What Parents Should Know About the Novel Coronavirus and the Flu

The outbreak of a viral infection known as COVID-19, caused by a newly discovered coronavirus, is dominating the news, and governments, public health experts, and doctors are preparing for a growing number of cases around the world and in the United States.

The possibility of a coronavirus outbreak in the New York region, as well as the seasonal outbreak of the flu, pose special concerns for children. “There is a lot of anxiety out there and a lot we don’t know,” says Roberto Posada, MD, a pediatric infectious disease specialist in the Jack and Lucy Clark Department of Pediatrics at Mount Sinai Kravis Children’s Hospital and an Associate Professor of Infectious Diseases, and Medical Education, at the Icahn School of Medicine at Mount Sinai. “Fortunately we are learning from cases in China that most children don’t seem to get very sick from the coronavirus. But we also know that youngsters are one of the ways that viruses travel from one household to another.”

In this Q&A, Dr. Posada offers some basic advice for parents in the New York area.

What general advice do you have for parents who may be worried about their children?

The most important prevention strategy is to get your flu vaccinations. It’s not too late, and every child should be vaccinated every year. We are still seeing a lot of cases of the flu in the community, and some of these children need to be hospitalized. With all viruses in general and with respiratory-borne illnesses, everyone should wash hands frequently, with soap and water or with an alcohol-based sanitizer—especially before eating, after blowing your nose, and after entering your home from the outside. There is no difference between soap and water and a hand sanitizer when it comes to most viruses. Soap and water is preferable for eliminating gastrointestinal pathogens—infectious agents like viruses and bacteria that cause disease in your digestive tract—so that’s best after using the bathroom.

Also, teach children the proper etiquette for coughing or sneezing. They should use the inside of their elbow or blow into a tissue, and then wash their hands.

Are kids more at risk from viral outbreaks generally?

Kids tend to get more viral infections than adults, partly because their immune systems are not fully developed. How sick they can get depends on their age. Kids less than two years old are at higher risk for many infections like the flu.

How much of a risk does the coronavirus present for children?

We know from the data so far that the coronavirus seems to result in a very mild infection for children. Most of the patients that have been hospitalized or have died are older adults. Also, it is important to note that about 80 percent of people who have gotten the coronavirus experienced a very mild illness and did not need to be hospitalized. Unfortunately, about 20 percent of infected people develop more significant disease, and about 1 to 2 percent of all of those infected have died, again most of them older adults.

Should parents keep children out of public spaces, maybe off the subway?

At this time, I would suggest people in the United States go about life as normal, so long as they are washing their hands frequently. For example, if you take the subway or public transportation, or if you have been around people who are coughing or sneezing, it’s a good idea to wash your hands. Avoid as much as practical being in close proximity to people who are sick. You should also follow the news, as the recommendations from public health officials may change rapidly depending upon the cases we see. As always, the Centers for Disease Control and Prevention (CDC) and your local health department are the best sources of information.

The CDC recently said that if a widespread outbreak occurred in the United States, schools could be closed. Why is that an effective step?

If public health officials see the virus is spreading fast, and believe schools may be playing a role in facilitating the spread of the illness from household to household, closing of schools may be warranted.

How do children help transmit viral infections?

What happens with the flu or any virus is that young children pass them to their classmates. Young people are in such close contact with each other, especially if they are at day care, and it’s not uncommon for their saliva or mucus to mingle. They share toys, maybe even eating utensils. When kids get sick with an infection, they can pass the causative virus or bacteria along to other kids, and those kids then can bring it to their parents. That is how an illness crosses from one household to another and contributes to the spread of the viral infection.

Should we wear face masks?

At this point we are not recommending you or your children wear face masks to avoid getting sick. Face masks are mostly for health care workers who are in close proximity with people who are sick. And it can be helpful if someone who is already sick wears a face mask when in public spaces to prevent infecting others.

When should parents call the pediatrician if their child is sick?

My recommendations for the flu and other viral infections is the same as for illnesses in general. If your child’s symptoms are mild and in the respiratory tract, like a runny nose and sneezing, and if they are continuing with their other normal activities and these symptoms have lasted less than 24 hours, I would not worry or call. But if symptoms last more than 24 hours, if children also have a cough and fever, if they are not eating or drinking enough, and if they are disinterested in normal activities and look tired or sleepy, I would call your pediatrician. And let your pediatrician know if there is any history of travel or interactions with people who have been sick.

What You Need to Know About the Recent Novel Coronavirus Outbreak

A newly identified coronavirus now known as COVID-19 was first recognized in Wuhan, China, in early December 2019 and is rapidly spreading throughout the world.

Bernard Camins, MD, MSc, Medical Director for Infection Prevention for the Mount Sinai Health System, offers some basic guidelines for understanding this latest health concern. You can also get up-to-date information from the Centers for Disease Control and Prevention (CDC).

 

Who is most at risk?

According to the CDC, those at the most risk include: people in places where ongoing community spread has been reported and people  who have had close contact with those who have COVID-19. In addition, people who recently traveled to an area where cases of COVID-19 are occurring are most at risk, and they should consult their doctor or the CDC for the latest information. The CDC maintains a list of countries with significant COVID-19 cases.

What are the symptoms?

Symptoms have included mild to severe respiratory illness with fever, cough, and difficulty breathing. The symptoms usually begin within two to three days of exposure but could take as long as 14 days to develop. These symptoms are also typical of the flu and other seasonal viral illnesses, and if you have symptoms like these and you have not traveled to an area with COVID-19 cases or been in close contact with someone who has, you probably have a seasonal illness and not the novel coronavirus.

What if I recently traveled to an area with COVID-19 cases and now have symptoms of a respiratory illness and/or fever?

If you feel sick with fever, cough, or difficulty breathing within 14 days after you return to the United States, you should seek urgent medical care. However, before going to your doctor’s office, an urgent care center, or an emergency room, call ahead and alert the staff about your recent travel and symptoms.

Avoid contact with others. Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing. Frequently wash your hands with soap and water for at least 20 seconds to avoid spreading the virus to others. Use an alcohol-based hand sanitizer if soap and water are not available. As soon as you arrive at the medical facility, let a staff member know about your symptoms and travel history.  You should be provided with a mask and moved to an area away from other patients.

How is coronavirus spread?

There are many types of human coronaviruses, including those that cause the common cold. They typically spread from an infected person through the air in tiny droplets produced when coughing or sneezing. These droplets, when they come into contact with another person’s mucous membranes (e.g., mouth, nose, or eyes), can lead to infection. The virus can also be transmitted if you touch a person, an object, or a surface on which the virus has settled and then touch your mouth, nose, or eyes before washing your hands.

How can I protect myself?

As with other respiratory viruses, you can protect yourself from infection through frequent, proper hand hygiene, either with an alcohol-based hand sanitizer or with soap and water. Also, practice proper respiratory hygiene by covering your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.

How is Mount Sinai prepared to treat infectious diseases?

For a long time, Mount Sinai has been developing procedures to make sure that people arriving for care at our facilities are quickly screened for infectious diseases. This includes questioning people about whether they have traveled abroad in the last three weeks or come into contact with people who are traveling abroad. Our procedures enable us to quickly isolate any possible cases of infectious disease.

 

Bernard Camins, MD, MSc, is Medical Director for Infection Prevention for the Mount Sinai Health System.

How Important Is Getting the Flu Shot?

Despite all the media attention about the novel coronavirus, now known as COVID-19, influenza is currently a much bigger risk for most people in the United States. Yet many people do not plan to get a flu shot this year. You may be busy, or perhaps you think you might get sick from the shot, or that it’s not necessary. Matthew Weissman, MD, MBA, a primary care doctor with the Mount Sinai Health System, explains why you shouldn’t put it off.

Why should I get the flu shot?

The flu shot is extremely important. It not only prevents you from getting sick from flu, but it can lessen the severity of flu even if it’s not a perfect match for the type that is going around. For instance, my own daughter got the B strain of the flu. Luckily, she had a much milder case of it because she got the shot.

People forget that the flu is a deadly disease. Each season, tens of thousands of people die from the flu, and hundreds of thousands are hospitalized, according to the Centers for Disease Control and Prevention (CDC). Most of the people who died were not vaccinated. If you’re overweight, pregnant, elderly, or a child, or you have other diseases, you’re in a high-risk category. When you add all those up, you’re talking about a wide swath of New Yorkers.

Keep in mind that the flu shot doesn’t just protect you; it protects your co-workers, your classmates, your parents, and your grandparents—including people whose immune systems may not be good enough to build up their own defenses. It’s like a ripple effect, or herd immunity. It would be a great idea to have a workplace event for people to get vaccinated. It’s a smart idea for businesses to help cut down absenteeism this way.

Some people don’t get the shot because they think they’re going to feel sick for a couple days. Is that true or a myth?

People’s responses vary. Some people do feel a little feverish, get a sniffle, or have a sore arm for a bit. That’s actually a good sign, because it means their immune system is revving up to combat the flu. I think that’s a fair price to pay for not being incapacitated for over a week or being at risk of death from a vaccine-preventable illness. And these side effects don’t happen to everybody, and it doesn’t happen every time.

People have all kinds of excuses why they can’t get the flu shot. People are sometimes worried that the shot may cause a bad reaction because they have an egg allergy. But there are lots of ways to deal with that, including some vaccines that were not created using eggs. People should ask their doctor to find out what’s right for them.

Bottom line, the benefit of the flu vaccine outweighs the risk for most people, by far.

Is it too late to get a flu shot this season?

Definitely not. Flu season doesn’t appear to have peaked yet.  The flu season is generally during fall and winter. The CDC recommends that everyone six months or older get the flu shot. You can get it any time up until spring, so don’t wait.

Matthew A. Weissman, MD, MBA, is Chair of Medicine at Mount Sinai Downtown and Associate Professor of Medicine (General Internal Medicine), and Pediatrics, at Icahn School of Medicine at Mount Sinai

Renowned Microbiologists Explain the Coronavirus

The novel coronavirus is transmitted through the air and replicates in the respiratory system and in blood.

The novel coronavirus that began in Wuhan, China, has been labeled a Public Health Emergency by the U.S. government. As confirmed cases of the coronavirus now known as COVID-19 continue to increase in this country and around the world, and additional information unfolds, two renowned microbiologists at the Icahn School of Medicine at Mount Sinai, Peter Palese, PhD, and Adolfo García-Sastre, PhD, recently provided insights into the disease. Dr. Palese is the Horace W. Goldsmith Professor and Chair of the Department of Microbiology, and Professor of Medicine (Infectious Diseases); and Dr. García-Sastre is the Irene and Dr. Arthur M. Fishberg Professor of Medicine (Microbiology, and Infectious Diseases), and Director of the Global Health and Emerging Pathogens Institute.

What is COVID-19?
Dr. Palese: It belongs to a group of viruses known as coronaviruses, to which the SARS (severe acute respiratory syndrome) virus and MERS virus (Middle East respiratory syndrome) belong. It is transmitted through the air and replicates in the respiratory system and in blood.
Dr. García-Sastre: The COVID-19 and the SARS-CoV are closely related and they originated from bats. In the case of the COVID-19, we are not yet sure of its precise origin—whether the virus went directly from bats to humans or whether it went from bats to a host animal and then to humans, which is what happened with SARS. But we believe it originated from bats.

The SARs outbreak in 2003 is different from the novel coronavirus in that it was traced to civet cats and raccoon dogs, which were eaten as a delicacy in some parts of China. The animals were originally infected by bats—either through bites or by breathing in bat urine and feces. MERS, a respiratory illness relatively new to humans and traced to the Arabian Peninsula, is believed to have been spread by camels that were also infected by bats.

How did this novel coronavirus start?
Dr. Palese: Samples of the virus were found in a large fish market in Wuhan where other live animals are kept in cages and sold as food.

Dr. García-Sastre: People went to the market to buy food and were exposed to the virus, which infects through the respiratory tract. Like the flu, it is spread by aerosols.

What are the most important factors to consider as the disease unfolds?   
Dr. Palese: The reproduction number, or “R” number, appears to be around 2.5. That means every person who is infected will pass the disease on to 2.5 other people. The influenza virus is a little lower. Measles has a much higher R number of about 18. These are averages. But we have to be vigilant. There are reports that the disease can be transmitted for about 24 hours before symptoms develop. If that is confirmed, it would make it more difficult to contain. The disease caused by the novel coronavirus is accompanied by flu-like symptoms, including very high fever. Fatalities stem from pneumonia and comorbidities, such as old age, asthma, or chronic obstructive pulmonary disease.
Dr. García-Sastre: Don’t panic. The virus does not seem to be associated with very high mortality. It is progressing more quickly than the SARs virus did, but it also appears to be less deadly. The rate of transmission appears to be similar to that of the seasonal flu. That is an estimate because we don’t know for sure whether all of the people who have the disease have been diagnosed. Some may have very mild cases. Another consideration is at what moment does an infected person begin to transmit the virus? With flu, people can transmit the disease before there are symptoms. With SARS, most transmissions happen after there are symptoms.

Are vaccines available?
Dr. Palese: Our government is rapidly developing vaccines and they are in the pipeline, but nothing has been approved as of today.
Dr. García-Sastre: Vaccines may be first available only on an experimental basis.

 

Universal Flu Vaccine Moves Closer to Fruition

Mount Sinai scientists, from left, Peter Palese, PhD; Florian Krammer, PhD, with a 3D model of the influenza virus hemagglutinin; and Adolfo García-Sastre, PhD.

The quest to develop a universal influenza vaccine that would be administered only once or twice in an individual’s lifetime and cover every strain of the virus moved closer to becoming a reality in October, when researchers at the Icahn School of Medicine at Mount Sinai showed that a novel method of protection against the influenza virus was safe and induced strong immune responses in humans.

The interim results of this phase 1 clinical trial—led by Mount Sinai scientists Florian Krammer, PhD; Peter Palese, PhD; and Adolfo García-Sastre, PhD—were published online in the October 17, 2019, issue of The Lancet Infectious Diseases.

Two types of proteins, hemagglutinin and neuraminidase, cover the surface of the influenza virus. Current influenza vaccines target the head of the hemagglutinin—a structure that changes often. Mount Sinai’s strategy, known as chimeric hemagglutinin (cHA), targets the stalk of the hemagglutinin, which is less variable.

In the Lancet Infectious Diseases study, the research team tested several cHA vaccine regimens in combination with an adjuvant, an ingredient that boosts the immune response to vaccines. All of the regimens induced antibody responses. But, “one vaccine regimen induced a broad antibody response after the first dose, and this response was not only cross-reactive for the currently circulating influenza virus but also to avian (bird) and bat influenza subtypes,” according to Dr. Krammer, Mount Sinai Professor of Vaccinology and Professor of Microbiology at the Icahn School of Medicine at Mount Sinai.

This, he says, showed that one vaccination might be enough to induce protection against changing seasonal influenza viruses and pandemic influenza viruses yet to arise. “The results indicate that we are moving toward a universal influenza vaccine, but these are still interim results.”

Dr. Palese, Horace W. Goldsmith Professor of Medicine, and Professor and Chair of the Department of Microbiology at the Icahn School of Medicine at Mount Sinai, says the “ideal vaccine, given only once in a lifetime and protective against all influenza virus strains,” would go a long way in improving the health of millions of people in the United States and around the world.

A universal vaccine would overcome “antigenic drift,” the small changes in the genes of influenza viruses that render viruses different from one another and allow them to escape human immunity. This is the primary reason why influenza vaccines vary in effectiveness from one season to another and must be updated every year.

Still, influenza vaccines do offer protection from severe disease and physicians strongly recommend that patients get them annually. Despite their widespread availability, however, more than half of Americans were unvaccinated as of the beginning of December 2019, according to NORC at the University of Chicago, which conducts the National Immunization Survey for the U.S. Centers for Disease Control and Prevention (CDC).

Influenza remains deadly for some. The World Health Organization estimates that influenza-related respiratory illnesses account for between 290,000 and 650,000 deaths per year. Dr. Krammer says, “Developing new vaccines takes a lot of time and it’s hard to estimate how long it will take, but I firmly believe we will have a universal flu vaccine in our lifetime and probably sooner.”

In addition to Dr. García-Sastre, a co-senior researcher on the Lancet Infectious Diseases study, and the Irene and Dr. Arthur M. Fishberg Professor of Medicine, and Director of the Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, contributors included Cincinnati Children’s Hospital Medical Center; Duke University School of Medicine; the University of Chicago; and the nonprofit international health organization PATH. Funding was provided by a grant from the Bill & Melinda Gates Foundation.

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