*This interview was conducted on June 22, 2020. Please be aware that some information could change as cases increase and we learn more about the disease.
We now know that COVID-19 is spreading in Tampa Bay with a surge of cases seen among young adults. We wanted to find out what this means for families and kids in the Tampa Bay Area.
We’re chatting once again with Dr. Juan Dumois, a pediatric infectious disease physician at Johns Hopkins All Children’s Hospital to learn more about what they’re seeing locally and how we can continue to protect our kids.
You can watch our interview here or scroll to read the very important Q & A.
We know that cases are surging locally among young adults. Are you seeing more cases in kids at this point?
Dr. Juan Dumois: Actually, we have started seeing more cases in kids VERY recently. As of last week, 1/3 of all of the cases we’ve seen since the beginning of the pandemic were recorded in the last week.
So that’s a huge increase in the frequency of positive tests in kids who have presented here.
Obviously that is concerning for doctors—are the symptoms mild or more severe?
Dr. Dumois: Most of the children who present here and test positive for COVID-19 have relatively mild symptoms, some have had no symptoms at all and they were just picked up because we are now screening all children who come in for surgery.
Some had very mild symptoms and were sent home from the emergency room, so very few have had very severe symptoms.
When children do get sick, they seem to have a variety of symptoms. They tend not to have as many symptoms or as severe symptoms as adults. But the symptoms children can have include fevers that may be low grade or occasionally very high, they may just be irritable, they often complain of being achy, they may have cough and congestion but they don’t have to have that. Their appetite may be decreased and they may be more lethargic than usual.
If we suspect our child may have COVID-19, should we take them to get tested or treat them as though they may have COVID?
Dr. Dumois: If your child is starting to get sick and you are interested in having them tested for COVID-19, I think the first step is to call your pediatrician’s office and ask them what they advise. Some offices may be doing testing and that’s going to be the most convenient and best way to get it done. If they are not doing the testing there, they will have some recommendations locally in the town or community where the office is located about where you can go to get tested.
Are you surprised when you say 1/3 of the young patients diagnosed with COVID since this pandemic began have been diagnosed just in the last week?
Dr. Dumois: I’m not surprised, but I’m extremely concerned. It is reflecting the numbers we are seeing across the state of Florida that have been rising daily over the last week and a half. I’m very concerned that we are losing the reigns on this horse and that we may lose control of this pandemic locally and it may even force us to start shutting things down again. I hope that doesn’t happen.
What can we do as families to help you all-physicians and hospitals-to not overwhelm you?
Dr. Dumois: We don’t have great treatments for COVID-19 if you’re not sick enough to be in the hospital, so the best thing, to prevent overwhelming the doctors and hospitals is to not get infected in the first place, so prevention is number one.
And prevention is best done by avoiding contact unnecessarily with other people. If it’s necessary, try to do it as safely as possible.
One of the big concerns and risks for being exposed to other people during the summer are summer camp and daycare. With more people going back to work, someone needs to take care of the kids and unfortunately, a lot of people do not have a family member who can care for their kids when they are going back to work.
What summer camps and daycares have been trying to do as much as possible -and what you want to look for in what may be a safer type of summer camp or daycare -is where they’ve broken up the children into smaller groups, smaller classes so that if COVID-19 is introduced into that summer camp, it will affect a smaller group of the kids and not everybody in that camp.
I think the groups should not be interacting with each other. The group stays together all day, everyday with minimal interactions with all those other groups.
They shouldn’t ben having lunch all together in one big dining hall like they usually would any other summer. You can ask about that when you are signing up your child for summer camp or daycare. Also, the more outdoor activities they have, the better because it’s probably harder to spread it outdoors than indoors.
Are you surprised how quickly this virus has spread in our community since we reopened?
Dr. Dumois: No, I am not surprised at how quickly the virus has spread. I know that I, and I think that most infectious disease doctors who have been following this, expected this to happen. In fact, Dr. Fauci has been saying this for a few months now that the reason we were closing things down was to decrease the spread of the virus with the primary goal of not allowing the hospitals to get overwhelmed and we succeeded in doing that across most of the country.
Because things started opening up, and I’m not saying they shouldn’t have opened up…because things started to open up, unfortunately some people started to think that the pandemic was over or ending soon and they were completely relaxing their practicing of precautions in a way to increase the rapid transmission of this virus. This is a relatively easy virus to spread.
What if a parent was exposed to COVID-19. Should the child be tested too?
Dr. Dumois: If a parent is exposed to COVID, then you do not automatically test the child exposed to that exposed parent who is not yet sick because nothing may have happened. There may not have been any active virus in the parent yet that could be transmitted to the child.
So, generally what we’ll do is recommend the parent who was exposed to COVID, first you want to find out if it was a significant exposure or not a significant exposure.
If you find out somebody at the office tested positive for COVID-19, but you never spent more than a few seconds around that person or maybe passed them in a hallway, that does not count as a significant exposure compared to someone with whom you work regularly with or were in a meeting that lasted an hour-that is a more significant exposure.
So, let’s say it was a significant exposure, that parent may not be contagious for several days. They may be contagious eventually before they develop any symptoms and in some cases they won’t develop any symptoms.
So the parent is going to be recommended -for 14 days after that real significant exposure to a co-worker -that they monitor themselves for symptoms and, if possible and to whatever extent possible, they try to isolate themselves from the other people at home so that as they become contagious with the virus, they don’t accidentally spread it.
If they can do that self isolation at home to prevent the spread to other people in the family and nothing happens after 14 days, then we’ll usually say that they weren’t infected or they can get tested at the end of the 14 days and see if they were one of these people who had no symptoms.
Let’s talk about ways we can continue to protect ourselves-I know we’ve talked about the hand sanitizer, washing our hands, not going out when you are sick, but we’re coming up on a big weekend with July 4th—what can we do about that summer travel?
Dr. Dumois: It is still possible to travel safely and avoid getting infected. Your risk when traveling basically depends upon how many people you are going to be exposed to and are you going to get close to many people in crowded situations or are you going to be relatively isolated from people most of the time?
If your vacation entails going to a theme park like Disney World or Universal, that will entail being in lines, being in crowds, being in restaurants compared to staying in an isolated cabin in the mountains where you’ve stocked up on groceries at the beginning of your trip and you can eat in most of the week.
You can schedule your daily activities to minimize exposure to people who might be contagious with the virus and be relatively safe.
If you want to go to a beach, some beaches are crowded and some are not. The less crowded beach is inherently safer than the more crowded one. If you’re going to travel by plane, that’s going to entail much more exposure to larger numbers of people than traveling by car.
So, your relative risk all depends on how much you can isolate yourself from the other people that might be shedding the virus and you can’t tell just by looking at them.
So, that’s why we have to wear those face masks when we go out and wash our hands.
Dr. Dumois: Right. The very healthy person that you are chatting with in line at the grocery store could be blowing virus right into your face if they are not wearing a mask and you are not wearing a mask.
We have the local mask orders requiring people to wear a mask indoors when you can’t social distance. Some people refuse to follow this order. What would you say to them?
Dr. Dumois: I think I would say three things.
One-the pandemic is not over and it is starting to get worse in the Tampa Bay area.
Two-You need to protect yourself and the people around you including your co-workers and family members and the people you love by not getting infected.
The third—is when you leave your home, your attitude should not be what can I get away with doing and not get into trouble and therefore if one place makes me wear a mask, I’ll wear the mask and if the other place doesn’t make me wear a mask, I won’t wear a mask. Instead, the attitude one should have when leaving your home is I need to protect myself and the people around me, so I am going to wear a mask when I have to be closer than 6 feet to other people.
One big thing is kids and masks. What is your advice to parents to encourage kids to wear a mask and to not fiddle with it when they do wear one?
Dr. Dumois: Yeah. It’s very challenging to have a young child keep on a mask.
It’s recommended by the American Academy of Pediatrics to not even try to put a mask on a child under two years of age and we don’t want to put a mask on a child with underlying respiratory problems who have trouble breathing on their own.
What we would recommend for younger children is to not put them in a situation where they should wear a mask. So don’t put them into crowded situations and if they are with a group of people, it’s just family members.
Sometimes they’ll want to schedule a playdate with another child –that should only be done with other families who are practicing the same precautions and social distancing that you are. Other families that are not engaging in those precautions of social distancing, you should not have play dates with them because that entails more risk of introducing the virus into your household.
Remember when we were kids and our parents would make us hug the neighbors kids with chicken pox…what would you say to people saying that…let’s just get it and get it over with. Herd immunity. (We don’t support this theory at all.)
Dr. Dumois. Okay. If your solution to the pandemic is to let people get infect quickly so that herd immunity rises to the level to slow down the pandemic, you are accepting the deaths of thousands more people than otherwise would have to die in the state of Florida and millions of people in the United States, so it’s a bit of a callous solution to the pandemic and that’s why it’s not being recommended by most public health experts.
It’s a respect for our fellow neighbors is what it comes down to.
Dr. Dumois: It does. And for those people who are religious and most of the major religions do encourage respect for fellow neighbors, those who are not respecting their neighbors are not adhering to the tenets of that religion.
Let’s focus on the upcoming school year. How should parents handle sending kids back to school because it seems in many cases, there will be options.
Dr. Dumois: I think the first question a family should address is, is someone in the family at significant risk of dying if COVID-19 is brought into the home. If the answer is yes, the first choice for school is to do virtual school for the next year starting in August.
If you are not sure someone in the family has that weak of an immune system, then you need to speak with that family member’s physician and get their opinion if they are likely to survive or how likely they are to survive an infection with COVID-19.
If that is not the case and nobody is at a significantly higher risk, there are no grandparents living in the home, then the next step should to look at what options are being offered by your child’s school.
Some schools are offering extensive options for how to start. In some cases, it’s just being in school all day, every day. In other cases, it’s being in school half time and virtual half time. And another option is virtual all the time.
Some schools are not offering many options. With all of the private schools out there, they can have totally different plans based upon their own resources and their own building structure.
If you think it’s possible for your child to go back to school and no one in the family has a significant risk factor for dying of COVID-19, then start checking now to see what the school is planning to do and see if one of the options is acceptable to you.
Is there anything else you want to add that you want people to understand?
Dr. Dumois: One thing I would say is do not listen to the people who have been saying that the numbers of COVID-19 rising in Florida are only due to the increased testing. That is completely false.
Questions from an earlier interview about how to protect our families from COVID-19:
We keep hearing that hand washing is one of the best ways to prevent illness. What’s the general rule of thumb to teach our kids?
Dr. Dumois: When using soap and water, use enough soap to lather the front and back of both hands and in between the fingers while cleaning under running water. To clean your hands effectively, it should take at least 20 seconds, which is similar to singing the ABC song at a normal tempo or the happy birthday song twice.
If using hand sanitizer, use enough so that it takes at least 15 seconds before both sides of both hands are completely dry; most people do not use enough.
Can viruses/germs/bacteria exist for a long period of time on “daily use objects” like cell phones, laptops, books, etc., and if so any benefit in trying to clean them regularly?
Dr. Dumois: Yes, viruses may temporarily live on hard daily-use objects. For some viruses it is a matter of hours, and others may last for days.
If you are the only person touching that object, it may not have to be cleaned since you are just exposed to your own germs.
A big exception would be cell phones, since people frequently handle those in public before and after having touched other potentially contaminated objects in their environment.
It is probably a good idea to minimize use of your cell phone in public until you have had a chance to clean your hands with soap and water or hand sanitizer.
Is there a better or worse way to clean (example: spray something on a surface and immediately wipe or let sit for a minute?) Any benefit in increasing regularity of cleaning bathrooms/toilets/etc?
Dr. Dumois: The virus may last for a few days on hard, nonporous surfaces.
It is best to clean surfaces in the home using common disinfectants that leave the surface slightly moist after you have wiped it. The time that it takes the disinfectant to evaporate helps to kill the virus.
Most household disinfectants work, including diluted bleach (1 part bleach to 10 parts water).
If someone in your home is sick with a respiratory virus (common cold, flu, coronavirus, etc.), it may be helpful to clean objects frequently touched by the sick person at least once a day and preferably before those objects are touched by well people in the home.
Are there any benefits to HVAC A/C filters that advertise as filtering out virus particles?
Dr. Dumois: No. Outside of a hospital setting, expensive High Efficiency Particulate Air (HEPA) air conditioner filters or room air filters probably would not make any difference.
Are there any benefits to taking vitamins like Vitamin C, etc?
Dr. Dumois: We currently have no information on whether certain supplements help people infected with the COVID-19 virus.
However, people who do not maintain a healthy, broad-based diet may have an immune system that is not working at peak capacity.
Since our immune systems help fight off infection, people with a poor diet might benefit from a daily multivitamin that also contains trace minerals.
Note: A Vitamin D supplement may be needed for kids who do not get a lot of time outdoors in the sunlight which allows the body to naturally produce Vitamin D. Talk to your child’s pediatrician for direction.