May 14, 2020: Public Health Update

From: Tom McLarney, MD

Subject: Public Health Update

Date: May 14, 2020

To the Wesleyan Community,

Not only does the coronavirus continue to challenge us, but the predictably unpredictable New England weather is keeping us guessing with snow squalls in May! I hope everyone is weathering this season of uncertainty.

Over the past week, we’ve continued to learn more about Covid-19—particularly how it may be affecting children, who were previously thought to be largely spared by this disease. The medical community is now seeing a condition in children called Pediatric Multisystem Inflammatory Syndrome (PMIS), which is believed to be caused by Covid-19. The initial case was described in England in late April as a combination of Toxic Shock Syndrome and Kawasaki Disease (KD), the most common inflammatory condition affecting children aged 6 months to 5 years. At this time, there have been over 70 reported cases of PMIS in the New York City area with other reports of similar cases in Boston, Los Angeles, Philadelphia, and cities in Europe. PMIS is characterized by fever and rash, as well as with some or all of the other signs and symptoms of KD, including swollen lymph nodes, rash all over the body and most notably on the palms and soles of feet, and the characteristic “strawberry tongue.”  Not all the patients have tested positive for Covid-19 but a significant number have. At this time, experts feel this possible manifestation of Covid-19 is rare, but parents are advised to have any child with these symptoms promptly evaluated.

Also this past week, the Centers for Disease Control and Prevention (CDC) has issued new guidelines on when a person can be released from quarantine (whether due to a positive test or, more commonly, due to clinical presentation since tests are still not readily available). The criteria include a minimum of 10 days quarantine, improving symptoms, and no fever for 72 hours without the use of fever-reducing medication.

There are also some new developments to report in testing. Under the Emergency Use Authorization Act, the FDA has approved a home nasal swab to test for Covid-19 from Pixel by LabCorp. It has also approved a test to directly detect the Covid-19 antigen. This test is felt to be very specific (meaning few false positives) but it is not as sensitive as the polymerase chain reaction (PCR) swab (thus, it may have more false negatives). The FDA has also just approved a home salivary test, which is currently only being performed at Rutgers University’s Human Genetics Institute.

Finally, thanks to the parent who assured me that the naso-pharyngeal swab is not as bad as I described in last week’s email. I certainly didn’t intend to scare anyone away from testing!

I wish you all safety and good health.  I continue to keep all of you who have been affected by Covid-19 in my thoughts.

Tom McLarney MD