Doctors' opinions differ on keeping grandchildren away

Kevin Gore (from left), visiting from Manchester, England, helps his grandchildren Tim Gore, 4, and Rose Gore, 8, of Centerton make bead icicles during Winter Break Wonders at Crystal Bridges Museum of American Art in Bentonville in this Thursday, Dec. 29, 2016, file photo.
Kevin Gore (from left), visiting from Manchester, England, helps his grandchildren Tim Gore, 4, and Rose Gore, 8, of Centerton make bead icicles during Winter Break Wonders at Crystal Bridges Museum of American Art in Bentonville in this Thursday, Dec. 29, 2016, file photo.

As the coronavirus sweeps across America, families face some hard decisions.

Doctors say the elderly are particularly vulnerable to the covid-19 illness, and children could be asymptomatic carriers of the virus.

Obviously, if kids have the sniffles or other signs of illness, they shouldn't visit elderly grandparents.

But what if there are no symptoms?

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Arkansas doctors have varying opinions on whether grandparents over the age of 65 should be separated from young grandchildren who aren't showing any signs of sickness.

"I think the risk is that children can carry the disease without being symptomatic," said Dr. Rob Williams, chief medical officer for Arkansas Children's Northwest in Springdale. "If it's at all possible, grandchildren and grandparents should stay apart."

He said 6 feet is the "magic distance."

"It's unlikely if someone was to cough that the virus would reach the other person's mucus membranes," said Williams.

Dr. Joel Tumlison agreed that grandparents over 65 should be kept from young children during this pandemic. He is the physician consultant in outbreak response and medical director for child and adolescent health at the Arkansas Department of Health.

"The root of all this is we know that covid-19 is much more serious for the elderly and those with significant chronic medical conditions," said Tumlison.

But the disease is much milder in children, he said, and parents may assume their kids' symptoms are a cold.

Two doctors at the University of Arkansas for Medical Sciences in Little Rock said grandparents and grandchildren don't need to be separated if none of them is showing signs of illness.

"I think the emotional and psychological benefits of families being close together, it's hard to beat that, at least in my mind," said Dr. Robert Hopkins, professor of internal medicine and pediatrics at UAMS.

"I have talked to an awful lot of very stressed people about this," Hopkins said. "I don't think it's a good idea to have a big family gathering ... but if it's a grandparent with one or two of their grandkids, or a parent with a niece or nephew, and they're cautious about not doing those meetings if somebody has respiratory symptoms or a fever and we're careful with hand-washing and not touching faces, then the benefits may outweigh the risks."

And hugs?

"I have a hard a time saying no to that," said Hopkins.

"The challenge we're faced with is how do you mesh science, unknowns, practicality and what makes life worth living," he said. "The joys in our life often for many of us are our kids and grandkids."

Hopkins said he has observed in his own family: "When the kids are not around the grandparents, there is distress. When the grandparents are not around the kids, there is distress."

"I'm sure it is emotionally stressful and hard, but we'd ask people during this time to try other ways to alleviate that emotional stress," said Tumlison, who recommended grandparents and grandchildren visit through Skype or other technological means for the time being.

If only a grandparent is available to care for a child, then it's OK, said Tumlison, but if the child is sick, "they definitely don't need to be around their elderly grandparents."

Dr. Nikhil Meena, a critical care pulmonologist at UAMS, said grandparents and grandchildren don't have to be separated unless someone is symptomatic or has had a known exposure to someone with the coronavirus.

"If either of them have a fever, they should not be around each other," he said. "If there has been a known exposure to covid-19, it's best to stay away for 14-21 days."

According to the U.S. Centers for Disease Control and Prevention, the virus is thought to spread mainly from person to person during close contact, within about 6 feet, through respiratory droplets produced when an infected person coughs or sneezes.

"These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs," according to cdc.gov.

Frequent hand-washing with soap and water, the use of hand sanitizer with at least 60% alcohol and social distancing are recommended as precautionary measures.

Williams said that it probably takes between five and 10 days for people to become sick after being exposed to the virus. They can be contagious for part of that time before being symptomatic and for a few days after feeling well again, he said.

Children aren't likely to have a serious infection from the virus, said Williams.

The elderly, however, are more likely to die from the disease.

According to a report from the Chinese Center for Disease Control and Prevention, the country had 44,672 confirmed cases of covid-19 as of Feb. 11. The case fatality rate was 2.3% overall and 14.8% for patients 80 or older.

Of 171 young patients with covid-19 at Wuhan Children's Hospital in China, 111 were diagnosed with pneumonia, 33 with an upper respiratory tract infection and 27 had an asymptomatic infection, according to a letter from 25 researchers published Wednesday in The New England Journal of Medicine.

"In contrast with infected adults, most infected children appear to have a milder clinical course," it read. "Determination of the transmission potential of these asymptomatic patients is important for guiding the development of measures to control the ongoing pandemic."

Meena said preexisting conditions that put people at greater risk from covid-19 include respiratory abnormalities like COPD, bronchiectasis or lung cancer, or immunosuppression for any reason, including chemotherapy, heart disease, kidney disease and diabetes.

"When covid-19 is doing its worse, it is acting in the lungs, so people with lung disease are at greater risk," Williams said.

Meena said there have been no cases of the virus being passed from a mother to a newborn.

"But health care professionals should still remain cautious once the baby is born," he said. "C-section followed by 14-day isolation is recommended for babies born to mothers with covid-19. Data is limited. Less than 10 deliveries have been studied. In those cases, researchers found no traces of covid-19 in amniotic fluid or cord blood."

Williams said people should be worried but not panic about the coronavirus.

More testing is being done in Arkansas, so more confirmed cases are being announced daily.

"I think there's every reason to believe we have community transmission," Williams said. "I do think we'll get through this, but the reporting every hour on the number of cases we have is probably not helpful."

With spring weather around the corner, Williams said people should get outside and enjoy it, but still avoid crowded areas. He said sunlight and heat are likely enemies of the virus.

"Being outside is really great," said Williams. "It's hard to get your cough to land on any single surface. It doesn't last long outside. Being outside in the warm spring or summer air is going to be helpful."

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