Flu and Covid

With Labor Day approaching we should focus somewhat on influenza season/shots. I have previously commented on this regularly at this time of year. With covid now it’s critical for every eligible person to be vaccinated.

Last year approximately 34,000 US residents died from flu (169 children). This is better than in years past(2017-18: 61,000 fatalities),  likely due to yearly variation but also the effects of social distancing from covid which, recall, commenced in mid-March during the latter stages of 2019-20 flu season. New Jersey suffered approximately 1300 deaths.  There were perhaps 40-60 million US cases with almost 740,000 hospitalizations(78/100,000 population). Nationally immunization rates approximate 45% of total population but the rate in the essential 18-50 age cohort is unfortunately lower. About 58% of children are immunized annually, and, thankfully, 81% of healthcare workers get their flu shots.

Most people are eligible for flu immunization:

• 6mo-9 years need a second  shot >30 days after their first if it’s their first year being immunized. In subsequent years only one shot is needed in that age group that year. < 6 mo are ineligible. Therefore, all household contacts and caregivers for <6mo infants should be immunized for baby’s protection. There are some reports of very small risk of febrile seizure in young children receiving DTaP and flu shot simultaneously, however, the data is inconsistent(some say yes, some no) and even among the positive reports there was no evidence of long term harm to any child in that affected group.
• People with chronic illnesses like asthma, diabetes, heart disease, or neuromuscular disorders need their flu shot.
• Immunosuppressed people, like cancer chemotherapy patients should definitely be immunized, although with “inactivated” vaccine only–NOT “Live, attenuated” vaccines.
• Pregnant women should be immunized. Side effects are mild and infrequent, essentially the same as non-pregnant women; serious side effects are extremely rare. Hospitalization rates during pregnancy are lowered approximately 40% by immunization, and infants born to immunized mothers contract influenza 63% less in their first 6 months (recall, they are ineligible to be immunized at that young age)
• Egg allergic patients can be immunized safely if they only had mild allergy reactions like hives as opposed to anaphylaxis.  In between reactions should consult an allergist first.

We all witnessed with horror as corona gripped the tristate area this past early spring and with similar dismay as it rolls across various states and regions now. I witnessed first hand how it devastated our local hospitals and, as the father of a NYC based ICU pediatrician, know from first hand reports how City hospitals were pressed to the breaking point and beyond with ER, inpatient, and ICU admissions for corona.  Most authorities predict increased covid activity as the weather chills, so it’s imperative that every eligible person gets his/her flu shot this year so that we don’t create a public health crisis, with hospitals overwhelmed by corona, flu, and combined cases. That scenario puts literally everyone at greater health risk.

Our flu shots are in, please call to schedule for your child. I urge everyone to get immunized: protect your community, your loved ones, and yourself.

Thanks for following.

 

Kids and Face Masks

I have previously blogged on the importance of face masks to enable our country to gain control of the covid pandemic.  No reason to use the word “controversy” or “debate” here.  There is none: it is settled science among all established authorities.  Currently, public mask wearing is the most effective way to stop the spread of covid, period. Doubt its effectiveness?  Try to blow out a candle wearing a good mask. Uncomfortable, inconvenient? Perhaps–A BIT. Hardly any major disruption of one’s normal routine. Threat to democracy?  CERTAINLY NOT.   It is simply good citizenship and good manners: you are showing concern for your fellow citizens and protecting potentially vulnerable neighbors.  What is “controversial” about that?

It does get to be a bit challenging with younger children– younger the kid, greater challenge.  Under age 2 or with special needs/incapable of removing a mask by herself—no mask. Older toddlers/young school age children should be encouraged–NOT FORCED–it’s cruel and counterproductive (a crying, resistant child, constantly pulling at the mask only INCREASES aerosol spread).

Some suggestions to improve cooperation for a more pleasant experience:

• Talk it up. Explain what masks are, why they help.  Use simple terms. Answer questions honestly–if you don’t know, don’t make it up–look it up. Emphasize that they are being brave, grown up, and are helping others–Grandma, their teacher.
• Demystify the process. Demonstrate mask use yourself: how to put it on, take off. Show them multiple times, have them practice those things on you. Have young children draw pictures of people wearing masks; put them on dolls for practice.
• Personalize the mask. Buy or draw on action figures, super heroes, designs: planets, rainbows–whatever themes your child likes (Beatles masks for Dr. G?) She can add beads, studs/costume jewels if she likes (be sure secured to avoid breathing problems).
• Acknowledge fears. Younger children read entire faces. Covering half can be confusing and frightening. Compare them to Halloween masks, have several “models”(parents, grandparents, older sibs) show what they look like in masks with different expressions. Do the same if the child has breathing fears. Multiple demonstrations, reviewed and reinforced over time, are helpful. Brief “practice periods” at home are beneficial.
• Proper mask and fit. Snug but comfortable.  Triple layer is best. High tech “N-95’s” more expensive and probably not necessary.  Later study suggests that bandanas and “neck grinders” may not be effective. However, as above–cooperation is key, so generally get the mask your child likes best.

Mostly keep masks on for all indoor play, especially if high risk people are present in that dwelling(exceptions for cohabitants in the home and perhaps a very FEW close loved ones beyond that group–“a pod.”).  Typical outside play–with constant movement and not too much direct contact– usually does NOT require mask wearing; the aerosols quickly dissipate in cross breezes. Avoid kisses and hugs.

Remember it’s rare to know one is contagious in the early stages of infection(if at all!) so caution is always best. Again–these are small inconveniences for a much larger good.  This is hardly any threat to “freedom” and forgive an editorial comment–asserting one’s “rights” without accepting “responsibilities” is not “liberty.”

That is adolescence.

Thanks for following.

Covid and Your Grandchildren

Each of the past 2 weekends my married children and their families have joined Kim and me to relax by our pool.  I love that phrase–“and their families”, because it includes my adorable, delightful little grandsons. How to approach these family visits?

I have made some comments about socializing before. Stay outside as much as feasible. That is safest.  If indoors, wear masks as much as you can, especially if in close quarters (grandchild on your lap while you read them a story). Once in a while, I steal a kiss on the back of my grandson’s shoulder or foot(or tush!). Otherwise I have not kissed either one’s face or hands since March. It kills me, but it’s the safer thing to do.  Grandparents, wash your hands before and after any closer interaction with your grandchildren (like lap time above).

In October, we look forward with joy to meeting grandson #3. The above particularly applies to that more vulnerable age of baby.  Masks are imperative around infants. NO KISSING! If Grandma is planning to cohabit with the new baby to help Mom for those first few weeks, I strongly suggest that  both adults endeavor to self isolate for as close to 2 weeks before “the blessed event” as possible. More liberal interactions between Grandma and baby are probably ok after that.

Another question that this raises in the Geneslaw clan is nursery school: what to do with the toddler, especially if a new little sibling has arrived? The risk/rewards here are at least as great as older children and school. Toddlers derive great benefit from the social and educational stimulation of preschool, are typically safer from severe covid illness, but are more difficult to keep clean, limit exposure, and are therefore at risk to bring disease home to potentially vulnerable family members. Generally I favor putting your healthy toddler in nursery school.  The AAP has published sensible guidelines for safe practices.  Endeavor to be sure that your preschool follows as many of these practices as possible.

Finally, the CDC has updated guidelines(they stress these are not “rules”) for when previously ill individuals may return to normal activity.,  Retesting is not necessary. Rather, the person should be > 24 hours fever free(<100.2) without the use of anti-pyretics like acetaminophen, all symptoms of illness are resolved(chest pain, cough, shortness of breath, diarrhea), and are > 10 days since onset of being sick.

Unfortunately, the US is a laggard among developed nations in our response to the pandemic–with 4% of world population, we have >25% of cases and fatalities.  This is horrible and TOTALLY unacceptable. We simply MUST take this seriously to do better. Follow some of the above suggestions and previous posts. Listen to science and public health experts (not pundits or politicians). WEAR A MASK IN PUBLIC. It’s annoying and a bit inconvenient, but it’s really not that hard, is it?

We can still enjoy family and friends, and be safe.  And save lives–maybe your own.

Thanks for following.