So much has happened in 48 hours, that I have to read my last post to remember what life was like then. It seems like just when we have heard something we never thought we’d hear (e.g. a ban of gatherings of 50 or more), we hear something else we never thought we’d hear (e.g. a ban of gatherings of 10 or more and a mandate closing all bars and restaurants in Maine except for takeout and delivery).

I apologize for not being able to respond to the hundreds of questions many of you have asked. I am very busy working at MaineHealth, but am trying to take time every couple of days to post some thoughts on the pandemic as well as to answer some of the question you’re asking. Below are a few questions and answers.

Why aren’t the towns of residence provided for COVID-19 cases?

As the pandemic spreads into Maine, there is some familiarity. Nor’easters most often start along our southern coast, and work their way north. Schools and businesses close, and we all shift into our snow day routine. And although the weather report says it’s snowing in Portland, we know if we live nearby in Westbrook, it’s snowing there as well. Likewise, with the reports of COVID-19 up to 42 in the state (as of yesterday), with over half of them in Cumberland County, everyone needs to assume COVID-19 is where you live too. That is one reason why public health reporting does not usually include the town of residence.

Federal laws require such reporting maintain the privacy of the individual patient, unless there are certain compelling reasons not to. With COVID-19, just like knowing where it’s snowing, we are no more protected if we know the town or street of the patient versus the county. And we still need to hunker down into a nor’easter routine.

Why aren’t child cares closed?

Although school closures are a complicated matter with COVID-19 (as I wrote about last Saturday), day care closures are even more complicated. The main goal of social distancing and closing businesses is to slow this pandemic. Ideally, if we can all hunker down at home, without anyone leaving, we could stop the spread. But people providing services we cannot live without must leave their homes. This includes first responders, health care workers, and people working in grocery stores, pharmacies, and gas stations. If we do not provide child care for those who work in these essential services, how are those services supposed to continue? Hospitals across Maine and the country reported a reduction in workforce when schools closed (which occurred on Monday here in Maine).

The other issue to consider is if children in child care are transmitters of infection across the community. School children are well documented to be major transmitters of influenza across a community. We do not know yet if they are with COVID-19. For most schools, there are usually hundreds of children in one building, all sitting in classrooms of 20 or so students each, switching classrooms every hour or two to co-mingle with 20 other children, congregating in the cafeteria and playground, sitting together on the bus, and generally moving in and about the school all day long. At the end of the day, they’ve potentially exchanged germs with dozens of other students, and then they disperse across the community, heading home to families, transmitting viruses to them, who in turn, disperse in different directions across the community — to workplaces, to grocery stores and other businesses.

By contrast, child care facilities are generally much smaller, caring for a handful to a few dozen children, rather than hundreds. And, children in child care more often spend the day with a small group of similar age children, and do not circulate and co-mingle as widely as school children do. There is little evidence that children in child care are major transmitters of influenza across a community, in contrast to the situation with school children. With COVID-19, even less is known.

So, the issue about child care closing is much more complicated than school closures, especially with known risks to closure (e.g. losing more health care workers and first responders) and very uncertain benefits to closing. At MaineHealth, we have provided this link and other resources to our care team members to find licensed child care providers, and are also giving a new (due to the pandemic) stipend to assist in paying for child care: https://childcarechoices.me/.

Who needs to be tested?

First, there are two major reasons for testing for a novel virus. The first one is to determine if the infection is in Maine so that healthcare systems and first responders can implement their pandemic plans.

The second one is to determine if action is needed for an individual patient. For this first few days of testing being available, both reasons for testing have been active.

However, as test collection materials (e.g. nasal swabs and the liquid the swabs are transported in) and testing kits, or the materials that comprise the kits, become scarce, and with over 1,700 tests having been conducted in Maine in the last 10 days, it’s clear there is a need to narrow the testing. We know COVID-19 is here in Maine, so the first reason for testing is not as compelling.

When community spread was documented through this testing, actions were taken across the state, and pandemic plans were implemented. For instance, elective surgeries and healthcare visits have been postponed to free up our hospitals and health workforce. Hospital incident command systems have been activated. It is unlikely additional statewide actions would be taken based on just testing and identifying more people who are recovering from COVID-19 in their homes.

That leaves the second reason for testing — taking action with individual patients.

For the vast majority of patients with the symptoms of COVID-19 — whether they have COVID-19 or another respiratory virus — the actions are no different. However, for some patients with symptoms, there may be different strategies called for. Those include patients who are hospitalized, who live in a long term care or other senior living facility, who are inmates in a jail or prison, or who live in a homeless shelter or other group setting, since these places are at high risk for outbreaks that need quick public health interventions to prevent or mitigate.

People who are at high risk for severe disease, such as those who are older (60+ and especially 70+) or who have serious chronic medical conditions should be considered for testing, since they may need to be considered for hospitalization. These are some reasons why you’ll see the reasons for testing narrow, likely to those who meet these criteria.

If you’re under 60 and in good health (and not pregnant) and don’t live in a group setting, if you have symptoms, you likely do not need to be tested. Just stay home and follow care instructions as if you had the flu or a similar illness.

Are there any data on the impact of COVID-19 in the U.S.?

Since January, we have been reliant on data from China to make decisions about COVID-19 here in the U.S. Yesterday, data from the first 4,226 cases of the disease in the U.S. were published by the U.S. CDC. (The word “case” refers to someone who is diagnosed with the disease; it is not meant to de-humanize someone, as I and others fully recognize there are real people behind this term.) They report that 31% of the cases, 53% of the ICU admissions, and 80% of the deaths so far in the U.S. occurred among adults ages 65 and older.

Data from China are similar, showing 80% of the deaths there are among those age 60 and older. The new report states that severe illness leading to hospitalization, including ICU admission can occur in adults of any age with COVID-19, though so far in the U.S. those 18 and younger appear to have milder illness, as they did in China. A link to this study is below.

What about the impact of COVID-19 on children?

A new study from China of 2,143 children diagnosed with COVID-19 shows that infants and toddlers are more vulnerable to severe illness, with 11% of infants (birth to age 1) and 7% of toddlers (ages 1 — 5) experiencing severe or critical illness (both categories were hospitalized, with the latter needing ventilator support).

None in these young age groups died. There is a theory that school children’s common and repeated exposure to the types of coronaviruses that cause the common cold may lend some protection to COVID-19. This study from China may add a bit of support to that theory, given that infants and toddlers, who are less likely to be as exposed to cold viruses, seem to be at higher risk for more severe COVID-19. A link to this study is also below.

So, I hope this these answers help a little. I realize we’re at the beginning of this COVID-19 storm, and we all have more questions than answers. But I also know that as this pandemic evolves we’re figure this out, and we’ll do better figuring this out, together.

More information:

Copy the Story Link

« Previous

Wardens find body of missing Kennebunkport man

Next »

Maine coronavirus cases rise to 52; Gov. Mills pushes U.S. for more testing supplies