President of Doctors for Disaster Preparedness Explains COVID Concerns on Reopening Schools

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Every school year, children catch illnesses at school, and so do teachers and parents. Occasionally an outbreak causes schools to close for a time, say during a flu epidemic that is causing a lot of absenteeism.

But never before have all schools been closed for months—even though COVID-19 has the unusual feature that children seldom either get sick from it or transmit it to others.

The CDC reported 14 deaths involving COVID-19 in children age 5-14 between Feb 1 and Jul 11. There were 2,173 deaths from all causes in that age group in a population of 41 million. As seen in the graph below, deaths in older age groups rose sharply after Mar 21, reaching a peak on Apr 18, and have been declining since.


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A recent surge of "cases" (positive PCR tests) has not so far caused a bump in deaths, which have returned to the baseline of expected mortality. By that metric, the pandemic is over.

Scary reports of "child COVID syndrome" are probably Kawasaki disease, which has been associated with many viral syndromes. There are about 5,000 hospitalizations per year attributed to this, and the number of cases has not been increasing.

Some teachers are reluctant to return, and some  parents are also hesitant to send their children back to school. But if it is not safe to re-open schools now, when will it ever be safe? Who will believe it is safe if children are forced to wear masks and stay six feet apart?


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The hiatus in schooling could lead to far-reaching changes. Parents may be more aware of what their children are learning—and  not learning. Taxpayers may ask: if online learning works, why do we need so many teachers? Parents who find they are able to work from home and avoid an exhausting, expensive commute may want to keep doing that—and home-school their children. Several states report a sharp uptick in interest.

Giving parents more choices could be a positive outcome. But the long-term consequences of keeping children in fearful isolation will worsen, the longer the uncertainty continues. It is possible that the disruption has not prevented a single COVID-19 death.

For further information on COVID-19 diagnosis and testing, see Civil Defense Perspectives, January 2020, and on the surge or "second wave" see AAPS News, July 2020

Vaccine

Hopes are riding on a "warp-speed" vaccine. During this week's coronavirus briefing, President Trump said his administration had reached an "historic agreement" with Pfizer to manufacture and deliver 100 million doses of its vaccine after it is approved for use, and eventually 500 million doses. The deal is worth $1.95 billion. This suggests that approval is assured.


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Safety testing for the Pfizer vaccine was completed in 45 subjects. The highest of three vaccine doses was associated with fatigue, headache, or chills in more than 70% of recipients. Only the lower doses were used for the second injection, which caused more reactions than the first. More than half of those who received the intermediate dose (30 mcg) reported fever, fatigue, headache, chills, or muscle pain, and 100 percent reported headache after the second dose. But only a few were judged to be severe, so further testing could proceed.

A rival vaccine is being developed by Moderna, which is recruiting 30,000 volunteers for Phase 3 efficacy studies at 89 sites in the U.S. A preliminary report on 45 subjects showed that all recipients of the intermediate or largest dose had some type of systemic reaction after the second injection (muscle or joint pain, fever, headache, chills, or fatigue), most judged to be mild or moderate.

It is too soon to rule out long-term complications such as autoimmune disease.


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Despite his support for a vaccine, Trump also said, "You tell me, but I almost would prefer the therapeutics even first. You go into the hospital and you make people better. But we're doing very well with remdesivir and other things. Steroids are turning out to be great, plasma is turning out to be good."

He did not mention hydroxychloroquine (HCQ), which can also be used as a prophylactic at a dose as low as 200 mg/month. Prophylaxis is the approach used for malaria or HIV, for which there is no vaccine despite decades of effort. Patients are also given prophylactic antibiotics if exposed to tuberculosis, meningitis, anthrax, or other diseases.

Further information: Prophylaxis or early treatment with HCQ

 

Jane M. Orient, M.D. obtained her undergraduate degrees in chemistry and mathematics from the University of Arizona in Tucson, and her M.D. from Columbia University College of Physicians and Surgeons in 1974. She completed an internal medicine residency at Parkland Memorial Hospital and University of Arizona Affiliated Hospitals and then became an Instructor at the University of Arizona College of Medicine and a staff physician at the Tucson Veterans Administration Hospital. She has been in solo private practice since 1981 and has served as Executive Director of the Association of American Physicians and Surgeons (AAPS) since 1989.

She is currently president of Doctors for Disaster Preparedness. She is the author of YOUR Doctor Is Not In: Healthy Skepticism about National Healthcare, and the second through fifth editions of Sapira's Art and Science of Bedside Diagnosis published by Wolters Kluwer. She authored books for schoolchildren, Professor Klugimkopf's Old-Fashioned English Grammar and Professor Klugimkopf's Spelling Method, published by Robinson Books, and coauthored two novels published as Kindle books, Neomorts and Moonshine. 

More than 100 of her papers have been published in the scientific and popular literature on a variety of subjects including risk assessment, natural and technological hazards and nonhazards, and medical economics and ethics. She is the editor of AAPS News, the Doctors for Disaster Preparedness Newsletter, and Civil Defense Perspectives, and is the managing editor of the Journal of American Physicians and Surgeons.

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