Sorting through the news and finding serenity....

"Attitude is Everything"

Our primary job is to ensure that our loved ones are safe. For most of us- there is an added benefit in that our schools can reopen once we decrease transmission. Don't get distracted by those who gather in groups. They are putting their own lives at risk more than anything. While you cannot control others, you can educate your family about how COVID19 spreads. For everyone, changing common social behavior is very hard. When you add to this challenge the social invitations of our neighbors, friends and family we easily forget what is at stake. California's COVID19 death rate is at 1.8%. I remind myself of this number when I don't want to put on a mask. You should too.

The US is leading the world in number COVID19 cases because we cannot slow the spread.

WHO currently estimates that 16% of people with COVID-19 are asymptomatically transmitting. Most other data shows that 40% of coronavirus transmission is due to asymptomatic carriers. As a result, public health officials stress keeping a distance of 6 feet from one another and wearing a mask when able.

We are happy to test patients and their families for COVID19 via nasal-pharyngeal PCR.

R apid tests still have the medical community weary. This spreadsheet from Harvard details out the logistics of testing. The FDA has allowed dozens of tests to be available for use without the typical criteria met. Several of these are going to market flawed. Companies used their own statistics on accuracy which is now being questioned . A few more months of post marketing studies will reveal the best rapid testing machine. I promise you that I am looking for the most accurate test to have available in the office. For now our send out test takes 24-72 hours and allows for the most accurate results.

While large scale testing in the near future will help slow spread we must be vigilant that anyone can be a carrier.

Individuals who are 41 and younger account for about 57% of the new cases — an ongoing trend that county officials have said confirms that younger people are driving the spread of the virus.

A recent University of California, San Francisco, study found that there’s a high load of SARS-CoV-2 shedding in the upper respiratory tract, even among pre-symptomatic patients. Such a viral load makes symptom-based detection of infection less effective.

Please email me if need help locating KN95 masks, hand sanitizer, or reusable pediatric small masks. For school children you should consider having 4 washable masks in ziplocks each labeled for different parts of the day. Once your child takes a mask off (to eat or play outside) they should put a clean mask on. The goal is to eliminate the risk of your child touching contaminated surfaces and then touching their mask. Once they soil a mask and have it on their face, they can potentially breath in viral particles. Children need to learn to clean their hands before they touch their masks. Hand sanitizer will work and be sure to instill this lesson now! Practice makes perfect.

CHOC needs convalescent serum for hospitalized patients. If you know anyone who can donate please have them contact (714) 509-8339

The UPSIDE of our recent surge and orders from Governor Newsom:

The infection rate is dropping. OC percent positives dropped from 12.9 to 9.3 in the last 9 days. We are not gathering at restaurants, movie theaters and bars spreading infection. People will hopefully recognize this and place schools before bars. This past week physicians all over OC are truly seeing urgent care visits drop and hospital numbers plateau.
Schools now have more guidelines prepared for return to the classroom. Over the summer break many schools lacked clear safety protocols, spacing/cohorting plans, and well designed online curriculum. These factors are being rectified. Now more people are advocating for safe practices. Moreover, teachers will have time to voice their concerns as we watch other schools open around the nation.
We are buying time so that our children are not the first guinea pigs. A large and necessary UCI research project is going to follow 4 local schools (when they open) to learn about transmission. Any extra time to learn from classroom outbreaks in other states and school related transmission elsewhere, will help guide us when it is time. With every month we delay school restart, hospitalists are feeling more confident that they can treat COVID19 effectively. I couldn't agree more with a physician who wrote "the later the infection, the better off we are. I took care of COVID19 in March and now in July, I don’t see deaths and misery like I used to see in March... plasma, Remdesivir, Tocilizumab, steroids are making a difference. What we know now we did not know in March, what we will know in October, we don’t know now. So the later the better." I was very distressed after the July 15th AAP Townhall meeting wherein doctors outlined all of the unknowns regarding risks with the current back to school policies. Before the criteria set by Governor Newsom on July 17th, physicians left that meeting feeling as if we were marching our children into an inescapable COVID19 trap that was sure to ensnare the entire family.

You can review past newsletters on my website:

https://askdrvivi.com/covid19/

Tips to avoid Burnout:

Focus on masking and distancing. Plain and simple. Read the above if you don't think it is worth your time!

Be kind to others when you ask them to give you space or mask. When I meet resistence I repeat phrases of gratitude such as "Thank you so much for helping slow the spread. My mom is sick in the hospital and we take this seriously." You may not mask up immediately but I find that in time, people will change their behaviors.

Children 4 and older children can learn to wear a mask, keep their hands off their faces, and space 6-10 feet from people. It's a matter of priority. You need to show them and practice with outings in masks. There are studies showing that children of all ages carry and shed the virus. California had it's first teen death this week.

For older children make the current sacrifices into lifelong lessons. Teach them that distancing is about doing something for others. This is a transformative period and when you let your child go to parties you are missing out on a valuable moment to discuss what sacrifice really looks like. Even our president has had a change of heart.

- Did you know the OCHCA is tracking preschool and daycare outbreaks?

- Did you know there have been children hospitalized locally with multi system inflammatory syndrome?

- Did you know it usually takes 2 decades to create a vaccine?

- Did you know that 13-17 year olds are showing a large increase in case counts?

- Did you know that CHOC has rising numbers of asymptomatic cases on pre-screening?

Learn all of this and more from July 22nd's AAP OC Townhall meeting . This presentation reviews the concerns around the production of the COVID19 vaccine and how our community conducts OC case reporting .

Dr. Paul Offit and Dr. Matt Zahn were our special guest speakers. Think Oprah and Chris Martin in the eyes of a physician. Dr. Offit is from Children's Hospital of Philedelphia's Vaccine Education Center and Dr. Zahn is the local Medical Director of OCHCA.

Controversies IN THE NEWS answered:

YES- Children of all ages can spread COVID19

NYT discusses how older children spread the virus as much as adults

CNN reports on young children

NO- For now there is nothing exciting or new about hydroxychloroquine. This is the feeling of all physicians whom I have asked.

The most recent and largest controlled study shows no benefit.

NO- You do not need to worry that our president has hijacked all case counts and hospital data!

CDC Director Dr. Robert R. Redfield and HHS Chief Information Officer Jose Arrieta Remarks on HHS Protect

Need a tutor or help with online teaching?

Math: roseanneacostello@gmail.com

Reading: nicole.mynewreader@gmail.com

General Classes: http://www.beachcitiestutoring.com

Other Help: Huntington Learning Center

Try a delivered box to keep your child engaged and learning: Kiwi Co, Super Powers Kids Academy, Greenkids Craft, Little Passports Inc, Bitsbox, Birchbox.

Follow the Extraordinary Lives Foundation for upcoming free seminars on anxiety and mental health in children.

OCHCA Reported Numbers

PATIENT SPOTLIGHT:

Read here how Q has brought a community together to overcome COVID19.

Inspired by Q's plea to help, the NguyenLe family has set up a non profit foundation with their first goal being to provide 1 million reusable, high quality, cloth face masks to those in need. Their 3-ply mask has a removable filter insert (same material used in surgical masks). 500,000 of these masks will be in the US before the end of August. I was very impressed with their efforts and success in such a short timeframe.

If you know of a community in need please contact me and we can arrange for delivery!

Their website: themaskhub.org

CHOC'S FAQ PAGE CLICK HERE

Follow Dr. Vivi on Instagram and Facebook for up to date information and resources on COVID19 - @ASKDRVIVI