will be utilizing separate rooms to evaluate patients who we have fever and cough.  We are requesting that patients with these symptoms wait in their cars or on our outdoor balcony until our staff can further evaluate them.  In some cases, masks will be provided.

3.      We have instructed our nursing staff to thoroughly clean every room that children with symptoms consistent with coronavirus have been in.  This includes careful cleaning of tables, sinks, walls, doorknobs and other surfaces with a virus-eradicating Clorox wipes.

4.      All books and magazines have been removed from our exam rooms and lollipops and stickers will be distributed to children from the front desk.

5.      We appreciate your help in teaching your children hand-washing and proper cough techniques (cough into a tissue or elbow) to minimize spread of all respiratory viruses during the time and always.

Thank you for your patience during this time. 

We will keep you apprised of any policy changes at Pacific Ocean Pediatrics as this situation unfolds.

              Robert C. Hamilton, M.D., F.A.A.P.                                  Leian Chen, M.D., F.A.A.P.

              Noel H. Salyer, M.D., F.A.A.P.                                            Lily Marouf, M.D., F.A.A.P.