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Hospitals across the country have seen an uptick in visits from children having difficulty breathing over the past month. The new enterovirus started in the Midwest, but has now spread to 38 states. Though these types of viruses are common, this particular strain has doctors and health officials unsure of what exactly is happening and how to respond. We talk to Dr. Roberta DeBiaisi of Children’s National Health System to find out what we know and what’s next.
- Roberta DeBiasi, MD Faculty, Infectious Diseases, Children's National Medical Center Associate Professor, Pediatrics, George Washington University
MS. CHRISTINA BELLANTONIFrom WAMU 88.5 at American University in Washington, welcome to "The Kojo Nnamdi Show," connecting your neighborhood with the world. I'm Christina Bellantoni, Editor-In-Chief of Roll Call, sitting in for Kojo. Later in the hour, could climate change push local birds like the oriole and wood thrush outside our region? We will talk to the Smithsonian's migratory bird center director to discuss recent trends and bird populations. But first, hospitals around the country are seeing an uptick in visits from children with a new virus.
MS. CHRISTINA BELLANTONIThe CDC, Center For Disease Control and Prevention, says there have been more than 200 confirmed cases across most states in the country. And though the actual number of people affected is probably much higher than 200, the illness has not led to any deaths. And many people are able to recover on their own. Still, the increase in children with more severe symptoms has parents worried. And doctors and scientists are working to figure out what makes this particular strain more severe.
MS. CHRISTINA BELLANTONIJoining me here in studio to discuss is Dr. Roberta L. DeBiasi. She's the Chief of the Division of Pediatric Infectious Diseases at Children's National Health System. Thanks for being here, Dr. Biasi.
DR. ROBERTA DEBIASIThanks for having me.
BELLANTONISo, let's just start with what exactly is the enterovirus and what are you seeing?
DEBIASIEnteroviruses are really a term we apply to a group of viruses and there are literally almost 100 of these. And every year, year in and year out, around this time of the year, we see enterovirus infections. So, this particular strain we're seeing this year is not unusual from the standpoint of it is expected to come around this time of year and cause respiratory and colds and diarrheal type illness.
BELLANTONIAnd what -- there have been more than 200 confirmed cases, but it's been reported in 38 different states, so how many people have actually been affected here?
DEBIASIYeah. It's difficult to know how many people, exactly, are affected. And let me explain that. Every year, when we are in enterovirus season, we keep close track of how many cases nationwide are occurring. But we don't really do specific sub typing to give it the specific number or name of the enterovirus. And the only time that's really indicated and what happened this year was when we see something in the hospital that seems a little out of the ordinary.
DEBIASISo what happened was in Kansas City and Chicago, on top of the usual number of kids being admitted to the hospital with increased respiratory illness, like we always see every year, these kids just seemed sicker. And they seemed to have more of them. So, when that happens, what we do is work closely with our public health departments and our local and county ones. And then move on to the CDC. And the CDC did an analysis and therefore did the more specific testing to give an actual name to this enterovirus. And that's where this enterovirus 68 comes from.
BELLANTONIAnd does it specifically affect children? What are we seeing with adults?
DEBIASIEnteroviruses affect all age groups. So, it is -- enteroviruses, in general, are the most common cause of the common cold or, you know, runny nose, low grade fevers, diarrheal illness. Basically, always in the late summer and early fall and usually they kind of have their 15 minutes of fame and then peter out in the fall before flu season starts. But this particular phenomena that we're seeing where the children are a bit sicker and needing hospitalization is really been confined to the pediatric population so far.
BELLANTONIDo you have questions about the new respiratory illness affecting children across the country? You can join our conversation. Give us a call at 800-433-8850. Send us an email to email@example.com or of course send us a tweet to @kojoshow. We're in studio talking to Dr. Roberta DeBiasi of the Children's National Health System in the Division of Pediatric Infectious Diseases. So there have been some cases, locally, and what are we seeing in the D.C. region?
DEBIASIWell, enterovirus 68 has been confirmed in 40 states out of 50, so it's very widespread, just like we said we would expect, since enterovirus does this every year. We do have it, just like the other 40 states, in Virginia, Maryland, D.C., West Virginia, so right around us here. And in D.C. And we do, indeed, like all other years, have cases of enterovirus disease admitted to our hospital. We are working with CDC like all the other states, to decide if these are specifically the D68 strain or not.
DEBIASIBut on a clinical standpoint, or what does it mean if it is or isn't, it really doesn't change the way we treat these patients. So we are very prepared at Children's National with intensive care unit beds, regular hospital beds, everything we need to take care of patients with any respiratory illness, whether that be mild or severe.
BELLANTONISo your job must really be two fold, educating doctors to make sure they're reporting it properly, so people can start tracking it at the CDC. But then also, talking to parents about what to watch for. So, what advice do you have for parents?
DEBIASII think the most important message is that enterovirus is, if you think about infections in general, kind of like an iceberg. So, the very, very, very tippy, tippy top, that little tiny triangle at the top, are the patients that have the severest disease. And that's what you hear about in the media. But you have to remember that there are lots of kids that just get a common cold and a runny nose and they're gonna be just fine and they're not gonna be admitted to the hospital.
DEBIASIAnd furthermore, if your child gets cold symptoms, don't panic, because they're probably going to be just fine. So, our job is really to tell you what to look for, when should you bring them for other medical attention.
BELLANTONIAnd why is this particular strain different from the common cold that we see every year?
DEBIASIWell, it actually may not be. So, all the strains can cause common colds, including this strain. So what we're picking up on is that little tippy iceberg. So, we're not testing everyone with the cold for this particular strain. Nor does the CDC want us to be sending specimens from everyone with a cold.
BELLANTONIIt's difficult, especially as school season ramps back up.
BELLANTONISo, are there tips that you tell parents to help their kids stay healthy and not spread any sort of infectious disease?
BELLANTONIYeah, and this really applies to all respiratory illnesses, including this one. So, wash your hands, 20 seconds. Sing the alphabet song while you're washing your hand with your kids. Use soap. That's really the best way to avoid infection and spreading a respiratory disease. And in fact, my son, who's in elementary school, actually middle school now, came home and said, mom, what's this enterovirus 68? Because the school told us we better make sure we're washing our hands. So, in a way, it's actually, I applaud the schools, because they're raising attention, you know, for the kids themselves to know that they need to take these precautions.
BELLANTONIWhat about antibacterial wash?
DEBIASIYeah, antibacterial washes that are alcohol based are also useful for these type of viral infections, but the best is the actual wash with soap, whenever you can.
BELLANTONIAnd how do you prevent people from getting over scared about this, to be able to know that they shouldn't panic, necessarily?
DEBIASIYeah, I think it's shows like yours where we can reach a broader audience and let people know that what they hear or read about in the newspapers, of course, the most sensational or the most severe parts of the disease. But the vast majority of cases are not going to be that way. But I think it is important for us to tell you not just wash your hands, but what should you look for? Cause what if your child is one of the unlucky children that gets more severe disease?
DEBIASISo, like all respiratory illnesses, a little runny nose and a cough and a fever is fine. But if your child actually is breathing very quickly, cannot catch their breath, tells you they're having difficulty breathing, if they are a smaller child and can't tell you but they're not drinking as well or eating as well, that is a sign that, you know, they may be having difficulty catching up with their breath. And you can see this. It's not subtle. Parents are very vigilant of their kids and you know, you just need to keep an eye on them.
DEBIASIAnd if you see that they're having any increased respiratory problems, that's the time to let a doctor know or bring them to Children's National. The other thing I was going to say is the kids that have had the more severe disease, two thirds of them have underlying asthma. So, it doesn't mean that if you don't have underlying asthma, you aren't going to get as sick. But, this is a particularly important time for kids who have underlying asthma to be more vigilant about their asthma care for their parents if they start to have an asthma flare to not let it get out of hand, to get on top of it as early as possible.
BELLANTONIYou can join our conversation and ask your own questions of Dr. Debiasi. Give us a call at 800-433-8850. Send a tweet to @kojoshow. Find us on Facebook or send an email to firstname.lastname@example.org. And tell us, at what point do you keep your child home from school? Are you more concerned about your student missing work or other children getting sick? Your student missing school, of course. School, work. So, Dr. Debiasi, when should you keep your child home from school?
DEBIASIAny time your child has a fever or a rash, most schools, and we agree, suggest that you not have your child be at school. The reason for that is that when you have a fever, you're sort of at your peak amount of virus. That you are shedding or excreting from your body. And at the highest risk of transmitting that to other people. When the fever's gone and you're feeling better, you still can be transmitting virus, so you still need to wash your hands and be careful, but the amount of it that you're excreting is much less than when you're in the febrile period.
BELLANTONIWe're gonna get to some callers in a moment, but how are hospitals and emergency rooms handling this influx of cases? You said 40 out of 50 states now.
DEBIASIIt -- we're always very vigilant always, at this time of year, for our bed needs. And what I mean by that is we have meetings on a regular basis to assess how many intensive care unit beds do we have? How many are being filled by certain illnesses, including an illness such as this? We make plans to expand beds into intensive care purposes, if we need to. And we're lucky at Children's National that we have a very large hospital and a lot of capacity that's very dedicated to children.
DEBIASIIf you're in a smaller hospital, a regional hospital that also, you know, kids are a very small part of that hospital, and there aren't many beds, then they will have plans to transfer as needed when they hit a certain number of cases. So, all of the hospitals in the D.C. area are very aware of this problem. We're all working collaboratively and I can assure you we're ready to take care of these kids.
BELLANTONIAnd it's also, of course, flu shot season, so what is your recommendation there?
DEBIASIThe flu shot is available, as it always is every year. It's recommended for everyone, so it's -- over six months of age, that is. But it's really important for everyone to get their flu vaccination. We're all kind of paying attention to this virus, but the next one that comes every year is influenza. So I encourage everyone to get vaccinated.
BELLANTONISo, we have a caller on the line from Columbia, Maryland with a question for Dr. Debiasi. Hi Ralph. You're on the line.
RALPHHi. Thank you. Well, I was just wondering. I spent 17 years in Japan, and one of the things that was very obvious that when the season came around, flu season, cold season, all of this, everybody was wearing these white masks over their mouth and nose and covering it up. And there was no stigma about that. It's just very common practice, people protecting themselves. Or people who actually have a cold or something so they can get around and without infecting other people, or at least to a lesser degree.
RALPHSo I'm wondering why we don't encourage that. Why we don't build a culture to do that kind of thing?
BELLANTONIThanks for your call, Ralph. Dr. Debiasi.
DEBIASIIt's an interesting comment. Probably more of a sociology question. Another interesting thing in Japan is you'll notice that when they greet people, they don’t shake hands. And that's probably, actually more effective in limiting the spread of infection than the mask part. So, they'll have a very cordial way to greet people when you meet them, but it doesn't involve actually physically touching their hand and shaking it. But your question about masks.
DEBIASIYou know, another thing that's different about some of the Asian countries that implemented this is they have much more dense population. So, most of these respiratory viruses are spread after you're at least three feet, within three feet of someone. And, you know, if you take a kind of slice of the United States and a slice of some of these Asian countries, it's a lot easier to stay three feet away from someone and more common too than if you're in a dense metropolitan area, so that may be part of the reason.
BELLANTONIAnne from Alexandria, Virginia. You're on the line. Thanks for calling.
ANNEYes. Hi. I had a quick question. My son just got over this virus and I was wondering how long I would have to wait until giving him the flu shot.
BELLANTONIThanks for calling, Anne.
DEBIASIYeah, there's no reason to delay the influenza vaccination if you have a child who's recently had any other viral illness. It's -- the flu vaccination is safe to give despite any other recent viral infection.
BELLANTONIWe also had an email to email@example.com with someone asking, "What are the symptoms in young children and the pre-kindergarten to kindergarten age?" They're the same for everyone, it sounds like, right?
DEBIASIYeah. They would also, in the mild form, maybe have a runny nose, clear nasal discharge, maybe a little bit of fever or maybe not. But the warning symptoms, if they were getting into trouble in a smaller baby would be breathing very rapidly, any change in the color of the skin, bluish tint or blue lips or not being able to eat. You know, because babies, they're pretty good at eating that bottle or the breastfeeding.
DEBIASIAnd if you see a difference that it's slacking off or that their urinary output is decreasing, they're not peeing as much, the diapers are not wet, those are all signs that maybe they're having difficulty breathing.
BELLANTONIWe have Allison from Washington, D.C. Allison, you are on the line. Thanks for joining us.
ALLISONHi, thanks. I was wondering how quickly you're seeing symptoms get worse going from looking more like a cold to hospitalization? And in particular, recommendations for parents. I have two young sons who are -- don't have asthma officially yet but have already had wheezing episodes and spent some time at Children's Hospital before.
DEBIASIYeah, I don't think there's a one size fits all question. And we don't -- to be honest, we don't have a broad amount of data from the CDC looking at specifics as how many days it took for them to progress to hospitalization. But in general, if we extrapolate -- you know, all kinds of viral infections, as I'm sure you know, can exacerbate asthma. And in general, it usually occurs within that first week that they have their viral infection that the asthma starts to get revved up. So it's not, you know, something that happens two, three weeks later.
BELLANTONIAny final tips you would have for our listeners just on things to watch out for and what their first call should be, should it be to their doctor or should they just go straight to an emergency room?
DEBIASIYeah, I think, you know, the things we've talked about to stay calm, keep this in perspective but still be vigilant for your particular child. If it looks like they're getting into any kind of respiratory trouble for -- if it's common cold symptoms, you're going to stick with what you usually do, keep them home if they have a fever or a rash, make sure they stay hydrated. If they -- if you feel that they're getting into difficulty, your primary doctor is always the best place to start. But if it's after hours or if you think things are escalating, we are available at Children's to take your call directly.
BELLANTONIWell, thank you very much. A very interesting conversation about enterovirus with Dr. Robert L. DeBiasi. She's the chief of the Division of Pediatric Infectious Diseases at Children's National Health System. Thank you very much for joining us. I'm Christina Bellantoni, guest hosting for Kojo Nnamdi. And we'll be back after a short break.
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