Page 32 - IMCJ April 2020

3.3%. BUT – let’s take a look at South Korea. In South Real-Time Reverse Transcriptase (RT)-PCR Diagnostic
Korea, of the currently 7,869 people who have tested Panel.” In the US, these test kits are NOT available
positive for 2019-nCoV after testing 100s of thousands or currently through doctor’s offices, community clinics, or
people, 6 have died: hospitals (i.e. I do NOT have test kits). The CDC has
That’s a 0.8% mortality rate – much lower than the begun rolling out test kits to certain state public health
2-3.5% mortality rate that is currently being reported in departments, including California and hospital labs and
the news. In an editorial written by Dr. Anthony Fauci, MD commercial labs like Quest and Labcorp have already
director of the National Institute of Allergy and Infectious rolled out their testing. BUT, there are still not enough
Disease, he writes: “If one assumes that the number of testkits to test every patient with fever and upper
asymptomatic or minimally symptomatic cases is several respiratory symptoms. There are not enough nasal swabs
times as high as the number of reported cases, the case and “V-C-M” media for community clinicians like me to
fatality rate may be considerably less than 1%.” 33 test possible cases, and sending nasal swabs to Quest or
Note that even 0.8% is still significantly higher than Labcorp have the further difficulty of needing to be sent
the estimated 0.1% mortality rate from influenza. No on ice.
death is to be taken lightly, and my heart goes out to those Currently, the recommendations are to test patients
who are suffering tragic losses. But before we accept the with fever and lower respiratory symptoms (cough or
high reported mortality rate and succumb to the rapidly shortness of breath) who have had close contact with: 1) a
worsening hysteria and potential worldwide economic person with confirmed COVID-19; or 2) history of travel
collapse, we need REAL NUMBERS. I urge policymakers from affected geographic areas with 4 days of symptoms;
to quickly develop more widespread and rapidly available OR anyone with severe acute lower respiratory illness that
testing capabilities, not simply to quarantine those who requires hospitalization and does not have another
are infected, but to shed real light on the gravity of the diagnosis like influenza, even without any known source
situation and help the public, clinicians, public health of exposure. Remember, the CDC defines close contact as
departments, and businesses be calmly and rationally being within 6 feet or within a room or care area for a
prepared. prolonged period without personal protective equipment
That being said, we certainly do not want to take any OR having direct contact with secretions of a person with
deaths lightly. Certain populations do seem to be more at COVID-19 infection.
risk for serious infection and for death. Increasing age This is the protocol that was emailed to me by my
seems to be the most important factor, and as mentioned local health department :
8
above, children appear relatively spared. In a report
released by the Chinese CCDC on February 17, 2020 in The CDC also recommends that providers test for other
the Chinese Journal of Epidemiology, the risk of death respiratory pathogens, like they would as part of their
increases with age, with being over 80 the highest risk usual workup for anyone who comes in with fever, runny
factor. The fatality rate of patients over 80 years old was nose, and cough – like the flu! Because let’s face it, we’re
estimated to be 14.8%. Death in those under 50 appears to still in the middle of flu season, and …
be unlikely, with the mortality rate of 40-49 year olds
estimated to be 0.4% and 0.2% for patients 10-39 years of If you or your child have cold or flu symptoms,
age. As noted above, there have been NO deaths in there is a good chance that your child has a cold or the flu!
children 0-9 years old. Having a chronic, pre-existing
medical condition also significantly increased the risk of As we begin to see more domestic spread of COVID-19
death. Without any pre-existing condition, the mortality in the United States, please …
rate was 0.9%. A history of cardiovascular disease increased
the risk to 10.5%. 7 Do NOT rush to your doctor’s office or hospital to get
So like the influenza virus, the elderly and those with tested at the first sign of fever or cough unless your
underlying chronic medical conditions appear to be most health is declining and you need urgent medical
at risk for serious complications and death from COVID- attention.
19. However, unlike influenza, children so far appear to be
relatively protected. Your doctor or emergency department likely has very
limited capability to test for COVID-19, and going
How and who do you test for COVID-19? unnecessarily to the doctor’s office or emergency
COVID-19 is detected by testing nasopharyngeal department may inadvertently expose you or your child
swabs (basically a q-tip up the nose), oropharyngeal swabs to COVID-19 or other infections and likewise expose
(a throat swab), and sputum for genetic material of other people to whatever illness you may have. Many cases
COVID-19 by polymerase chain testing (PCR). The test of COVID-19 in China are likely due to uninfected people
kit is called the “Centers for Disease Control and becoming infected after exposure while waiting in long
Prevention (CDC) 2019-Novel Coronavirus (2019-nCoV) hospital and clinic lines to be tested. The California

30 Integrative Medicine • Vol. 19, No. 2 • April 2020 Song—Coronavirus Pediatrician's Perspective