Seems like the natural world is infecting human kind with some nasty pathogens these days. Just think about it, in just the past 20 years we have had to deal with SARS-CoV-1 (likely coming from bats), and MERS (a camel cold virus), H1N1 (from pigs and birds), and Zika jumping from rhesus monkeys to humans via mosquitoes. And this is just a partial list. In a world where pathogens are coming at us faster than a major league fastball, it’s time for us to learn more about epidemics and more importantly, how to defend ourselves. That’s exactly what we are going to do in today’s pedcast.
Above Image by Pixabay
How do Germs Move Around?
As we have just witnessed, infectious diseases can travel very fast and won’t stop until they have run out of susceptible hosts. Some germs require a “vector” like a mosquito but others have the ability to jump from human to human without an intermediary insect or animal, the way corona viruses move. This type of germ is more likely to cause pandemics like we are experiencing today. Any highly transmissible germ will continue to circulate and make children and people sick until enough the microbe literally runs out of children or people to infect. The contagiousness of a germ is measured by a number called the R-naught. The R-naught represents the average number of people each sick person will infect. The higher this number is, the more contagious the germ. Once a large number of people have become immune to infection, the population has reached a critical percentage of immunity known as “herd immunity”. At this point, the epidemic stops. With SARS-CoV-2, it has an R-naught of between 2-3 and experts guess that person to person transmission will stop when about 60-70% of our population is immune. For measles, a much for infectious germ with an R-naught of 12-18 , epidemic spread will continue until 95% of the population is immune. At the time of this writing, a sample of North Carolina residents finds that only 10% of our residents are immune to SARS-CoV-2. As you can see, we have a long way to go before we can say good riddance to Covid-19.
Other Ways of Getting Immunity to SARS-CoV-2
Specific immunity to an infection like SARS-CoV-2 can come from a child acquiring that specific infection, from the child getting an antiviral medication that works against that virus, from getting the immunity that someone else acquired (convalescent serum or monoclonal antibodies), or can be derived from a vaccine. And here is something that researchers have hopes might also provide some protection to children during the 2019 pandemic- there are indications that getting a live virus vaccine like the MMR or chickenpox vaccines, can help both children and adults fend off other viral pathogens not specific to that vaccine. Wouldn’t that be ironic if the MMR vaccine ends up saving us from this pandemic! Anyway, It appears that getting any live virus vaccine jump starts a person’s immune system into reacting faster to SARS-CoV-2, Case in point, it was noticed that after giving children live oral polio vaccine like children like me got in the 1960’s, seemed to protect them for a few months from getting influenza and other viral infections that year. In some seasons, the live oral polio vaccine helped protect the children from influenza virus better than the flu vaccine! Let’s hope that re-purposing an old vaccine might protect both children and adults from Covid-19. Wouldn’t that be amazing.
How Do You Protect Your Children Today from Getting Covid-19?
All of this information is very interesting, but what can you do today, to protect your family from contracting Covid-19 until we, as a nation, develop immunity to SARS-CoV-2-until we get the herd immunity we talked about before? Now, I am about to give you some advice as we understand this pandemic today, July 4th, 2020. Things can change very fast however and I might tell you something different as we learn more in the future. So, let’s go down the current action list:
Advice tip 1. Let’s go beyond the advice of keeping your hands clean and not touch your face. That was the o.k. advice in March of 2020 but was given before we knew how this germ can be spread by touch and in the air. Yes, you or a family member can touch SARS-CoV-2 and rub it into your nose or eye, but more likely, it will infect you from an aerosol in the air, left there by an infected person. And we now know that about 40-45% of people who are infected, have no symptoms. Both they and you have no idea that there is potential for sickness to be transmitted. That’s where masks come in. Yes masks for everyone, including your children. Masks are not practical for children under 2 years of age but after that, yes. I know that stinks, but it is the reality of controlling the spread of the virus and getting life back to normal. Mask wearing will stop most of both the droplets and aerosols from being spread to those around you. We now know that this is the major route of spread of SARS-CoV-2. We didn’t in March but we do now. Skeptical of the whole mask wearing thing, check out this visual and I think you will change your mind. And by the way, don’t believe all the claims that wearing a mask will cause you to have COPD, will weaken your immune system by eliminating exposure to germs, or will reduce your child’s or your blood oxygen levels. If any of that were true, wouldn’t every surgeon or operating room worker have been sick long ago? These arguments, in my mind, are just excuses not to wear masks.
Advice tip 2. Have your family avoid crowds of people, especially crowds that gather in small spaces indoors-currently defined as 10 or more persons. This comes back to that aerosol thing again- here the factors are time spent together, size of the room, and the number of people. Currently in my community of Charlotte, as many as 1 in every four people randomly selected are shedding SARS-CoV-2! That means that if you or your family are unfortunate enough to get on an elevator with four high risk people, at the time of this writing, in Charlotte, and that elevator ride is a long one- not yet defined- and no one has on a mask, there is a good likelihood that some or all will get sick from that elevator ride. Moral of the story- avoid crowds, especially if they are unmasked, avoid small confined spaces with other people- that’s called socially distancing- and spend as little time as possible around non-immediate family members. It goes without saying that international travel is ill advised. As far as school attendance, I am going to give you my opinion on that one. For elementary age children, who follow distancing and hand hygiene and wear masks, I think school attendance has been shown to be safe in places like Denmark. For teens and university students however, we are going to just have to grope our way through this and see if attendance will be possible.
Advice tip 3. But humans are social creatures and you and your children need social interaction. We can’t stay “sheltered-in-place” forever. So how do we socialize with others? By maximizing outdoor activities. Social gatherings, should be kept small, outdoors, distanced, and masked of course but I believe as do many experts, that getting infected outdoors is much less likely than indoors for various reasons. I think that families should keep their social circles small and confined to others who follow the guidelines i am laying out in this article.
Advice 4. And let’s not forget that if 100 people contract SARS-CoV-2, only about 20 of the 100 are going to be moderately or severely ill. Age and other preexisting conditions are predictive of illness, but undoubtedly, a person’s overall physical and mental health are a important factors as well. Are you and your children getting enough sleep and exercise, is your diet rich in a variety of whole foods, do you and your children have adequate levels of nutrients known to provide good resistance to infection like vitamin D, zinc, and vitamin C, and are you and your children managing the stress of the pandemic adequately. These are all important factors to help your family weather the storm and stay healthy.
Advice tip 5. And finally, it’s time we talk about how we greet each other. We have all heard that hand shaking or hugging is totally passe because so many germs pass from that kind of contact. That’s why during the ebola outbreak of 2015, I brought you the “Elbowla”– a tapping of elbows. Then, at the beginning of the Covid-19, I coined the term “The Corona Safe-Shake” which is actually the elbowla with a new name. But now that we know that the distance between greeters is the major factor determining transmission, we need a new way to greet each other. So today, I am unveiling the “Malady-Howdy”. With this greeting, greeters stand at least 6 feet apart since speech greatly increases the number of infectious particles emitted, and simply bows at the neck with a quick bend forward of the head. Try it, and teach the malady howdy to your family. It, along with these other tips, will hopefully keep you all well!
Wow, where does the time go? Another pedcast in the can. If you find the information you get on Portable Practical Pediatrics valuable, please consider rating our podcast where you get your podcasts or on social media. Likes and shares are very helpful as well. This is Dr. Paul Smolen, also known as Doc Smo, hoping that you now know when your town is full of malady, the proper way to say howdy. Until next time.
Many thanks to Drs. Monica Miller and Charlotte Rouchouze for their help in preparing this pedcast.