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In Episode 25 of Dr. Dave On Call, we discuss the neurological effects of COVID-19 with Neurocritical care specialist, Dr. Eric Liotta of Northwestern Medicine.Many individuals who have experienced COVID-19 have encountered neurological symptoms. For example, loss of taste and smell have been pathognomonic for the disease. However, many patients have experienced other neurological symptoms such as stroke, malaise, numbness, "brain fog", weakness, etc. We have received much feedback from our listeners regarding their neurological symptoms and thought it would be best to discuss these symptoms with a Neurological specialist, Dr. Eric Liotta. Dr. Liotta is Assistant Professor of Neurocritical Care and Surgery at Northwestern Medicine, Feinberg School of Medicine. He has been on the front lines of the COVID-19 pandemic, treating severely ill patients in the Neurocritical ICU. Further, he has had the opportunity to follow both severely and mildly ill patients in his clinic throughout the pandemic and has valuable insight into the neurological sequelae of COVID-19. We are honored to speak with him.More questions, please visit us:https://drdaveoncall.comEmail us: hello@drdaveoncall.comTweet us: https://twitter.com/drdaveoncall

In Episode 24 of Dr. Dave On Call, we discuss sleep and COVID-19 with sleep specialist, Dr. Beth Malow, Director of the Vanderbilt University Sleep Division. Many individuals suffer from sleep disturbances. Sleep is critical to physical health, our immune system and a key promotor for our emotional and mental health. Adequate sleep can help combat stress, depression and anxiety. The COVID-19 pandemic has provided a "perfect storm" to cause sleep disturbances. Our routines have been disrupted, increase in anxiety/worry, depression, isolation, combined with greater family and work stress. Not to mention all of the excess screen time. We are privileged to discuss the COVID-19 pandemic and how it is affecting our sleep with Dr. Beth Malow, who is a Professor of Neurology and Pediatrics at Vanderbilt University Medical Center. She is also the Director of the Vanderbilt Sleep Division and has tremendous experience treating both children and adults with sleep disorders. More questions, please visit us: https://drdaveoncall.com Email us: hello@drdaveoncall.com Tweet us: https://twitter.com/drdaveoncall

In Episode 23, we discuss the importance of wearing a mask after being vaccinated. A mask is the single most important mitigating technique to prevent the spread of COVID-19, even after being vaccinated. There are 3 central reasons to continue to wear a mask after being fully vaccinated. There are many variants circulating throughout the US, and as predicted the UK variant will be the dominant mutation in the US very soon. Some variants like the South African and Brazilian variant, the vaccine is less effective as protecting ourselves. Therefore, in order to decrease the ability for these variants to spread, we must continue to wear masks after being fully vaccinated. The vaccine does not necessarily protect you from experiencing COVID, it will likely help reduce symptoms. By wearing a mask, you could prevent spreading COVID to other populations who have not been vaccinated yet. Finally, a mask can help prevent the spread of other respiratory droplet illnesses like the influenza that are more common during cold/flu season. We have seen during this Winter 2020, a dramatic decrease in the prevalence of influenza, a large part due to the general population wearing masks. It is extremely important to wear a mask during the pandemic, especially after being fully vaccinated. More questions, please visit us: https://drdaveoncall.com Email us: hello@drdaveoncall.com Tweet us: https://twitter.com/drdaveoncall

In Episode 22 of Dr. Dave On Call, we discuss the COVID-19 variants and the effects on vaccine efficacy with Dr. David Montefiori. Dr. Montefiori is Professor and Director of the Laboratory for AIDS Vaccine Research at Duke University Medical Center. During the COVID19 pandemic, Dr. Montefiori and his colleagues were one of the first scientists to warn about COVID-19 variants. As COVID-19 cases rise, the virus has more opportunity to mutate. Most mutations will be small and have no evolutionary benefit. However, some mutations will cause COVID-19 to adapt, increase its survival to infect others. There are many geographic mutations (i.e. UK, Brazil, South Africa) occurring in the world that result in COVID-19 adapting to improve its survival. These mutations are causing COVID-19 to be easily spread and effect the efficacy of the COVID-19 vaccines. We discuss with Dr. Montefiori how viral variants occur, the status of the COVID-19 variants and how they are affecting the efficacy of the COVID-19 vaccines. More importantly, we discuss the future of possible variants and how we can plan accordingly. More questions, please visit us: https://drdaveoncall.com Email us: hello@drdaveoncall.com Tweet us: https://twitter.com/drdaveoncall

In Episode 21 of Dr. Dave On Call, we revisit pediatric mental health during the COVID-19 pandemic. We welcome back Child-Adolescent Psychiatrist, Dr. Karen Pierce. Dr. Pierce is a Clinical Associate Professor of Child Psychiatry at Northwestern University. She is a Distinguished Life Fellow of the American Academy of Child and Adolescent Psychiatry and the American Psychiatric Association. She is currently in private practice in Chicago, Illinois. The research demonstrates that COVID-19 is affecting the mental health of children and adolescents at an alarming rate and that depression and anxiety are becoming even more prevalent. We are seeing these staggering effects of the pandemic on pediatric mental health all over the world. For example, a survey of 1143 parents measuring the effects of the lockdowns in Italy and Spain, nearly 86% reported changes in their children such as difficulty concentrating and spending more time online and asleep, and less time engaging in physical activity. In China, a study of 2330 schoolchildren found that the rates of anxiety and depression has risen during the pandemic. In the United States, the proportion of Emergency Department mental health–related visits for children aged 5–11 and 12–17 years increased approximately 24%. and 31%, respectively when compared to 2019. It is imperative that we monitor indicators of children’s mental health. We must encourage appropriate coping mechanisms to facilitate resilience. Importantly, we must expand access to critical mental health services to support children’s mental health during the COVID-19 pandemic. More questions, please visit us: https://drdaveoncall.com Email us: hello@drdaveoncall.com Tweet us: https://twitter.com/drdaveoncall

In Episode 20 of Dr. Dave On Call, we discuss the reported 95% effectiveness for the experimental COVID-19 vaccines. There are currently 2 vaccines by the companies Pfizer and Moderna that are reporting 95% effectiveness, an impressive number. Both companies have applied for Emergency Use Authroization to the FDA for approval. Today we are going to discuss the press released data. Of note, this information has yet to be submitted for peer-review. For the purposes of this episode, we will focus on the Moderna data as it is very similar to the Pfizer data. In addition to discussing the reported 95% effectiveness data, we will also use the reported data to answer the following questions: 1)  Does the COVID-19 prevent contracting the disease altogether? 2)  Does the COVID-19 vaccine prevent clinical disease? 3)  Does the COVID-19 vaccine prevent serious disease? More questions, please visit us: https://drdaveoncall.com Email us: hello@drdaveoncall.com Tweet us: https://twitter.com/drdaveoncall

In Episode 19, Dr. Dave On Call-Quick Hits, we discuss the flu vaccine and if it can give you the flu. The seasonal flu vaccine is an important first-line defense to protect humans again the influenza virus. This year, it will be especially important to receive the flu vaccine during the COVID-19 pandemic. How do flu vaccines work? They cause antibodies (proteins) to develop in our bodies about 2 weeks after vaccination. These antibodies provide protection against the influenza strains contained in the vaccine. The CDC recommends that people ages 6 months and older to receive the seasonal influenza vaccine each season. There are many different types of flu vaccinations available for the general public, please ask your health care provider which specific type of vaccine would be suitable for you. Can you get the flu from the flu vaccine? The answer is no. However, there are several reasons why someone could encounter flu-like symptoms after receiving the flu vaccine. First, someone could become ill from other respiratory viruses beside influenza, like the common cold (rhinovirus). Second, someone may have been exposed to influenza shortly before being vaccinated, and not enough time for antibody production to develop immune protection. Third, a person may be exposed to a type (strain) of influenza that was not included in the flu vaccine. Finally, in rare instances, a person does not develop appropriate antibodies to prevent influenza infection. Do your part and help prevent the spread of influenza, get a flu shot, it could save your life and the life of others! More questions, please visit us: https://drdaveoncall.com Email us: hello@drdaveoncall.com Tweet us: https://twitter.com/drdaveoncall

In Episode 18, we begin Dr. Dave On Call-Quick Hits and discuss the purpose of a Stay-At-Home Order. In the United States, we are recording about 150K COVID-19 cases on a daily basis, and in the next month or so, we should likely be over 200K daily. In addition, our average hospitalizations around 50K admissions throughout the country. Obviously, there are places in the US that are faring better and some worse than other places. North and South Dakota, Wisconsin and Illinois are faring poorly, whereas some areas in the Northeast are doing a little better. As cases are rising so quickly and community spread is so rampant, more talk of “shutting down” or enacting “Stay-at-Home order” becomes more apparent in the media and even during public health official briefings. We discuss the central thesis behind a Stay-At-Home Order and why they will likely be needed in some areas of the United States as the COVID-19 pandemic worsens during the Fall 2020 season. More questions, please visit us: https://drdaveoncall.com Email us: hello@drdaveoncall.com Tweet us: https://twitter.com/drdaveoncall

In Episode 17 of Dr. Dave On Call, I discuss my experience in the Moderna COVID-19 vaccine trial. This episode has been a culmination of about 2 months of my observations while participating as a research subject in the Moderna mRNA-1273 COVID-19 vaccine trial. The trail is named the COVE Study, it's an acronym for Coronavirus Efficacy and Safety Study, and the name implies protection from COVID-19, as a "cove" can be thought of a sheltered inlet. The goal of the COVID-19 vaccine study is to understand if the mRNA-1273 study vaccine can prevent COVID-19 (efficacy) and if the study vaccine is safe. In general, the purpose of vaccines are prepare our immune system to fight infection and prevent illness. Following an effective vaccine, our immune system will produce antibodies (special proteins) that will recognize and other pathogens and make them harmless to our bodies. About 30,000 people in the Unites States will take part in this study at about 80-100 research sites. The particular research site that I am enrolled in is at The University of Illinois Health System, Division of Infectious Diseases coordinating by Project WISH. The Principal Investigator is Dr. Richard Novak, Chair of Infectious Diseases at the University of Illinois Health system. He has dedicated his entire professional career at research treatments for emerging infectious diseases. I would really encourage you to listen to Episode 14 of Dr. Dave On Call, where we discuss the Moderna mRNA-1273 vaccine trial in greater depth with Dr. Novak. I participated in this trial for a variety of reasons. First, I felt that I would be an ideal candidate to study the effectiveness of a COVID-19 vaccine. I am a minority, health worker with 2 children who are currently receiving in-person learning, therefore I am potentially exposed to COVID-19 more frequently. I believe that my contribution of scientific data would help answer key questions about this vaccine on a larger public health scale. As an Allergy-Immunology specialist, I have a unique understanding of vaccines and this trial would be an educational experience for myself. Further, I had a tremendous example in my mother, who participated in many experimental trials while she was being treated for acute leukemia, knowing that she was contributing for the greater knowledge of medical science. Participation in the study is a big commitment; 6 in-person visits, 25 safety telephone calls, app surveys over a period of 25 months. Also, if a subject is diagnosed with COVID-19 there are extra visits associated with it as well. After completing the screening process, we scheduled my first appointment for September 3, 2020. I reviewed the 24 page consent form, had a few additional questions about the potential side effects and signed the consent form and was officially enrolled. The 1st visit was intense and long, over 3 hrs filled with medical examinations, blood draws, etc. Finally, I was assigned a unique patient number and the COVID-19 vaccine was delivered for injection. This study is a Double-Blind Placebo Controlled trial; both the subjects and researchers do NOT know if a placebo vaccine (saline) or the experimental vaccine is given to the research subjects. Further, it's a random assignment, a flip of a coin to determine if the placebo or experimental is given. I received my first injection on September 3, 2020 and was confident during the first few days, I received the experimental vaccine. I had some of the common symptoms (headache, fatigue, injection site pain) that were listed in the consent form. They resolved with supportive care. However, at Day 9, I developed unusual gentito-urinary symptoms that were extremely painful and concerning. These symptoms progressively worsened throughout the next 10 days that necessitated a visit to a Urological specialist, who diagnosed me acute non-bacterial prostatitis. After discussing with the research team, Dr. Novak and...

In Episode 16, we discuss the COVID-19 saliva test with creator, Dr. Martin Burke, Professor of Chemistry at the University of Illinois at Urbana-Champaign (U of I). During the Spring of 2020, as the majority of the United States were sheltering in place and students at colleges/universities were learning remotely, The University of Illinois began to formulate a plan for re-opening their university in the Fall 2020. The university recognized that in order to successfully reopen their campus for in-person learning, they needed to create a testing platform that could test all students multiple times weekly. Dr. Burke and his colleague, Dr. Hergenrother were approached by university leadership to create a novel COVID-19 test. They determined that using the patient's saliva as the testing source instead of the conventional nasal swab test, they could scale and deploy the new testing platform efficiently. Through a collaborative effort of many scientists, university officials, faculty and staff, Dr. Burke and his team accomplished this amazing scientific feat. By late summer, 2020, the I-COVID saliva test that Dr. Burke and his colleagues created received EUA authorization by the FDA and they are now running almost 15,000 COVID-19 tests daily on campus (almost 2% of daily US tests) The I-COVID saliva test is an RNA-based saliva test, that skips the RNA isolation step, which is a very expensive and slow step. This allows the I-COVID test to bypass many bottlenecks of the standard nasal swab COVID-19 testing. Further, the I-COVID test uses standard testing equipment which allows the process to be easily duplicated by other labs throughout the United States. The U of I campus in Urbana-Champaign implemented the I-COVID saliva testing into their Shield T3 Program. This innovative testing program tests all students and faculty on campus twice weekly and returns their results in under 24hrs of reporting to an application on their phone. In order to enter a university building, students and faculty must produce proof that they are compliant with testing. Further, if a COVID-19 positive diagnosis is made, rapid identification with quarantine and contact tracing are implemented. The I-COVID saliva testing platform that Dr. Burke has created is highly sought after by many other universities and companies throughout the US and world. The following are a few distinct advantages with the I-COVID testing platform: 1) Eliminate testing bottlenecks observed with standard nasal swab COVID-19 testing 2) No nasal swab use, only saliva 3) Cheaper test, faster results 4) Safer for workers handling the test (heated at high temperatures to inactivate the virus) Dr. Burke is optimistic the U of I campus can remain open for in-person classes during the COVID-19 pandemic. However, there are always challenges that they will continue to address. More questions, please visit us: https://drdaveoncall.com Email us: hello@drdaveoncall.com Tweet us: https://twitter.com/drdaveoncall

In Episode 15 of Dr. Dave On Call, we interview forgiveness therapy expert, Dr. Fred Luskin. We discuss forgiveness and its profound impact on our health and well-being. Dr. Fred Luskin is the Director of the Stanford University Forgiveness Project. His extensive research centers upon the training and measurement of forgiveness therapy, and he is the author of Forgive for Good: A Proven Prescription of Health and Happiness. Dr. Luskin's research into forgiveness therapy has influenced both the psychological and medical sciences. He has worked with many patients of different backgrounds and experiences. For example, he lead the HOPE 1-2 projects. Families who experienced profound loss in war-torn Northern Ireland (both Catholic and Protestant) received forgiveness therapy and benefited both psychologically and medically. He defines forgiveness as "the experience of peace and understanding that can be felt in the present moment.” Forgiveness can be achieved by allowing oneself to feel hurt less personally, take responsibility for how one feels, and to become a hero instead of a victim in the story you tell. Dr. Luskin describes that in order for us to understand the process of forgiveness we must address our grievances-an unwanted event that "rents too much space" in our minds. Further, if we try to enforce unenforceable rules, we will continue to write "mental tickets" to punish the once who acted wrongly. However, the only person we end up hurting is ourselves. We clog up our minds with these tickets. We can practice forgiving by implementing many physical techniques such as Positive Emotion Refocusing Technique (PERT), Heart Focus and Breath of Thanks. Further, we can challenge our unenforceable rules. For example, we can recognize when one is upset in the present and not yesterday. Importantly, if we change our grievance story to a hero's story we can reconnect to our goals. As the Northern Ireland patients who suffered traumatic loss in their lives, their goal was to achieve a loving family. Dr. Luskin describes the 4 stages of becoming a forgiving person: 1) Self-justified anger after being hurt 2) We realize that our hurt or anger doesn't feel good 3) We remember how good it felt the last time we were able to forgive 4) You simply become a forgiving person (rarely take offense) Citations: Luskin, F. Forgive for Good: A Proven Prescription for Health and Happiness. ISBN: 9780062517210. More questions, please visit us: https://drdaveoncall.com Email us: hello@drdaveoncall.com Tweet us: https://twitter.com/drdaveoncall

In Episode 14 of Dr. Dave On Call, we discuss the Phase 3 COVID-19 vaccine trial of Moderna lead by Dr. Richard Novak, Chief of Infectious Diseases at the University of Illinois at Chicago. Vaccines are responsible for eradicating many diseases that were historically responsible for excessive morbidity and mortality in many populations. For example, the WHO estimates that the measles vaccine prevented an estimated 23.3 million deaths from the years 2000-18.     The goal of a vaccine is to activate our immune system. The lymphocyte cells of our immune system produce antibodies to a particular virus (or bacteria, fungi, etc). These protein antibodies recognize viruses and destroy them in an efficient process. Vaccines prepare the immune system to fight a particular disease without exposing the body to the disease symptoms. Some vaccines, like the chickenpox vaccine, can produce long-lasting, sustained immunity and only require periodic “booster” vaccines to provide durable immunity. Other vaccines, like the influenza vaccine, provide shorter-term immunity, and require more frequent schedules of vaccination. The COVID-19 vaccine development is occurring at a rapid pace. Through aggressive government and private partnerships, the creation of the COVID-19 vaccine will have occurred in a faster time period than any other vaccine ever created. Typically, the creation and development of a vaccine can take many years. However, with the use of tremendous funding, new technology and pooling of scientific resources, the development of the COVID-19 vaccine has occurred at “warp speed”.  The hope is to create, develop and deploy multiple, COVID-19 vaccines in about 12 months.  Dr. Richard Novak, Chief of Infectious Diseases at the University of Illinois at Chicago is one of the lead investigators for the Phase 3 mRNA COVID-19 vaccine trial by Moderna. Dr. Novak has dedicated his professional life to fighting infectious diseases and his research over the many decades has led to significant medical advances in the fight against HIV/AIDS and other emerging pathogens. His double-blind placebo controlled Phase 3 trial of the mRNA COVID-19 vaccine seeks to enroll 1000 patients. We are excited to discuss his trial today and are extremely appreciative of his service during these difficult times. More questions, please visit us: https://drdaveoncall.com Email us: hello@drdaveoncall.com Tweet us: https://twitter.com/drdaveoncall

In Episode 13 of Dr. Dave On Call, we discuss food insecurity during the COVID-19 pandemic. We speak with Jennie Hull, Director of Programs at the Lakeview Pantry, Chicago's oldest and largest food pantry. The United States Department of Agriculture estimates that 1 in 9 Americans are food insecure, roughly 37 million Americans, inclusive of 11 million children. "Food insecurity" is defined by the USDA as a "lack of consistent access to enough food for an active, healthy life." Food insecurity refers to a lack of available financial resources for food at the household level. Hunger differs from food insecurity, as it relates to a personal, physical sensation of discomfort. Food insecurity is a complex problem, as it affects many individuals of different ages, races and geographic areas. Moreover, food insecurity is not an independent problem, as families with food insecurity are affected by issues of lack of affordable housing, social isolation, food deserts, chronic health conditions and low wages. Food banks play a vital role in providing more security to those in need of food. For example, the Feeding America Intervention Trial for Health-Diabetes Mellitus (FAITH-DM) trial took place between 2015-17 within 3 large cities in the Unites States. This trial sought to determine the effectiveness of food-bank interventions and improving blood sugar control in those with uncontrolled diabetes mellitus. Intervention group participants who full engaged has significant improvements in there HbA1c (long-term blood sugar control) compared to less engaged participants. With the COVID-19 pandemic, there has been an explosion of food need as many families have lost their incomes. Nearly 1 in 6 people in Chicago struggle with poverty and food insecurity. For almost 50 years, the Lakeview Pantry has been an invaluable resource to the North Side of Chicago, and ensures low-income residents have enough to eat and have access to critical/life-saving social services. On a yearly basis, they serve almost 9000K unique clients with over 40000 site visits each year. Jennie Hull of the Lakeview Food Pantry leads the client facing work including food distribution, social services and mental health programs. Sources: https://www.ers.usda.gov/webdocs/publications/94849/err-270.pdf?v=963.1 https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/definitions-of-food-security.aspx https://hungerandhealth.feedingamerica.org/understand-food-insecurity/ More questions, please visit us: https://drdaveoncall.com Email us: hello@drdaveoncall.com Tweet us: https://twitter.com/drdaveoncall

In Episode 12 of Dr. Dave On Call, we interview New York Times best-selling author, John M. Barry. We discuss his book about the 1918 Influenza pandemic and its parallels to the COVID-19 pandemic. Mr. Barry's 2004 book, entitled, "The Great Influenza: The story of the deadliest pandemic in history", is a vivid and frightening account of the emergence, transmission and control of the 1918 influenza pandemic. It is estimated that an upward of 100 million people in the world died from influenza during the pandemic, 65 million people died in the United States. The 1918 influenza pandemic has relevant parallels to the current COVID-19 pandemic-it was a novel virus that affected the entire world. Currently, only a small percentage of people in the world have immunity to COVID-19, which leaves the majority of the world's population at risk for exposure and infection. We discuss Mr. Barry's detailed historical account of the evolution of the influenza pandemic and how it provides insight into a possible COVID-19 2nd wave of infections. The explosion of scientific discoveries during the 1918 pandemic has a similar parallel to our current desire for COVID-19 therapeutic and vaccine discoveries. The COVID-19 pandemic has forced our society to engage in extensive mitigation behaviors that has caused our world's economy plunge into a global recession. The subsequent political climate has been extremely tense, similar to the 1918-19 environment. Moreover, as countries and US states are pressured into reopening to preserve economic viability, COVID-19 cases continue to worsen. With the recent social justice protests throughout the world, health and government officials are on edge for outbreaks to occur. All of these current situations represent an eerily similarity to the 1918 influenza pandemic. John Barry's historical insight into the 1918-19 influenza pandemic provides a scholarly opinion on the parallels and future direction of the COVID-19 pandemic. More questions, please visit us: https://drdaveoncall.com Email us: hello@drdaveoncall.com Tweet us: https://twitter.com/drdaveoncall Call us and leave us a voicemail: 1-877-DrDave5

In Episode 11 of Dr. Dave On Call, we discuss the COVID-19 response in the Illinois prison system with Dr. LaMenta Conway, Deputy Chief of Medicine for the Illinois Department of Corrections. The Marshall Project has been tracking how many people in each US state have been sickened and killed by COVID-19 in prisons. As of May 27, there have been roughly 35,000 cases among prisoners with about 18,000 reported recovered. Jails are high-risk populations, as it can be difficult to implement physical distancing within the population because of finite space for inmates. Further, many prisoners have high-risk underlying conditions like lung disease, diabetes, heart disease or their immune systems may be compromised. The infrastructure of jails are varied by the states and counties they reside in. For example, in some prisons, extensive testing, tracing and mitigation efforts have been implemented on a large scale level to combat the spread of COVID-19. There are other groups of people who are at risk in these facilities, such as correctional officers, nurses, chaplains and wardens. These are also a potential source of COVID-19 and specific policies need to be implemented with these groups of individuals so that they may not be the source of spread to prisoners. Dr. LaMenta Conway outlines the Illinois Department of Corrections (IDOC) aggressive COVID-19 pandemic response and discusses the specific policies and programs IDOC has implemented to address the COVID-19 pandemic in the jail system. The IDOC instituted an administration quarantine early on during the COVID-19 pandemic in order to keep inmates safe from the disease. This means a reduction of normal movement for prisoners, like time outside and in communal areas. A creation of a medical quarantine was necessary as well, to isolate those individuals who were COVID-19 positive. As the number of prisoners who were testing positive, "tent cities" were imperative for to separate COVID-19 positive patients from the general prisoner population. Moreover, specific care locations were created for high-risk prisoner patients. The Illinois Department of Corrections took early steps to prepare for the COVID-19 pandemic. Their mitigation efforts in conjunction with PPE and sanitization use, coupled with source control allowed IDOC to control the COVID-19 cases within prisons. Further, the use of medical furloughs provided a reduction in non-violent prisoners, to reduce the possibility of COVID-19 infections. Earned discretionary credit also provided early-release for prisoners as well. Increased testing and contact tracing have been fundamental processes to control the spread of COVID-19 in Illinois prisons. Sources: https://www.themarshallproject.org/2020/05/01/a-state-by-state-look-at-coronavirus-in-prisons More questions, please visit us: https://drdaveoncall.com Email us: hello@drdaveoncall.com Tweet us: https://twitter.com/drdaveoncall Call us and leave us a voicemail: 1-877-DrDave5

In Episode 10 of Dr. Dave On Call, we discuss with 2 pediatric specialists, Multi-system Inflammatory Syndrome in Children and its association with COVID-19. Multi-system Inflammatory Syndrome in Children (MIS-C) has emerged as a concerning syndrome during the COVID-19 pandemic. Recently, the CDC issued a health care provider alert explaining the background information on several cases of reported MIS-C associated with COVID-19 and also provided a case definition for this syndrome. We discuss MIS-C with Dr. Melissa Tesher, a pediatric rheumatology specialist and Dr. Julia Rosebush, a pediatric infectious disease specialist. Both physicians are Assistant Professors of Pediatric Medicine at the University of Chicago Medicine, Comer Children's Hospital, Chicago, Illinois. Both have treated cases of MIS-C during the past 2 months. The following background of MIS-C will be important to our discussion on how clinicians quickly recognized this association with COVID-19. Toward the end of April 2020, doctors in the UK recognized that previously healthy kids were presenting to pediatric ERs and ICUs with a severe inflammation syndrome that had features of Kawasaki disease-like features. Kawasaki’s disease is an illness that was first described by Dr. Tamisaku Kawasaki of Japan in 1967, of an unknown etiology. Kawasaki's disease primarily affects children that are younger the 5-6 years of age. Clinical signs include fever, rash, swelling of the hands and feet, irritation/redness of the eyes, swollen lymph glands and the neck and irritation and inflammation of the mouth, lips and throat. Serious side effects of Kawasaki’s disease include inflammation of blood vessels, specifically of the heart that can cause coronary artery dilations and aneurysms. Treatment for Kawasaki’s disease is IVIG, aspirin and sometimes systemic steroids.  As UK doctors recognized the increasing cases of healthy children who with severe inflammation with Kawasaki disease-like features, these children also tested positive for COVID-19 active or recent disease. Their symptoms included low blood pressure, multiorgan dysfunction and elevated inflammatory markers, but not one child had respiratory symptoms. The UK described eight cases, one of which died and all tested positive for COVID-19. In early May 2020 in New York City, there were multiple reports of MIS-C in children and as of May 12, there were a reported 102 cases of MIS-C, many of whom tested positive for COVID-19. According to the CDC, the case definition for MIS-C is as follows: Less than 21 years of age, presenting with: a) fever b) lab evidence of inflammation c) clinically severe illness affecting 2 or more major organ systems AND no other plausible cause AND current or recent diagnosis of COVID-19 within 4 weeks of presentation. We know that MIS-C is a rare condition and that pediatric patients who are diagnosed early and treated aggressively do very well. Currently, we are still assessing the association of COVID-19 and MIS-C. This disease may be caused by a post-inflammatory process initiated by COVID-19, and more research will need to be conducted in the future to determine if the association between COVID-19 and MIS-C is strong or weak. Through the guidance of experienced clinicians like Dr. Tesher and Dr. Rosebush, they can provide helpful information to public health entities so that parents can be prepared for particular warning signs of MIS-C, as early diagnosis is paramount. We thank Dr. Tesher and Dr. Rosebush for their immense service to our pediatric patients and helping us navigate an aspect of the COVID-19 pandemic. Citations: https://emergency.cdc.gov/han/2020/han00432.asp

In Episode 9 of Dr. Dave On Call, we interview Andrew Coffield, who describes his near-death experience with COVID-19. He details his initial symptoms, how quickly his conditioned worsened as he spent days intubated in the intensive care unit. Andrew's conditioned improved and he provides some insights into his recovery from COVID-19. Andrew Coffield is a healthy 29 year old with no pre-existing health conditions. When the COVID-19 pandemic hit the Midwest, he decided to shelter-in place near his family in Michigan. Upon arriving, he noticed a feeling of shortness of breath after playing a routine basketball game with family members. Shortly thereafter, he started to develop high fevers, body aches and worsening shortness of breath that progressively worsened over the course of a few days. His mother, a nurse, assessed his physical health and determined that he should seek medical assistance in the emergency room at a local hospital. Andrew describes his harrowing experience in the emergency department, as his respiratory status declined very quickly. The supplemental oxygen he was receiving was not helping. He was subsequently transferred to the ICU and a decision was made with him and his treatment team for intubation. After a number of days intubated, Andrew describes in detail how he awoke with the breathing tube in his throat, trying to gather the strength to breath on his own. He describes the overwhelming encouragement he received from his treatment team and family. He was successfully extubated and details his long and arduous journey to hospital discharge. The road to recovery is still ongoing and Andrew thanks the countless health care professionals who have assisted him along his harrowing survival story of COVID-19. More questions, please visit us: https://drdaveoncall.com Email us: hello@drdaveoncall.com Tweet us: https://twitter.com/drdaveoncall Call us and leave us a voicemail: 1-877-DrDave5

In Episode 8 of Dr. Dave On Call, we discuss the disproportionate burden of COVID-19 on ethnic minorities with Dr. Kiarri Kershaw, Associate Professor of Preventive Medicine at Northwestern University Feinberg School of Medicine whose speciality is Social Epidemiology. The COVID-19 pandemic has highlighted a disturbing trend in the COVID-19 mortality rate; African-Americans and other ethnic minorities are dying at a disproportionate rate compared to other ethnic racial groups. This alarming statistic can be better explained using data from Cook County, Chicago, Illinois. African-Americans and other ethnic minorities have considerable challenges in achieving access to health care resources within their communities. Moreover, there is a lack of public funding for specific programs to address access to health care. This contributes to economic and social conditions that predispose African-Americans and other ethnic minority groups to chronic conditions like diabetes, heart disease, hypertension and also infectious diseases like COVID-19. Through our analysis of extensive data, we know that COVID-19 affects patients with chronic conditions more seriously compared to those patients without pre-existing chronic conditions. African-Americans and other ethnic minority groups are more likely to hold service-sector occupations that are deemed essential-services. Therefore, these individuals cannot work from home and also must utilize public transportation to their jobs and are therefore at greater risk of contracting COVID-19. When African-Americans and ethnic minorities become sick with COVID-19, many of their occupations do not provide sick/hazard pay without a confirmed diagnosis, which may be difficult to obtain in some circumstances. This places additional financial burden on these individuals to continue to work through their COVID-19 illness. Further, many African-Americans and other ethnic minorities live in large households. Self-isolation after being diagnosed with COVID-19 becomes very difficult as well as the ability to quarantine. In order to address the disproportionate burden of COVID-19 on ethnic minorities, we must continue to advocate for greater policies to address these health disparities. For example, the City of Chicago, under the guidance of Mayor Lori Lightfoot, has created multiple Response Teams deployed to specific neighborhoods where ethnic minorities are disproportionately affected by COVID-19. The data-informed strategies are designed to reduce the transmission of COVID-19 and improve health outcomes in these specific neighborhoods of high COVID-19 disease burden. If we can create targeted policies and strategies to address the disproportionate burden of COVID-19 on ethnic minorities, we can help address these health disparities both in the near term and longer term, should another infectious epidemic/pandemic occur in the future. More questions, please visit us: https://drdaveoncall.com Email us: hello@drdaveoncall.com Tweet us: https://twitter.com/drdaveoncall Call us and leave us a voicemail: 1-877-DrDave5

In Episode 7 of Dr. Dave On Call, we discuss pediatric mental health during the COVID-19 pandemic with Child-Adolescent Psychiatrist, Dr. Karen Pierce. Dr. Pierce is a Clinical Associate Professor of Child Psychiatry at Northwestern University. She is a Distinguished Life Fellow of the American Academy of Child and Adolescent Psychiatry and the American Psychiatric Association. She is currently in private practice in Chicago, Illinois. The COVID-19 pandemic has been challenging for all of us, including children/adolescents. Family members should be aware of that their child(ren) may be experiencing mental health distress. Usually, they will not be able to verbalize their concerns. Their mental health distress may include exhibiting maladaptive behaviors like acting out, arguments, and distancing themselves. As the majority of us are mitigating in our residences, it is important that we utilize our own physical space during times of distress, especially during conflict resolution. This defined "safe space", can create security, a time to decompress and regulate our emotions. As schools are now reliant on distance-learning platforms, we should understand that this added screen time can actually have a positive role in our children's' development. Further, we should understand that this increased screen-time for learning will not lead to maladaptive or sedentary behaviors. This learning process may actually provide an opportunity for collective learning at home with the family. It may be difficult to convey the importance of physical distancing with adolescents, as they have a strong desire for connections with their peers and significant others. However, we must be very clear the health risks of failing to physically distance themselves with non-family members. As adults and supportive family members, The American Academy of Child & Adolescent Psychiatry recommends that we: -Be open and supportive so children/adolescents can ask questions. -Be authentic about the uncertainty surrounding the COVID-19 pandemic. -Reassure children/adolescents that it is acceptable to have fears about this uncertainty. -Reassure our children of their personal safety and immediate family members. -Don’t overwhelm them, but be realistic. More questions, please visit us: https://drdaveoncall.com Email us: hello@drdaveoncall.com Tweet us: https://twitter.com/drdaveoncall Call us and leave us a voicemail: 1-877-DrDave5

In Episode 6 of Dr. Dave On Call, we discuss the fundamental tasks to safely open our economy in the COVID-19 pandemic before the availability of vaccines. In addition to implementing physical distancing measures, we will need the necessary PPE (personal protective equipment) for employers to distribute to their employees. This includes masks (ie. surgical, N95), gloves and other job specific PPE. For example, a hairdresser/barber may need disposable capes to be used for every client, therefore, this specific equipment will needed to be made produced and available. We will also need appropriate hand-washing stations with soap and hand-sanitizer needs to be available for all workers. This concept may seem obvious, however, there can be shortages in the supply chain to potentially disrupt workplace safety. Next, we need to deploy a valid, Rapid COVID-19 test at a large scale. This would allow employers to test employees regularly to ensure daily safety in the workplace. The test would be a quick and non-invasive, either through a small sample of blood, swab or saliva. Results from this rapid test would be available within minutes to determine if an employee had COVID-19, and if so, appropriate measures could be implemented to secure the workplace environment. For example, if an employee's Rapid COVID-19 test is positive, the employer must ensure that they self-isolate and receive the care they would need. If the employee cannot safely self-isolate at home, the employer could arrange a safe location (ie. hotel) to stay while self-isolating. The Rapid COVID-19 test must be valid, to ensure that if an employee tests positive, they truly have COVID-19 (true positive), and if an employee tests negative, they truly do NOT have COVID-19 (true negative). We will also need a valid COVID-19 antibody test to help identify employees who have been exposed to COVID-19. Currently, we do NOT know the level of antibodies needed to be protective against COVID-19. Large population studies will be needed to determine the appropriate level of protection against COVID-19. However, an COVID-19 antibody test could help an employer determine which employees are at higher risk of susceptibility. For example, assuming that COVID-19 antibodies are protective, we could identify those employees who are at greater risk of contracting COVID-19 (absence of COVID-19 antibodies). This could be helpful for employers who implement a work-from-home strategy. Employers could arrange for lower-risk employees to enter the work environment, while keeping higher-risk (ie COVID-19 antibody negative) employees at home. This strategy could also be implemented in a health-care setting, where COVID-19 antibody negative employees only work with non-COVID-19 patients. More questions, please visit us: https://drdaveoncall.com Email us: hello@drdaveoncall.com Tweet us: https://twitter.com/drdaveoncall Call us and leave us a voicemail: 1-877-DrDave5