Carey Chronis, MD, FAAP

New Normal: The R number & Social Distancing It’s a beautiful day and everyone wants to get out. But what’s that inner voice telling you? That annoyingly rational part of your brain is probably saying, Toto, I’ve a feeling we’re not in Kansas anymore. And despite the images of protest that are a result of understandable pent-up frustration coupled with economic concern, we know we need to proceed with caution. With that said, what’s with the R number and how long will soc...ial distancing be a part of our life? Reproduction or R number is a measure of how likely an infected person will spread a disease to another person. A number above one means a disease is spreading, whereas a number below one means the disease is fizzling. This isn’t a static number and our behavior can alter the infectiveness of a virus. Without any precautions, face masks or social distancing, SARS-CoV-2 has a presumed R number ~2.5-3. For reference, influenzae hovers ~1.3. But with social distancing, we can reduce the R number to below 1. Seems simple, right? Not so quick. The R number will vary from city-to-city, among subgroups of people within cities depending upon their behavior, and likely from other environmental factors beyond our control. This is why modeling and predictions are so difficult and why naysayers have an audience. Where does that leave us? Unfortunately, this leaves us with adopting social distancing as a standard and utilizing a face mask when distances cannot be maintained. Until an effective vaccine is available, it seems likely this will be the new normal. In the coming months as business start to reopen, the peak season for this virus will abate, fear will reduce and I imagine a fair number of people will disregard the new standard. As we resume our lives, those who persist in implementing precautions should take comfort in knowing that we are doing our part in keeping that R number low and our immediate risk can be minimized even if the R number should creep up. Our microenvironment of safety is our best defense. In the meantime, let’s hope there is a vaccine under the Christmas tree.

Contradictory Science, Basics Truths and a Clean Garage Watching public health officials attempt to formulate policy and make predictions in real-time is dizzying. The scientific world is based on formulating a hypothesis, performing testing with adequate controls, reaching a conclusion, and at times having that conclusion scrapped only to start the entire process over. This laborious process doesn’t sit well with everyone waiting patiently at home for an immediate answer. Gr...aduate students will make a carrier from the data collected during this current event. For the rest of us, the goal is to regain a new normal, both quickly and safely. Fortunately, our community and patients at our office have been resolute and supportive. It’s nice to see everyone working together and lending a hand when able. Our office has remained open and available. We have separated well children from others and sanitize our office on a continual basis. Telehealth visits and pre-telehealth physicals are being booked when necessary. Parents understand the need for well child checks and staying current with vaccinations. Many communities are reporting that children are not getting proper care and are now behind in immunizations. Our goal is to make sure this doesn’t become a problem for our patients. As for what to expect with regard to COVID-19, we too wait patiently for news. Hopes of an effective treatment and an effective vaccine rest on the scientific method playing out. Again, this is a process that takes time. As this virus transitions into a dormant phase, we will welcome the gradual easing of restrictions. Soon, we will all be facing the world with a clean garage and the desperate need for a haircut. Cheers to a flattened curve.

Are you suffering from Mask Confusion? The CDC (and much of Europe) have changed their recommendation, although the World Health Organization has not jumped onboard. Why can’t the medical community get their act together? The answer is simple. No large-scale, definitive studies have been conducted to look into the effectiveness of porous masks in reducing the spread of disease. Will the masks reduce the distance droplets travel should you cough? The logical answer is yes. Thu...s, if you have a virus, you may prevent the spread to someone who is standing nearby. But what if you don’t have coronavirus? Will a mask protect you? Not likely. Plus you may be at a greater risk because the temptation of touching your face when wearing a mask is increased. Furthermore, if your entire face isn’t shielded, the virus can still be transmitted to you. Even N95 masks are not fullproof, but they are much better at preventing the passage of viruses than any face protection. So where does this leave us. Basically, the best protection currently is to wash hands frequently and when out, maintain a distance of at least 6 feet from the nearest person. If you choose to wear a cloth mask, it only needs to be worn when you are out and close to others. The mask should be kept dry and change frequently. Wash your cloth mask and try not to touch your face when adjusting it. As for wearing N95 masks when going out, the CDC has not jumped on board with that idea. Those masks are in short supply, they are uncomfortable, proper fitting is important, and they too need to be changed frequently. We simply don’t have enough to make that a worthwhile option. We appreciate the effort everyone is making to stem the effects of this virus. Stay safe. Our office is here for you.

It is difficult to compare what we see from what we have previously experienced. A show of hands by all who have previously witnessed such a global phenomenon brings to light the uncharted territory confronting us. Fortunately, we are resourceful, innovative and will quickly learn to adapt. Conversations with parents whom have had to come to our office have been very uplifting. One mom recently shared how she has found a lot of positive in the time she has spent at home. She ...has two younger children and shifted her attention to engaging, spending meaningful time playing with them and watching her children learn. For those who are working at home, this situation shatters the illusion that family responsibilities disappear when we are at our day job. When two parents are available at home with children present, some have found it useful to divide their time. For instance, at certain hours, one parent is responsible for attending to their children’s needs. At other times, the other parent becomes the point person. How this is divided can vary, but the end result is allowing each adult ample time to concentrate on work while children are clamoring for attention. This is also an opportunity to rethink learning and education. The goal isn’t to replicate the school classroom at home. Focus more on setting a routine and making learning fun. This can occur indoors or in your backyard. Basics such as cooking, cleaning and crafts can be very educational. Any room in the house and all mediums of communication are fair game. Be creative and use this time to teach independence. As for one’s own sanity, limit your time to twice each day when you check to see what is happening in the news. For the remainder of your time, rely on relaxing music and home conversation to create a sense of calm. The manner in which we confront high levels of stress are not lost upon little eyes. Creating a calm and comfortable environment benefits all.

Received the nicest note today. Thank You. Dr. Chronis

After a week of speaking with concerned parents and allaying fears, weekends are a good time to reflect and put everything into perspective. It’s difficult to grasp the enormity of this situation and the degree to which the world has changed overnight. From a health perspective, let’s look at short-term goals and long-term expectations. It’s important to put this part in check as we deal with the stressful economic and social aspects of current events. From smallpox and polio... to measles and pertussis, societies have had to cope with diseases that profoundly affect lives. What’s different today is our ability to detect and quickly communicate events as they happen around our planet. We see the virus spreading and know it will likley touch our community. We also know that a large number of cases all at once can quickly put a strain on resources. Thus, bringing into play the goal of short-term measures. In the short-term, we are simply trying to reduce the number of serious coronavirus cases in a community, helping to prevent our healthcare system from being completely overwhelmed. Such isolation allows the virus to run its course in whomever is infected and also hopefully preventing the spread to those with whom complications would be more serious. With schools and daycares, we pretend to keep others healthy by keeping our child out of such surroundings up to 24 hours after a fever has resolved. Current measures highlight what is really necessary to prevent the spread of disease and why, short of washing one’s hands, most health measures we have taken in the past are of limited effectiveness. An unfortunate consequence of implementing such imposing short-term restrictions is heightened fear and panic. With time, we will realize that the fundamentals of who we are have not change and such anxiety will diminish. Long term, once we get past the initial peak in cases and until a cure is found, this virus will be part of our society. This doesn’t mean quarantine for life, but it does mean slowing down and taking care of ourselves when we are ill. As with influenzae and the common cold, hopefully we will develop a respect for the power of viruses without being completely fearful. Hopefully too we will develop a vaccine in short order. In the meantime, it’s a good time to reflect on our lifestyle and make changes designed to promote healthy habits. Basics such as exercise, hydration and proper nutrition are key and probably deserve a reassessment for most of us. Reflecting, decluttering, taking control when possible, and letting go of what is out of your control all play a part in reducing stress. Relax, take a walk and let’s strengthen up so we may tackle the week ahead.

Let’s talk Coronavirus. I’ve fielded a large number of calls from parents who are rightly concerned about the recent spread of coronavirus. With the understanding that that landscape is changing rapidly, let’s try to make some sense of this. WHAT IS CORONAVIRUS?...Continue reading

Happy Halloween!!!! From our superheros to your superheros.

I spoke with the Health Department today regarding a current case of meningitis in our community that was caused by Haemophilus influenzae type b (Hib), which is a potentially serious vaccine-preventable disease. Most people are vaccinated against Hib at the 2-month, 4-month, 6-month and 12-month well child visits (depending on the brand of vaccine used). The exposure took place at Coastline Bible Preschool. I was advised by the Health Department that the only precaution pare...nts need to take for their children who may have been exposed is to watch for signs and symptoms of meningitis or serious bacterial infections, including fever, chills, stiff neck, headache, nausea, vomiting and sensitivity to light. Such findings should prompt immediate medical attention. As long as your child is current on vaccines, especially the Hib vaccine, the risk from exposure (at this time) is minimal. In the rare instance that multiple children at this preschool or in the community become ill from this disease, recommendations from the Health Department regarding preventive measure may change. Should the recommendations change, I will update this post.

Our office has received many phone calls concerning possible exposure to tuberculosis. What we know and what to do: 1. Nearly 300 people at Rio Vista Middle School were possibly exposed to a person who had tuberculosis. The exposure occurred sometime between March and June. In addition, a second exposure during the same time frame occurred at 24 Hour Fitness at the Collection in Oxnard. The exposure has since passed and both facilities are safe to visit. 2. The Ventura Count...y Department of Health is determining which individuals should be tested for tuberculosis. They will contact people who they consider at risk. For questions about this process, call the health department directly at (805) 385-9444. 3. A person who has been exposed to tuberculosis may be completely asymptomatic, but still have the disease. People with active tuberculosis typically experience coughing, fever and night sweats. Such individuals are typically very weak and will lose weight because of the illness. 4. Our office has received many requests for tuberculosis testing. Because the incubation period for tuberculosis is up to twelve weeks, testing right now may not be sufficient. If you are concerned about your child being exposed to tuberculosis, but they are not displaying active signs of tuberculosis, the ideal time for testing would be right after Labor Day Weekend (the first week of September). If you feel the chance of exposure was very high, we can test now, but we should still repeat the test during the first week of September. Please contact our office if you have further questions. (805) 642-4704

Well wishes to all the families devastated by these wicked fires. For those families not evacuated and those who are unable to leave the area, staying inside and minimizing activity is best until the smoke dissipates. Ventura residents are advised to heat water to a rapid boil for 1 minute before using it for drinking or cooking although in this situation, bottled water would be best. The community support has been amazing. Thanks to all the Firefighters and Volunteers who have stepped up to help their neighbors.

Happy Halloween!!!!

Flu vaccine is here and we already have hints this year will be significant for influenzae. Although the medical community is notoriously bad at predicting the extent of any given flu season, our season often mimics that in Australia. For them, the number of cases is over double previous years and this years vaccine is very effective against strains of influenzae Australia is experiencing. Hopefully that’s enough incentive to bring your child in for a vaccine. See you soon.