Dr. Rajeev Agarwal, pediatrician at Agave Pediatrics — with locations in Chandler, Glendale, Phoenix and Scottsdale — is working long hours as concerns about coronavirus (COVID-19) have led to unprecedented measures to slow the spread.
Agave Pediatrics has revamped its practice because of the virus and is providing only well-child visits in the mornings with sick-child appointments confined to afternoons. Dr. Agarwal says Agave Pediatrics is not testing children for COVID-19, and he urges only children and adults with severe symptoms including respiratory distress to visit the ER or Urgent Care for testing. [Agave Pediatrics says children with respiratory distress or any infant younger than 3 months of age with a fever of 100.4 or greater should be evaluated in the emergency room immediately.]
Overall, Dr. Agarwal acknowledges this is a stressful time for everyone, but he believes if we all do our part with handwashing, social distancing and self-isolation when sick, we’ll see the other side of this pandemic before long. Dr. Agarwal, a father of two who lives in Paradise Valley, shared how he’s protecting his own family, and how he’s talking to kids about the pandemic.
“I am a die-hard optimist, and as I see it, this may be the time to reconnect with family and friends,” Dr. Agarwal says. “Use this opportunity to spend more time with our children and our own selves. Read books, rekindle relationships, play games, bring out the board games, go out for walks, do yoga and whatever you can do to enjoy this time. In a nutshell, do all those things that we have forgotten to do in this fast-paced day and age.”
How concerned are you about the spread of coronavirus (COVID-19) in greater Phoenix and Arizona? I am very concerned about the virus spreading. … We have a large elderly population, and from experience from all over the world, we have seen that this population is particularly susceptible to complications. With the rate at which the virus has been spreading, soon it will be prevalent throughout the world. It will invariably hit all the susceptible populations over time.
Luckily, the preliminary data that we have shows that the morbidity and mortality associated with the virus will not be much different from the flu (however, there are conflicting reports on this), though it seems to be more infectious than the flu. Studies have shown that symptoms include fever, dry cough, but no runny nose usually. The incubation period (time before someone starts showing symptoms) is 2-10 days, and during this time, although the patient is asymptomatic, they can surely transmit the virus and infect other people. Hence, social distancing is extremely important in slowing the transmission of the virus, which is highly recommended along with good hygiene measures like handwashing.
How are you talking to your kids about the virus so that they’re informed but not terrified? I have been talking to children about the coronavirus [because] the constant mention of it in the media and how their [lives are being affected by coronavirus] can cause considerable anxiety. I have been asking them directly what they know and what they would like to know. I have been explaining to them that this is a new disease, but it is like the flu and can cause cold-like symptoms. I have been also telling them that they need not be scared. The measures that are being taken such as school closures, city shutdowns, canceled vacations, etc. are all precautionary. This means that it is “just in case.” I have been addressing the scare around this disease, because nothing like this has ever happened before, and we don’t know very much about it. Soon life will be back to normal. I have already started addressing family screen time and have been discouraging parents from keeping the news on for long periods of time as this might give children increased anxiety.
What steps are you taking to protect your immediate family? My family and I are following the latest public health recommendations to help reduce the spread of the virus in our community. We do this by limiting outings for the grandparents, and generally for people [more than 60 years old] with health conditions such as heart/lung/kidney disease or people who are immunocompromised. We are not attending any social gatherings to prevent spreading the virus to others or contracting it ourselves. We have cancelled our plans for spring break and have decided to spend some quality time at home.
Every evening when we sit down for dinner, we do a fact check and share information about the disease. We also discuss what can we do as a family to keep our own family and neighbors safe. We have been limiting our visits to the grocery store and often call our elderly [friends, family] to see if they need anything. We are also encouraging everybody to wash their hands often.
Thankfully, in children, the virus does not present with severe signs and symptoms. However, children still can be carriers and spread the disease to others. It is important to educate our children on measures we can take to slow the spread of the virus.
What’s the most important thing we can do as a community? The most important thing we can do is social distancing. Young people are the least affected by this virus, but it’s essential that we act in solidarity with the most vulnerable. We must act in the best interest of our common society. Coronavirus is spread by droplets, and if a person is more than 6 feet away from another infected person, the chances of spreading are decreased. This is a very infectious virus, and the chances of asymptomatic carriers spreading amongst the healthy (and compromised) population are high — meaning you can have no symptoms, but still give another person the virus.
Keep good hygiene (clean high-touch surfaces, cover your sneezes/coughs) with frequent handwashing (20 seconds with soap and water). The other important thing to keep in mind is to educate families about how the majority of the infected patients can recover at home with antipyretics [medication used to lower body temperature, such as Tylenol], humidification and good hydration. There is no medication approved for treatment of the virus yet. Testing for this virus should be limited to high-risk individuals and those with severe symptoms (respiratory distress associated with extremely high fever). There is a large risk [that] people who need medical attention [will not be] getting it, because the hospitals are overwhelmed by those coming in with normal symptoms.
Though information coming from social media can be informative and educational, it can also create anxiety to an extent which may cause behaviors like hoarding of food/essential supplies. This may make the more at-risk people of society more vulnerable and perpetuate fear in the community at large. The consequences of this knee-jerk reaction puts pressure on the medical system and the equilibrium of supply and demand of basic human necessities. Be there for others; we are a community.
One silver lining is that kids do not seem to be getting as sick. Do we know why? The infection rate is probably not lower than anyone else’s, but it has been noted that the mortality and morbidity is lower in children. Having said that, kids are very important carriers of the disease, even when they are mildly symptomatic. The pathology and immunology of the virus infection is not clear enough to explain why children show less symptoms with the infection. Many scientists and doctors are following the disease closely, and very soon we will understand the disease much better.
What would you like to add? This is a very unique and unprecedented situation that most of us are dealing with for the first time in our lives. This has caused an immense amount of stress and anxiety. When there is not enough information about something, then misinformation fills that void. Most of the epidemiology has not been fully evaluated by the medical and scientific community yet. Because of this, there has been an exaggerated panic response. We are still learning from other populations in different parts of the world how this virus behaves. In this world of social media and rapid transfer of information, it is easy to stress over what may happen without truly understanding the denominator, which means that we only see what can happen, but not understand how frequently it may happen.
Overall, it is very important to understand that the medical professionals from all over the world, including the Centers for Disease Control and World Health Organization, have taken numerous steps to education us on preventing the spread of the disease and are working on treatment. The fact that travel has been restricted and other measures are being taken to implement social distancing should come as a source of comfort. We may be soon in a position that the spread of the virus is slow enough that all infected cases with get adequate care.
It is very important to keep the sense of community and positivity with faith in our medical community. It is good to be well-informed about the latest developments and regulation associated with the rapidly changing scenarios. Check the websites of the CDC, WHO, and other respected institutions for updated information.
Anxiety associated with this virus may lead to self-destructive behavior in our society, and things should be evaluated in perspective. As I mentioned earlier, I am a die-hard optimist, and as I see it, this may be the time to reconnect with family and friends. Use this opportunity to spend more time with our children and our own selves. Read books, rekindle relationships, play games, bring out the board games, go out for walks, do yoga and whatever you can do to enjoy this time. In a nutshell, do all those things that we have forgotten to do in this fast-paced day and age.