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News of Otsego County

LIFE IN THE TIME OF COVID-19

Suffer The Poor Children

Life In The Time of COVID-19

Suffer The Poor Children

Richard Sternberg, a retired Bassett Hospital orthopedic surgeon, has agreed to provide his professional perspective while the coronavirus threat continues. Dr. Sternberg, who is also a village trustee, resides in Cooperstown.

There remains a lot about SARS-CoV-2 and COVID-19 that we don’t know. What was “common knowledge” yesterday could be proved wrong tomorrow. The risk of morbidity and mortality in children was one of the things we thought we knew but now appears that we didn’t.

SARS-CoV-2, the currently accepted scientific name for the coronavirus that causes COVID-19, appears to be the precipitating cause of a newly recognized syndrome that causes destruction of multiple organ systems in children.

This syndrome is so recently recognized it is still referred to by many names, Pediatric Multisystem Inflammatory Syndrome, P-MIS (how the state Department of Health has been referring to it up to now), Multisystem Inflammatory Syndrome in Children, MISC (Center for Disease Control designation since this weekend), Kawasaki Disease-like syndrome, and Toxic Shock-like Syndrome. For all I know by the time you read this there will be an agreement on one of these or something totally different.

MISC was recognized only a few weeks ago. May 5 an article in the New York Times talked about a mysterious ailment in children possibly related to COVID-19. At that time, it was recognized in 15 hospitalized children with no deaths. As of Sunday May 17, there were 137 recognized cases with three deaths in New York. Other countries and regions having been alerted to this phenomenon are now reporting this.

At first children presenting with symptoms of this were misdiagnosed. They had none of the hallmark symptoms of COVID-19, i.e. viral pneumonia and other respiratory symptoms. They appeared to have Toxic Shock Syndrome or Kawasaki Disease but no reason for developing that was found. They hadn’t been recently ill.

Nevertheless a few specialty physicians in children’s hospitals thought to test these children for SARS-CoV-2 and some tests came back positive. Later in the approximately first hundred children recognized with MISC in New York, 40 percent had a positive test for SARS-CoV-2 and 60 percent had a positive antibody test which as most of us are aware of means it was highly probable that they had the disease even if there weren’t respiratory symptoms.

While so far there appears to be only a 2-3 percent risk of fatality in children with MISC we do know that there is damage to critical organ systems in the body: heart, lungs, vascular, kidneys, liver, etc. There is a very good argument that this may lead to permanent impairment of these organs such as in the case of many other infectious diseases in children in which initial symptoms appear to fully resolved. For example, scarlet fever, rheumatic fever, Lyme disease, and viral cardiomyopathy.

While there only appears to be a relatively small number of these cases so far (small statistically but what solace is that to a parent whose child develops this) it is totally unclear what long-term health consequences may occur in sub-acute forms of this syndrome. It is quite possible that a child who is infected develops this but not badly enough to be brought to a physician and diagnosed. Considering how Americans get upset about potential disease processes that have demonstrated miniscule risk, what response can we expect if this is now recognized as a long-term consequence of a child who is infected with SARS-CoV-2.

So, what can we do? One should seek immediate medical care for a child who has:
• Prolonged fever (more than five days)
• Difficulty feeding (infants) or is too sick to drink fluids
• Severe abdominal pain, diarrhea or vomiting
• Change in skin color – becoming pale, patchy and/or blue
• Trouble breathing or is breathing very quickly
• Racing heart or chest pain
• Decreased amount of frequency in urine
• Lethargy, irritability or confusion
Early recognition by pediatricians and referral to a specialist including critical care is essential.

Additionally, we need to reopen smartly. Based on news reports, pictures, and videos there appear to be a very large number of people who haven’t gotten the message about the requirements to remain open.
One, things will close down again if the transmission rate of the disease goes above 1.0. If we close down after opening because of a spike of cases many economists say that economic disruption could be worse than we have seen so far. Therefore, prevent spread!

This can be easily done by following all social distancing regulations and recommendations. Flaunting these may make someone feel empowered but it is only putting their health and the health of all those around them at risk. Possibly more important to those who are behaving badly, flaunting will lead to more infections which will lead to a new shutdown which will lead to continued economic pain.

Stay safe. Be smart.

STERNBERG: Your Arm, My Nose

Life In The Time Of COVID-19

Your Arm, My Nose

Richard Sternberg

In 1882, John B. Finch, then chairman of the Prohibition National Committee, wrote “… your right to swing your arm leaves off where my right not to have my nose struck begins.”

This seems like a very appropriate commentary on the current argument between those who are concerned about easing COVID-19 restrictions now and those who want to open the economy immediately.

Sadly this, like almost all things in this country, has become highly politicized with each side having its own facts. Interestingly, there appears to be a reasonable compromise to allow rapid and safe recovery of the economy while decreasing risk of propagation of the disease: Everyone wears a mask while in public, all the time, everywhere.

I am indebted to Martin and Meg Tillapaugh for directing me to the article “Masks for All? The Science Says Yes” by Trisha Greenhalgh and Jeremy Howard.

In it the authors, in very easy to understand language, discuss the epidemiology of disease spread, the physics of droplets and aerosols, the material science of masks, the mathematics of disease transmission, the politics of mask wearing, mask-wearing experiments, the behavioral science of mask wearing, the economics of mask wearing, and the anthropology of mask wearing.

The bottom line is that most of the scientific evidence supports mask wearing and, to quote Governor Cuomo, “It’s disrespectful to me (for you) not to wear a mask.”

In my opinion it would be much easier for me, someone who has six co-morbid conditions for complications with COVID-19, to accept opening things up more if everybody did everything
reasonable to protect each other.

The arguments against mask wearing that I’ve heard include its uncomfortable, it looks funny, I’m not at risk, kids and young people don’t get it, it’s a free country, I don’t have to do what anybody tells me, and it’s a Democratic conspiracy. None of these are valid in this situation.

Well, we are all at risk. We are all at risk of spreading it to friends, loved ones, other human beings, and of becoming infected, contracting the disease, getting sick, and dying.

Children are not immune. They can become very ill and die or transmit it to someone else who becomes sick and dies. One form of the disease in children, Pediatric Multisystem Inflammatory Syndrome, is particularly nasty.

If the number of children dying of this wasn’t overshadowed by the unfathomable numbers dying overall there would be public uproar of why we weren’t doing more to help these poor children.

Trying to out yell or politicize this disease is not going to lead to solutions. Marching on state capitals while refusing to social distance and not wearing masks, thereby putting everyone including the children present at risk, and carrying semi-automatic rifles which in that context can be for no reason but intimidation, which no government could capitulate to, doesn’t win any additional support.

On the other hand, if everyone who wanted to see everything open up quicker than it has so far, and that should be about everyone, were to wear masks whenever in public, transmission rates would drop, new cases would drop, and deaths would drop, all strongly supporting allowing a return to normalcy.

To quote a famous American, “Why can’t we all get along?” If we all work together and compromise in what we are saying to each other and in what we are doing, we will find that all win. This would not be a you or me, win or lose, but win/win all the way around.

Richard Sternberg, a retired Bassett Hospital orthopedic surgeon, has agreed to provide his professional perspective while the coronavirus threat continues. Dr. Sternberg, who is also a village trustee, resides in Cooperstown.

STERNBERG: Why Wasn’t More Done Sooner?

LIFE IN THE TIME OF COVID-19

Why Wasn’t More

Done Sooner?

By RICHARD STERNBERG • Special to www.AllOTSEGO.com

 Over the last several days I reviewed a great deal of material regarding COVID-19 and the novel coronavirus. I looked at videos. I read scientific and lay papers. I scanned media reports. All to determine what to write about.
It was like drinking from a fire hose.

Richard Sternberg, a retired Bassett Hospital orthopedic surgeon, has agreed to provide his professional perspective while the coronavirus threat continues. Dr. Sternberg, who is also a village trustee, resides in Cooperstown.

But the Monday, March 30, announcement by Dr. Deborah Birx, response coordinator for the White House Coronavirus Task Force, acknowledging that the best case scenario would be 100,000-200,000 deaths, made me really angry.

That’s not only because it is unacceptable that so many innocent lives will be lost, or because I know a great number of healthcare providers, first responders and public servants will be among them because of lack of proper protective equipment.

What made me angry was that again government officials kept painting a relatively rosy picture of problems either being or coming under control.

The last two months has shown the continued denial by America’s so-called leaders and lack of preparation that will probably lead to hundreds of thousands of unnecessary cases and deaths.

Why did they not learn from the outbreak in China and its response to it? In this modern age how could they begin to believe that it would not come to the United States? Why did they not prepare?

Dr. Anthony Fauci, director of the National Institute of Allergy & Infectious Disease who has generally been the voice of comfort, reason, honesty and reconciliation, has been repeatedly heavily criticized by some people in that he was not sufficiently loyal to President Trump.

This might be the man who has been really holding everything together at least on a national level. His numbers and statistics have been doubted and called fraudulent. My God, I wonder how we would be doing without him advising the president.

For several weeks, New York City Mayor Bill DiBlasio told New Yorkers they didn’t have to inconvenience themselves significantly during this outbreak. Where was he getting his information from and why was he contradicting the experts?

Many of our leaders have failed us. I can think of some exceptions, especially locally.

Otsego County Board Chairman Dave Bliss and Bassett Healthcare under the leadership of Dr. William Streck both started planning relatively sooner than many others. Bassett, in fact, began its planning way back in January before the first cases were reported in the United States. More on these in subsequent columns.

Right now, I don’t know what to believe. There are professionals, epidemiologists and statisticians, who provide data to support real predictions on how this will turn out. We all need to seek out these sources and then trust them.

I feel that at this point the only public figures I can trust to be straightforward and honest with us are Dr. Fauci and Governor Cuomo.

In the meantime, there are many good places to get information relevant to those of us in Otsego County. The bassett.org website (hit the link on top of the home page) has all the information Bassett has put out along with some excellent videos.

The state Department of Health, health.ny.gov, and the governor’s daily news conferences are also excellent sources of information.

I know that being angry is not going to help but it is the way I feel right now. I hope that other areas of the country stop their denial and learn from New York State’s experience.

I can also hope for some early breakthrough in treatment or immunization but that does not appear likely.

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