Not seeing cases in children because they are less likely to get infected, or are they getting infected but they have a milder disease . So they are not coming in with as severe as a disease. That remains to be seen. Host i am a parent, i have a 13yearold and 11yearold. What are you all suggesting that schools do at this point . Guest schools need to work handinhand with the local departments of health, and i think all schools are aware of that for any of the Infectious Diseases, even the emerging Infectious Diseases are not different. If you have a population of students who have traveled abroad, and they are coming back, even without symptoms, the schools need to work with the department of health to understand if the student should be quarantined at home for a period of 14 days prior to them going back to school. They would also work with the department of health to get recommendations about if any students develop symptoms, what should they do . What would be the things they should do at the school to make sure that other people are safe and not exposed to the virus . Host i know we are talking about children, but let us add in these collegeage students were going on spring break right now. Should that cause any concern for their age group as they go into their spring break destination and head overseas . Guest isnt it amazing that this virus picked the worst times to emerge. Over the chinese new year, and spring break with all the schools and college students. The overall number if we look at ages affected, in a very large series. Looked70,000 patients at, less than 1 were under 10 years of age and another 1 were 10 to 19 years of age. Overall, it was 2 in this group that you are talking about. That does not mean they will not get infected, but it is reassuring that in that large number of patients, which were skewed towards those probably very ill and got picked up and hospitalized. Even in that group, there was not a large number that were in this adolescent or Younger Age Group. Guest what is the difference that we are seeing between this Younger Age Group and this older im not going to cl to say elderly, but does older group that is more susceptible or the people being tested positive. Is it stronger immune systems . What is the difference or do we know . Guest we do not, but we will find out. There are over 70 countries that have this virus circulating, and we have had two months to put in place a variety of ways to look at what we call epidemiology of disease. We can actually go into communities and see how many people are infecte. That really tells you a lot about the virus. How much is out there and affecting which groups. As opposed to who is sick, showing up, and getting tested. To get back to your question about why would one group get ill and one would not, there is a variety of reasons. One could be related to immunity , it could be that younger populations have stronger immunity overall. The 1918her hand, in pandemic, younger people got sicker because their immune system was so good that the virus set up an immune response, and inflammatory response that made it worse. That is not always the answer. It is not a matter of young people have better immunity. The 2009xample is influenza epidemic, the younger kids were more affected. That was because the virus had some similarity to a flu strain that had circulated in the past. Older people had some circulating immunity that helped make the disease less severe. We do not know the answer yet. Host what are the suggestions that you all are giving to parents and schools to ensure that if that kid stay safe. What are your suggestions . Guest do not panic. Everyone has heard this over and over, but it is true. We are well prepared in the United States to face any emerging threat. We have systems in place that are not visible to the public on a daily basis, they should have some understanding that we do not just respond to things when they happen. This is going on every day of the year. When Something Like this happens we are in the position to make recommendations the public based on information we have before it hits your community. Not is number one, do panic. Another thing that we say, you have got to use good hygiene, because the way this virus, and most respiratory viruses get from persontoperson is droplets. When we talk about droplets, we are talking about little droplets that are big enough that when you cough and sneeze go out and get on our hands or bodies, and then you touch it and get it into your body that way from the initial droplet. They are not just floating around the sky were coming to attack you. It is just droplets. If you are good about hand hygiene, and you have all heard about that, wash your hands for 20 seconds, seeing the twinkle, Twinkle Little Star song, that is by far in large the best way to prevent inoculating yourself with the virus that has been spewed on you. You also want to get in the habit of social distancing. Right now would not be the time parties,ing crowded hugging everyone you know. I am not saying we need to become hermits. But it is reasonable during a time like this to back off a little bit from crowded situations. And that is a very effective way to stay away from respiratory viruses. Host point number one, wash her hands. Guest just like your mom told you. Host let me remind our callers that we can join in. We will open up regional lines for you. If you are in the eastern or central time zone, and you want to talk about coronavirus and children, your number is going to be 2027488000. Once again, eastern or central time zone, 2027488000. If you are in the mountain or pacific time zone, your line will be 2027488001. Once again, mountain or pacific time zone, 2027488001. We are going to open up a special line for medical professionals so you can tell us what you are hearing and seeing out there. The number for you if you are a medical professional will be 2027488002. Once again, medical professionals only, 2027488002. Keep in mind we are always reading on social media, and twitter, facebook. Had reported earlier this week that there are millions of students around the world who are at home because schools are closed. I will read a little bit from their story. Cases continue to be identified, the efforts to stem its spread has kept 290 Million Students home from school. According to the united nations, as of tuesday, 22 countries on three continents have closed schools because of the virus. Is that something that american schools need to start considering, especially in places Like Washington state, and pennsylvania where we heard here in maryland that someone from this area who tested positive winds to a school in pennsylvania. Went to a school in pennsylvania. Should more schools think about closing to stem the spread . Guest this is a great question and i guarantee you that schools are thinking about this. It is not on their own that they make about that they make these decisions. Let me go back to talking about internationally schools closing. It depends on where your school is. There are five countries where there is a large amount of sustained Community Transmission , and those are japan, south and italy. , in those areas it becomes more important to use Public Health measures such as School Closure to heighten this social distancing that i was telling you about. On the other hand if you are in maryland, we have had three cases, but those were purely imported from people on a cruise. We do not have any evidence of sustained Community Transition transmission in maryland. It might not be appropriate to say we need to shut down all of the schools, but that might change day to day and week to week, and School Closures are very effective and long used tradition of social distancing. What is great in 2020 is that we have ways that children and students will continue their education if that happens, because we have electronic ways to teach and there are ways to continue our educational process for students, whereas 50 years ago if we closed schools, they were not getting any learning for whatever time the school was closed. We are in an improved situation because of modern technology. I should mention the idea of electronic use of electronic measures is not just for schools. We use telehealth, for which Childrens National is well known. We use it internationally to see patients, so there are many ways that we will be able to meet this challenge, whether it is educational or a Health Challenge for parents and families. Host how do you suggest parents talk to their children about coronavirus . My son came home and set a friend of his told him that someone had died in washington from coronavirus and i had to explain that they met washington state, not washington, d. C. I had to have that conversation with an 11yearold. What do you suggest that parents tell their children aside from wash your hands . Guest children process things differently than adults. You do need to give them a facts and always be truthful, but it is helpful to put it in context that thing of things they can understand. Is, understand what a cold having a runny nose and a cough and not getting that sick. What we need to drive home is that the vast majority of people, even if they get the new virus, that is what they are going to have. Even in the large series from china, 80 of the patients were mild disease. It is true that an unlucky smaller number of people will get severely ill and can die. Year wea, every single have 30,000 people that can die from influenza. We do not want to scare the kids, but you want to put it in context that we do not expect every person to get coronavirus to get severely ill or die. In fact, it is reassuring that two of the viruses that are the most similar to the virus circulating had a much higher case fatality rate. The middle eastern respiratory virus syndrome had a 30 or 40 were tally rate. Compared to this virus which at twomost only looks like percent to 3 . Once we get more information and test more people, we will be in the range of 0. 1 or 1 like flu strains or one of the mild pandemic flu strains. Does that answer your question . Host i think i will say all of that to my son later on. J. D. Fromojd hot springs. Let us see if we can get them on here. Springs, national park, and arkansas. Caller every time there is an outbreak like this, there is a lot of conspiratorial things that come up, and i heard on the , likethat there was a lab an Infectious Disease lab in wuhan where they started, and these people over there had been in trouble before for selling lab animals to the markets around there for sale to the public. Have you heard anything like that at all . And i have a followup question after you answer this. Guest i have not heard that, but i would say that there is a longstanding knowledge that animal viruses can be transmitted to humans. It is usually an accident. Viruses are smart little germs. Hostadapt to infect the that is most likely to allow it into the host, and then the virus takes over the machinery to make more of itself. Thathe most part, a virus is well adapted to an animal almost never infects a human. It is an accident. Examples of that similar to this virus are these coronavirus is, which tend to hang out in bats and then bats as an intermediary will transmit to another animal that humans tend to be closer to. For instance, the sars epidemic in 2002 and 2003 originated in a andand went to a civet, then humans around it accidentally got infected. Or the mers virus, again bats, but the intermediary was a camel. Because people in that region are in close proximity is to the camel, they accidentally got infected. What are what we are waiting to figure out is the intermediate host. I am secure that we will find out what that is because this is extremely similar, 80 similar based on the genetic sequence to these other viruses that have circulated in that manner. We do not need to find a conspiracy theory. These are wellknown ways that these viruses get to humans. Host make your followup quick. Suppose one of, you two had this virus right now and did not know it, could just sitting there talking to him or him talking to you, but that infect either one of you . Just through the air without sneezing or coughing . Just natural conversation . Guest that is a great question. I am more than six feet away from jesse, and that is the magic number for transition of viruses trends knitted transmitted by droplets. That is different than if jesse had the measles. I would be able to get the measles easily because that is airborne, meaning it floats through the air, not just droplets that need a shorter distance to get to. So, the answer is no, i would not be able to catch it from jesse because we are six feet apart, and im going to wash my hands like crazy once i leave the interview before i touch my eyes or my mouth. That is an excellent question. Host bill from georgia. You are in the medical profession. What are you saying . Pediatrician, and i have not seen anything like what she is claiming is out there. The reality is, number one is that most of time seeing is the end of the flu, so i am seeing a lot less flu cases a month ago. Otherd like to make one comment about the corona vase coronavirus. There are many illnesses, like chickenpox which are much more mild in children. Ityou remember chickenpox causes a lot of the classic rash and high fever. Were sick for and got overor so it. Unlike adults. I wish parents would understand that children have a different Metabolic Rate than adults and they may not suffer from this illness at all, which is what we are seeing right now. Host go ahead and respond. Guest there are a lot of things. I agree it is important to reassure parents that the vast majority of children we have seen do not get severe illness. I will say that children with underlying conditions, and we take care a lot of those children, we need to be prepared for severe illness because it will occur. Have adrens national we wellworn path to deal with emerging Infectious Diseases. We have a special Isolation Unit where we can take care of patients with airborne or droplet transmission, and extended bed space if we are wrong and this does affect many children and need to be hospitalized, we have a safe place to take care of large numbers of children. Going back to his point about a completelyt is different category, and sometimes people lump all viruses together. Chickenpox is a highly contagious virus caused by a different class of viruses, and although it is true that many children have mild illness with chickenpox, or did before the vaccine, i can tell you that 20 years ago or 30 years ago before the vaccine was available, every single week i took care of a child with a severe complication of chickenpox. This was either pneumonia, encephalitis, or more likely, bacterial infection of the lesions that the virus caused that could cause sepsis and illness. I do not want parents to walk away thinking not it is such a benign bill illness that it should not be vaccinated. When that was instituted we saw all thedible decline in severe complications of chickenpox. I do not want to get too far off topic, that we want to talk about respiratory viruses. It will remain to be seen if children truly do not get infected or if they get infected and get a mild disease. We do not have an answer. Host let us talk about Hand Sanitizer because we are seeing runs in stores. It is sitting on the same shelf as soap. No we should wash our hands, those hands in a ties or help, should we douse our kids hands in sanitizers or just tell them to wash their hands. Guest in general, soap and water is still the best because an only is it antiinfective, but it is getting the particles of whatever is on your hands off. Alcohol works, and you want to make sure you are using an alcoholcontaining solution with 60 or 90 alcohol to be effective and kill this virus. If you have particles of dirt or you have used the restroom and you have particles of stuff, not just the virus on your hand, you are putting alcohol on top of the particles where it is better to just get them off. You and water, as long as do it correctly for 20 seconds, you cannot just pretend, you have to do it properly. As long as you are using it correctly, it is more effective. If you have alcohol sanitizers, that is a great thing to use in between. One thing i have to say is that all of the stock may have been falling, but the one stock climbing is clorox, because of bleach. Aboute been talking a lot disinfecting ourselves, which is super important, but these viruses can live for hours on surfaces. For instance, coffee cups, cell phones, anything that is a high touch area. Doorknobs, anything that we use frequently, at least once a day try and disinfect those areas with something containing bleach or that content of alcohol we talked about. Host let us go to our next caller, john from montana. John, good morning. Caller good morning. Sick, and itly got am not sure if it is the coronavirus. It could be flow. I was wondering are the hospitals able to test specifically for coronavirus, and how long after your symptoms go away should you worry about infecting other people . Guest these are good questions. A week ago, things were completely different on the testing landscape than they are this week. This is how it is with an emerging virus. Not things change, it is because the prior information was wrong, it is because things have evolved. Specifically about lab testing, week ago the only place to get lab testing was through the centers for disease control. For that reason, the criteria was much more restricted in the United States. Over the next week, we have had the fda allow other labs to validate the tests or similar tests so that this ability to get a test local to where ever you are is much easier now, although still not up and running to the extent it will be next week. Localr change is that the departments have the ability to do the testing so it does not need to go all the way to atlanta, which will expand the access to the test. Academic epidemic centers are developing tests within their hospital. It will become easier. Having said that, we will not be recommending that everyone run to their local doctor or hospital and say i am curious, i would like to know if i have this virus, because it would not be appropriate to use the tests for that purpose. It is expanded, we will certainly use it in hospitalized patients where we do not have an alternative explanation for severe pneumonia that is requiring Critical Care support. And, we keep a close eye on that because we have lots of children with respiratory disease that can become very severe. We will also use it for other criteria met the cdc and World Health Organization identify as this evolves. As you have heard thereof been outbreaks in a longterm care facility, so we might have a lower threshold to test someone in a longterm care facility with a respiratory illness, or, you heard about the cruise ships, there might be a lower criteria to test those individuals. It will evolve, but the testing will become and already is more broadly available than it was. Host one of the things we have not talked about is pregnant women and coronavirus. Do we know anything about the impact or how it affects women who are pregnant . Guest Childrens National, we are very invested in our Fetal Medicine Program and we work handinhand with the Fetal Medicine Program. We have a track record of looking at the effect of any infection on a pregnant mother and how that affects the pregnancy, the baby and the longerterm effects on the child. Instance, cytomegalovirus, syphilis and rubella can affect a pregnancy. And the zika virus. We are leaders in that area where we have characterized what it does to the mother during the pregnancy. But we are wellpositioned to do is put that to work and see what does this particular virus, if a mother is pregnant when she gets it, does it have any problems with the pregnancy or the baby . Or its longterm development. What we know so far from what we know from china is that in general, a fever in the first trimester of pregnancy for any presentan affect if the pregnancy is lost or if the child is potentially born preterm or small. It is possible that a mother who got this coronavirus or any virus with a high fever in the first trimester could have an effect on the pregnancy. But we do not know is any direct effect of the virus on the brain of the baby. These are things that we and other centers will be looking at closely. Host let us see if we can get a couple more callers in. Let us talk to joseph from maryland. Good morning. Caller good morning. Thank you for your work. We appreciate it. Aam heading into a d. I. Destination imagination, and i have my daughter. I am a judge and my daughter is a contestant. My daughter had cancer a couple of years back and all of the cuban therapy did a lot of things to her hot chemotherapy that today a lot of things to her heart, so now she is 12 and takes eight pills a day for her heart. We are blessed, and so blessed for the medical people. Told my doctor do not go to this place where all the kids are. And then the adults, they are at risk too, but everybody is mad at me because you need to go because they are counting on you all. I do not want know what to do to be honest, i am driving there right now and i do not want to go. Guest the problem is that we are at a point where if you are in a country that has already been labeled as level 3 alert, he would not be having this struggle. He would say, of course i cannot go. If you are in a country that had never been a case, you would not have this struggle. It is going on right now is we are seeing expansion into other countries, including our own. I do not think that you would be unreasonable with either decision. One decision would be, i am not going to take any risk. My child has an underlying disorder and i do not want to take any chance that they would be exposure because i am going to be in a crowded situation. That is a valid decision. At the end of the day, you are the advocate for your child. That would be an appropriate decision. On the other hand, if you could organize your trip such that you could not shake everyones hand and not hug everyone and be at somewhat of a distance and spend a shorter time than you had planned, if they really are depending on you for one event, that would be a reasonable decision. It is personal, but both are valid. On the side of reason, but if it were circulating and i am not sure and i had a child with an underlying problem, i might say let us err on the side of not taking a risk. Host renee from new york. In morning. Caller good morning, i have a question and concern. We live in upstate new york, and in our School District we have families from 60 of families from all over the world. My concern is that i have a grandmother who is 85 and i note the kids are not being affected as much i know that the kids are not being as affected as much as the elderly. Do i keep my daughter away from their grandparents . The kids families are traveling all over. The kids might be ok, but they are bringing it back into our community through the children. That is my concern. Guest is the grandmother living in your house . Is thet i was asking answer to that question is if the grandmother is living in a house, then of course there is no way to stay apart. You can certainly avoid heavily kissing and touching, and backing off a little bit. Using the six foot rule. On the other hand, if the grandmother is out of the home, you can try at least not to have your children visit children visit when they have symptoms. If your child has a runny nose or a fever, you want to stay away from elderly individuals or immunocompromised or any underlying condition. Is if thereot know is significant transmission when someone is asymptomatic. There is a little bit of data that shows there is not a lot of transmission when someone is completely asymptomatic. Based on what we know about other respiratory viruses, there is some chance. The biggest risk and a time to do the distancing and aggressive handwashing and disinfecting is if you are actually symptomatic. If it is possible to stay away while they are symptomatic, that would be the safest thing to do. Host we would like to thank you for being here today and being and giving us good in