The Great Realisation

What more can be said? NY State is seeing declining numbers of hospitalizations and deaths. I don’t think you can draw any conclusions about positive tests since the more you test, the more you will diagnose. Actually seeing the number of cases rise but hospitalizations fall suggests that there can be mild illness. But cases across the US are rising. We need to continue to listen to the recommendations of the experts. Social distancing and staying home has worked. This is not over. 

However on a different note, a friend forwarded me a link to an extremely well done, touching video.   The Great Realisation.

2 Months and Counting

NY state diagnosed its first case of COVID-19 61 days ago.  But, looking at some of the flu like illness we saw in January and February that tested negative for influenza, chances are the virus has been here for a longer period of time.  61 days of “NY on Pause” is beginning to try some peoples’ patience. We are all eager to start getting back to “normal” (which is going to be a “new normal.”) We read about other states opening back up and become impatient.  Please do not rush things.  The number of new cases of COVID-19 in NY is down to 933 yesterday (still almost 1000 new cases in 24 hours) and deaths are down to 306 (still a large loss).  Other states that have opened back up are still seeing the number of cases rising, not falling. What is the logic in that?  Which is more important, physical health or financial health? I don’t have the answer to that. I don’t know anyone who has not been affect financially by this pandemic and the stay at home order (other than maybe Amazon and supermarkets). But our financial health means nothing if we are too ill, or even dead, too benefit from it. 

Please Stay Calm, Stay Home and Socially Distanced and Stay Patient.  

We at Lewis Pediatrics are here continuing to do what we do best, look after the health and well being of our patients and their families. Stay in touch. 

Stay Calm and Keep Your Fingers Crossed

Both local and statewide reports continue to be optimistic. I think we can safely say we have “flattened the curve” and have probably passed the apex of the “surge.”  Hospitalization rates, ICU admissions and intubations are down. Deaths, still at 481 yesterday, are trending downward but still represent tragic loss from this virus.  Locally the numbers reflect these trends too although the number of deaths from over the weekend are up. 

I think all of you/us who have heeded the recommendations to stay home and socially distance can pat yourself on the back. BUT… it is not over. This is a virus unlike any most of us have ever seen and it will not take much for it to rear it’s ugly head again.  Just like spring is “sort of” here, and we see intermittent sunshine, we can start to look for some hope that NY state will “reopen” in May. 

Please take a moment to, once again, count your blessings, no matter how few or small they might seem at this point in our lives.  John Krasinski (Office and Jack Ryan fame) has started the Some Good News Network on Youtube. Take a minute or 20 to watch them. They are entertaining and uplifting. 

We at Lewis Pediatrics remain here for you. Please do not hesitate to reach out. 

Harper misses you all.  

Stay Calm and Trust the Experts

Last week we passed the 1 month mark of “NY on Pause.” Scientific models predicted  that week to be the “apex” for NY and although we still see about 2000 new cases of COVID-19 per day in NY state, intubations, hospital and ICU admissions are significantly less, but the number of NY deaths remains pretty steady. The trends certainly look like we are seeing a plateau at a lower level that initially anticipated.  Governor Cuomo is cautiously optimistic that the numbers of new cases of COVID-19 are plateauing and the surge that we anticipated may have been “mitigated” by our staying at home and socially distanced.

President Trump planned on the country starting back up by Easter and now seems to be at odds with many governors about reopening businesses and the economy. As much as I, too, would like to get back to normal, just because I want to doesn’t mean it can or should happen.  

I find myself drawn to Governor Cuomo’s daily press conferences. At first it was for the “numbers” and to see the trends so that I could make sense of how significant this pandemic is. But, I also find myself drawn to the Governor’s leadership style. He tells it like it is, he presents the facts as he sees them, not as he wants them to be and he takes responsibility for the decisions he makes. He keeps reminding us that this situation should not be politicized. He has reached out to the governors of Connecticut, Massachusetts, New Jersey and Pennsylvania to coordinate efforts to “start back up” rather than trying to go it alone. I am impressed. But this is not about politics, it is about being informed. 

On the other hand, there is a lot of “misinformation” out there. Please be careful of promises and recommendations by people other than those who truly know the science behind their recommendations. 

There is a Facebook group recommending securing facemasks to babies’ pacifiers. There is no basis for this other than conjecture. And, when you weigh the benefits vs the risks, the risks win by a long shot. The risk of suffocation or choking are just too great. Likewise, there has been much conjecture about potential cures like hydrochloriquine and azithromycin. There may be some basis for them working, but they are not benign medications and the side effects can put patients at risks for complications and even death. We need more evidence and there are a number of controlled studies taking place to validate their usefulness. We should not base our choices on what we hope or wish will work but what has been proven to work.

I don’t know how many of you watched the “One World Together at Home” concert last night. It was a moving reminder that we are in this together as a world. We need to move forward together to get through this truly once in a lifetime event. We need our leaders to act in our best interests, not theirs. We need them to make good decisions based on the recommendations of the experts, not based on their perceptions of what should be. 

So, what is my point? Staying home and “socially distanced” is working. We have the numbers. As much as we want to get back to normal, we need to take a “pause” and listen to the experts, follow their recommendations that have some scientific/medical basis behind them and we will get through this.

Why 6 feet?

Social Distancing: Why 6 feet? A very good explanation for social distancing with 3D simulations published in the NY Times today.

The Sunday NY Times has so many good links this week that I may just send one a day to help us get through yet another week of the new reality.

At least the sun is shining. Stay calm, stay safe, stay home and stay healthy. 

We at Lewis Pediatrics continue to strive to keep our routine as normal as possible while socially distancing. The waiting room continues to be empty was we provide a “car to exam room” experience for all patients 

Children and Universal Masking

I have received several requests for information regarding the Governor’s Executive Order for wearing masks in public. The bottom line is that anyone over the age of 2 years is required to wear a mask in public if social distancing cannot be maintained. The American Academy of Pediatrics has published the following information with some tips on how to actually make this work:

The CDC now recommends people over age 2 wear cloth face masks when outside their homes. Below are some frequently asked questions about the use of face masks for children during the COVID-19 pandemic.  

Why are people wearing masks right now? 
CDC recommends that people wear a cloth face covering over their nose and mouth in the community setting during the COVID-19 pandemic, however, children younger than age 2 should not wear masks. 
The purpose of people wearing masks in public right now is to protect the community. Since so many people who have COVID-19 don’t have symptoms, wearing masks can help reduce the possibility that someone with no symptoms could transmit the disease to others. 
Since masks reduce the spray of that person’s spit or infectious respiratory droplets, masks can help reduce this kind of spread of the virus. 
Masks also can protect you from others who may have coronavirus but are asymptomatic and who could come within 6 feet of you, which is the range of transmitting infection through acts like sneezing or coughing. 
Is there a “right way” to wear and use a mask? 
Yes. For a mask to be safest and most protective for children and adults, they should securely cover the nose and mouth and stretch from before the ear to the other side.  
Masks should not be worn when eating or drinking.  
Masks should not be touched when on. 
Hand washing should take place before and after you remove a mask.  
Masks should be washed after each wearing. Remove the mask from behind without touching the front of the mask.  
Should children wear masks?  
The CDC does not recommend masks for children under age two.  
If children are at home with just the usual residents, they do not need to wear a mask, assuming that they have not been exposed to anyone with COVID-19. 
If children can be kept at least 6 feet away from others, and not be in contact with surfaces that could harbor the virus, then they do not need a mask for the protection of themselves or others.   
For example, during a walk outdoors, as long as children can maintain social distancing of more than 6 feet and do not touch tables, water fountains, playground equipment or other things that infected people might have touched, then they will not acquire the infection and would not need masks. 
Especially for younger children who may not understand why they can’t run up toward other people or touch things they shouldn’t, the best approach is to keep them home and in spaces away from other people and common surfaces.

Places where a child would benefit from wearing a mask are places where they are likely to encounter other people at a closer than 6 foot range. For example, if you must take your child to the doctor, or the pharmacy or grocery store, and are unable to leave them at home, wearing masks in those settings could be beneficial. 
Children with fever or respiratory or GI symptoms like a cough, congestion, runny nose, diarrhea, or vomiting should not leave home.  
Children with severe cognitive or respiratory impairments may have a hard time tolerating a face mask, so special precautions may be needed with these children, such as monitoring with a pulse oximeter if available, and/or maintaining greater physical distance from others outside their home.  
Situations in which children should not wear a mask include:  Children under the age of 2 years, due to risks of suffocation.  
If the only face covering available is a possible choking or strangulation hazard.  
If the child has difficulty breathing with the face covering or is unconscious, incapacitated or otherwise unable to remove the cover without assistance.   
If wearing the face covering causes the child to increase risk of getting exposed to the virus because they are touching their face more frequently. 
What about infants or children with special health care needs? 
If you must go outside or to a place where you are not able to practice social distancing with an infant, cover the infant carrier with a blanket, which helps protect the baby, but still gives them the ability to breathe comfortably. Do not leave the blanket on the carrier in the car or at any time when the baby and carrier are not in direct view.  
Children who are considered high-risk or severely immunocompromised are encouraged to wear an N95 mask to best protect themselves.  
Families of children at higher risk are encouraged to use a standard surgical mask if they are sick to prevent the spread of illness to others.  
What if a child is scared of wearing a mask, or too young to understand not to tamper with it? 
If your child is scared of wearing a mask, parents should wear masks too so your child doesn’t feel alone. Some other ideas to help make masks seem less scary are: While wearing masks, look in the mirror and talk about it. 
Put a mask on a favorite stuffed animal. 
Decorate a mask so it’s more personalized and fun. 
Show your child pictures of other children wearing masks. 
Draw a mask on their favorite book character. 
Have your child practice wearing a mask at home first. 
For children under 3 years old, it’s best to answer their questions simply in language they understand. If children ask about people wearing masks or other face coverings, parents can explain that sometimes people wear masks when they are sick, and when they are all better, they stop wearing the mask.  
An important way to reassure children is to emphasize how you are taking steps to stay safe. Children feel empowered and less afraid when they know what to do to keep themselves safe. 
For children over age 3, try focusing on germs. Parents can explain that germs are special to your own body and we need to make sure they stay within your body.  The masks help keep your own germs to yourself. Some germs are good, some are bad – we can’t always tell which are good or bad, which is why you need to wear a mask.  Some germs can make you sick.  We to make sure you keep those germs away from your own body. 
One of the biggest challenges with having children wear masks relates to them “feeling different” or stereotyping them as being sick. If this becomes more of a norm, it will help children not to feel singled out or isolated, and they may feel strange not wearing something. 
What kind of material is best for a mask for the average person to wear? 
Homemade or purchased cloth masks are suitable for the average person to wear. For a child, especially a small child, ensuring the right fit is important.  
Pleated masks with elastic are likely to work best for children, but the right size is important. Adult masks are usually 6×12 inches, and even a child-sized 5×10 inch mask may be too large for young children. Try to find the right size for your child’s face and be sure to adjust it for a secure fit.   
Due to very limited supply now, professional grade masks like N-95 masks should be reserved for medical professionals on the front lines who have increased risk of exposure to coronavirus in close proximity.  

Stay Calm and Keep Apart – It is working!

40 days since the first case of COVID-19, with some pretty awful predictions by “think tanks,” New Yorkers might actually be at the “apex” with a much lower  “plateau” than expected.  (worst case predictions – green and orange), effects of quarantine (red and yellow), where we are today (purple).  The crisis is definitely not over, but with everyone’s efforts to stay “socially” distanced, despite the sacrifices made, we may have averted the staggering toll that could have happened.

The death rate continues to rise (which is to be “expected” given the severity of the illness and the length of hospitalization for the most ill among us). The number of hospital and ICU admissions is trending downward with enough data to suggest that it is a true trend. 

BUT… we do not know everything about this virus, so it is not time to loosen up the restrictions.  We mourn the loss of almost 8000 New Yorkers and thousands more across the globe. It is safe to say that most of us have experienced the loss of someone to COVID-19  who has been a part of our lives to some extent. But with Easter, Passover and Ramadan observances taking place, we can stop to take a breath (with or without a mask on), and take stock of what we have to celebrate as well as to remember those we have lost. 

Stay Calm and Be Strong

thank you Evie…

We are tough and we continue to survive during this once in a lifetime event. he numbers from Albany and Monroe County are promising. The number of deaths is continuing to climb, but that is to be expected, representing patients who have been in the hospital. But, for the past 3 days, the number of patients hospitalized and those admitted to the ICU have been significantly reduced. We are seeing the “flattening of the curve” which is what we had all hoped for.

This does not mean that we are out of the woods. We have to continue to hunker down and stay at home and stay distanced from friends and family.  We are lucky to have telemedicine established in the practice. I am pleased with how we have expanded its use and kept patients at home. 

We continue to be here for you. We will do our best to accomodate your needs and provide you with the care you have been used to receiving from Lewis Pediatrics.

Day 37 – Better Days Ahead

Sidewalk art from my neighboor!
The message is (to paraphrase)
Better Days Ahead
April Social Distance Brings May Continued Existance

The messages from Albany and locally are cautiously optimistic. We may be seeing a plateauing trend of new cases, hospitalizations and intubations.  (orange line – without social distancing etc, blue line – with social distancing and staying home, purple line – where we potentially are today).

Everything we are doing is helping.  Fingers crossed.

I am sure some of you have seen this, but for those who haven’t it is just too good to not pass on:

On a different perspective

What if??? 

❤️❤️❤️ If they cancel the rest of the school year, students would miss 2.5 months of education. Many people are concerned about students falling behind because of this. Yes, they may fall behind when it comes to classroom education… But what if…
❤️❤️❤️ What if instead of falling “behind”, this group of kids are ADVANCED because of this? Hear me out…❤️❤️❤️ What if they have more empathy, they enjoy family connection, they can be more creative and entertain themselves, they love to read, they love to express themselves in writing.
❤️❤️❤️ What if they enjoy the simple things, like their own backyard and sitting near a window in the quiet.
❤️❤️❤️ What if they notice the birds and the dates the different flowers emerge, and the calming renewal of a gentle rain shower?
❤️❤️❤️ What if this generation are the ones to learn to cook, organize their space, do their laundry, and keep a well run home?
❤️❤️❤️ What if they learn to stretch a dollar and to live with less?
❤️❤️❤️ What if they learn to plan shopping trips and meals at home.
❤️❤️❤️ What if they learn the value of eating together as a family and finding the good to share in the small delights of the everyday?
❤️❤️❤️ What if they are the ones to place great value on our teachers and educational professionals, librarians, public servants and the previously invisible essential support workers like truck drivers, grocers, cashiers, custodians, logistics, and health care workers and their supporting staff, just to name a few of the millions taking care of us right now while we are sheltered in place?
❤️❤️❤️ What if among these children, a great leader emerges who had the benefit of a slower pace and a simpler life to truly learn what really matters in this life?
❤️❤️ What if they are AHEAD?
❤️❤️❤️❤️ (Copied and pasted from a friend but too good not to share! ❤️)