Coronavirus Q&A: Panel of Pelham Medical Professionals

 
 

On Thursday, November 12, 2020, Pelham Together convened a panel of local doctors to answer questions and concerns from fellow Pelham community members regarding the Coronavirus. Not only as experts in their fields, but also as fellow Pelhamites and parents, Dr. Tracy Breen, Dr. Jason D’Amore, Dr. Kusum Mathews, Dr. Emily Upshur, and Dr. Sarah Bren, shared their thoughts and opinions based on their vast experiences caring for people throughout this pandemic.

The message was sobering and consistent. This virus is still wreaking havoc on our country; in the Pelham vicinity infection rates are rising and area hospitals are seeing a second wave of Covid-19 patients in their ICUs, as well as “long-haulers” (those continuing to experience the effects of having been sick with Covid-19). The doctors described being better prepared now then they were in the spring, and that mortality and hospitalization rates are significantly lower than March – April 2020; however they all stressed that we cannot let down our guard.  Unfortunately, Thanksgiving and the holidays could not have come at a worse time! Everyone is thinking about the holidays, the joy of extended family, the return of college kids, and the limited outdoor socializing due to colder weather. Members of our Pelham community had so many good questions, and our panel thoughtfully answered each one, giving us the benefit of their experience and expertise, with the added solace of knowing that this is how they plan to care for their own families. Pelham coming together to help one another.

The questions were grouped into three categories: Holidays and Social Gatherings, Kids Socializing, and General Medical Questions. The full discussion was recorded, and can be seen by clicking on the link above. Below is a written account of most questions and a summary of the panelists’ responses. 

Topic: Holiday Gatherings

Thanksgiving: should we see grandparents? How to get family together safely? Is testing needed before and/or after visiting?

Dr. Breen: Truly the only safe Thanksgiving is being with the ones you are already around. Otherwise, risk is incurred. Anything else adds risk. Ask yourself, “Where do I want to land? What risks can I tolerate?” And remember that any risk you take is also an added risk to our community.

Smaller groups are better (NY has a cap of 10 for gatherings as of November). Outside is preferred, with one person serving, and one person cleaning (minimize contact with saliva). Everyone wears masks while inside. These measures can modify risk but can't make it zero.

What advice do you have regarding kids coming home for Thanksgiving?

Dr. D'Amore: First, it is important to determine how safe that child's college has been (how often are kids getting tested?, how good are they at practicing social distancing?). 

Next, the child should quarantine ideally 14 days before traveling (which began November 12). This will decrease their risk of acquiring infection prior to travel. They should get tested when they arrive at home; social distance and wear a mask for a few days. Minimize socialization while at home—you don’t want a basement full of teenagers while your teen is home. 

Dr. Breen: If you are establishing a true pod with another or extended family, operate under as much of a “quarantine state” as you can. Everyone decides to avoid the store and restaurants; are you going to send your children to school? Minimize your bubble as much as possible. Quarantine should start today (Nov 12)—which is exactly 14 days until Thanksgiving.

 Dr. Mathews: Open dialogue about expectations with your teenagers; create a social contract. Discuss how important their behavior is to keep grandma safe.

What is your advice regarding airline travel?

Dr. Breen / Dr. Mathews: First determine if travel is essential. If someone really needs to fly, my recommendation is to wear N95 mask, eye shield, and bringing hand sanitizer. Air is circulated better in a plane than inside a house, so it’s doable to get your child home from college, for example, but if the travel is non-essential, the risk may not be worth the reward.

 The concern is really all the steps it takes to get to and from the plane, not so much the plane itself (i.e. subway, taxi, airport, etc).

 Testing is only 70% accurate, which means that 30% of the time, you’ll get a false negative test. False negatives can be caused by the person administering the tests not taking a good enough sample, and also by the lag time between exposure/infection and accumulation of enough virus to result in a positive test. This lag time is generally about 5 days, so you are capable of infecting others throughout that time.

Topic: Kids Socializing

What is your advice regarding what to do if we are outside at a park/playground, our kids are masked, but other kids aren't? 

Dr. Mathews: I recommend either leaving/avoiding that park/playground, or kindly remind others to wear mask for safety. NY has a mask mandate for kids over age 2, with rare exception. This applies even when outside in general, if you can’t maintain social distance. On a playground, if there is any chance of kids being close together, all kids should keep their masks on.

As an example of how to ask someone: “I have someone at home who’s at risk, would you mind wearing your mask.” On that point, Dr. Bren said to think about how you would like to receive information, and try to approach others in a way that won’t make them feel judged. The best strategy is to state your need, as opposed to a statement about their behavior and how you feel about it.

Advice regarding sports: Should children wear masks while playing sports, indoor and outdoor? How do we asses these sorts of situations in these more fluid times?

Dr. D'Amore: YES! Wearing masks also applies during any kind of sports, whether outdoor or indoor. This virus depends on respiratory droplets, and when playing sports this just increases the presence and volume of droplets in the air as kids are breathing more heavily and more frequently while playing sports. When everyone is masked, transmission is low. Indoor is much riskier.

 How do you recommend we encourage teens to be socially distanced? How should parents handle the balance between their mental health and being responsible citizens?  

 Dr. Upshur: Have a family meeting; open up communication and explain your reasoning behind decisions. It is important for teens to hear it, participate in the conversation, collaborate on the solutions, and hear that over and over again. Be creative and collaborate with your teen. 

Discuss as a family if you can make your backyard the place a small group of kids can congregate; get a couple of heaters. That way you control the environment—the distance between chairs, extra masks and hand sanitizer available. Then step away as much as possible for your teen to implement what you have discussed. For virtual-only children, this is a very important discussion to have so they can maintain social connections.

Topic: Medical Questions

How long is someone shedding virus once infected? 

Dr. Breen: Incubation period is typically 14 days. It is unclear why it is that long. 

Dr. D'Amore: People are less likely to be shedding viral particles in the postinfectious period. People can still test positive for Covid, but that may represent small viral particles that may not be infectious, but still present. If antibody is positive, less likely to be infectious. 

Can we get reinfected? It is not clear, but there have been few case reports of this sort. Rare, but has happened. 

How can we support people who are in quarantine?

Dr. Breen: If you have a member of your family that is Covid (+), isolate them in their room, bring them food, give them a dedicated bathroom, if possible. If you only have one bathroom, clean it in between every use. Use the DOH to guide you. Wear masks, even inside.

A trickier situation is when a child has to quarantine due to exposure to a positive person, but you don’t know yet whether they were infected. The DOH has advice on their website. The safest tactic is to mask. Make sure they don’t touch things in the kitchen, prepare their food for them. 

Dr. Bren: If a toddler is positive, have one parent quarantine with that child to help them with isolation. This, and providing information will mitigate anxiety. If you don’t provide age-appropriate information, they will fill in the blanks and may self-blame or be more scared than necessary. Also allow them to participate in making decisions related to quarantine. Very important to validate their feelings! Label their emotions: "this is scary, this is different", then say "its ok to be scared, but we are here for you. We have a plan and this is the plan…" First validate, then reassure (don't just give reassurances like "its going to be fine", make sure you validate their emotions). 

Dr. Upshur: Recognize that teens may develop anxiety, depression because this is the time, developmentally, that they are supposed to be moving away from the family unit, and yet they are limited in doing that right now. Keep reassuring them. If they get sick, let them know they did nothing wrong. Have a family meeting to formulate a plan with your kids; that will be reassuring to them because otherwise Covid is like being on a long car ride and not knowing when you’re going to be there. Collaborate with kids to be creative; communicate often. 

Flu and Covid
Dr. Mathews: The flu shot will decrease the duration of infection, decrease symptom burden, and reduce chance of hospitalization, but it will not eliminate your risk for flu. Nonetheless, very important to get vaccinated. 

A variety of resources have been included in the Pelham Together Covid-19 page. Please check it out!