Unbabbled: Coronavirus Resources (Part 1)

Keeping Your Family Healthy and Safe

This is a bonus episode recorded on March 12, 2020 with pediatrician Rob Crowe, MD, in response to the recent concerns around the novel coronavirus known as COVID-19. In this episode, Meredith Krimmel and guest co-host Amy Tanner speak with Dr. Crowe about COVID-19, how it differs from other viruses, and ways to keep your family healthy and safe.

About Dr. Rob Crowe

Dr. Crowe has been a pediatrician for 20 years, spending eight of those years with the army. For the last three years, he has also practiced functional medicine. Dr. Crowe recently opened a new practice in Houston called Zenith Health.

Resources

Helpful Links

Stephanie (00:05):

Hello and welcome to Unbabbled, a podcast that navigates the world of special education, communication delays and learning differences. We are your hosts, Stephanie Landis and Meredith Krimmel and we're certified speech language pathologist who spend our days at The Parish School in Houston, helping children find their voices and connect with the world around them.

Meredith (00:26):

This episode of Unbabbled was recorded on March 12th, 2020 in response to the recent concerns around the novel coronavirus known as COVID-19. The information provided is based on reports and research available at the time of recording. In this episode, special guest host Amy Tanner and I sit down with Dr. Rob Crowe to discuss the novel coronavirus known as COVID-19 Dr. Crowe has been a pediatrician for 20 years, spending eight of those years with the army for the last three years. He has also practiced functional medicine. We are happy to have him as a guest in this timely episode, not only because he is an established medical doctor but he is also a father of five and grandfather of two. His youngest child, Joshua is a student at The Parish School. Dr. Crowe has recently opened a new practice in Houston called Zenith Health. Be sure to subscribe to Unbabbled in the podcast platform of your choice, as we will be releasing an additional episode featuring our directors of early childhood and elementary, discussing ways to keep your child engaged in learning in the event of an extended school closure.

Meredith (01:30):

Hi, we're here with Dr. Crow. Dr. Robert Crowe is a pediatrician and today we're going to speak with him in this special episode about COVID-19. Thanks for being here.

Rob (01:39):

Thanks for having me. Appreciate it.

Meredith (01:41):

Of course. And I have with me a special guest co-host today, Amy Tanner, the director of advancement. Amy, thanks for being here.

Amy (01:49):

Hey, thanks. Glad to be here. My dreams are coming true.

Meredith (01:52):

You're on a podcast, so we thought it was important to sit down with Dr. Crowe today to talk about COVID-19. It's a huge topic in our community right now and we have families who might be feeling a little anxious. So we just wanted to get a little more information. So, Dr. Crowe, can you tell us what do you know about COVID-19 and what should we know about COVID-19

Rob (02:15):

Great question. Just to give you a little bit of my background. I am a pediatrician. It's been about 20 years. I've practiced both as a civilian and in the army. So I did get a chance to uh, see things outside of the pediatric realm. And then most recently I've been studying in functional medicine and I'm completing my training in functional medicine over the last three, four years. And so we're going to hear something about that too in regards to COVID-19. But in general, COVID-19 is a Coronavirus. That's a cold virus. We see these types of viruses every season, every time cold and flu season comes around. One of the viruses circulating is a coronavirus. It just so happens that at times, these viruses change. And at this point, this is a virus that we have not had any experience with immunologically. So COVID-19, like SARS or MERS is another offshoot, if you will, from the coronavirus. We have seen two now morphing to something that we have no experience with.

Meredith (03:18):

Where do you think families could find reputable information about COVID-19?

Rob (03:21):

The CDC website is always a great reference point. Also, there is information going out state by state. So probably for the general lay of the land, the CDC, if you're looking for a worldview view, then WHO, the world health organization. And more locally there'll be information coming out from our local and state governments.

Meredith (03:43):

I think as parents, our biggest concern about COVID-19 is protecting ourselves and our children. What can we do to protect our families and the people in our community?

Rob (03:53):

Well the interesting part about all this is that, uh, this is not unlike being prepared for and making sure you're safe from any viral infection. It's just because of what we've heard. And we'll talk a little bit more about how COVID-19 compares with some other viruses with which you're familiar, that this is just heightened our understanding of what we should be doing all along. And those things would include mainly the fact that these viruses are spread by respiratory droplets. So basically people's coughs and sneezes. These droplets don't get transmitted very far. So far it looks like three to six feet and so everyone is using the six foot mark, which I think is probably an overestimation. This is not an airborne virus or airborne infection such as tuberculosis. So these viruses usually drop, they're heavy, they drop by way of gravity fairly quickly onto the surfaces that we're all around.

Speaker 2 (04:54):

Being aware of what we're doing with our coughs and sneezes I think is an important part. So coughing in one's elbow is an excellent way of doing that. If one's going to cough or sneeze in a tissue, then making sure your hands are washed or use sanitizer thereafter. And placement of our hands is also of importance. So touching surfaces we have to be aware of and also touching ourselves. So most of the time the typical way one gets exposed is by hand to face type of motion. So one has touched something, a doorknob, a desk, keyboard, and then touches our face, our eyes, nose or mouth.

Meredith (05:36):

And so the virus can live on surfaces. Do we know how long it can live on surfaces?

Rob (05:39):

You know, that's a good question. I, I don't know. I'm not an epidemiologist nor an infectious disease specialists, but, um, my gestalt, and I may be proven wrong, would be hours to days perhaps, but, uh, usually within hours. But like I tell my patients, uh, they've got history in period. They have no idea what happened to the desk in first period, what happened at the desk and second period. So to be aware of what they're touching in third period because that surface, their desk could have been coughed and sneezed upon just within hours. Right.

Amy (06:12):

It seems to be, there's a lot of anxiety around this, uh, virus, especially if it is, you know, similar to a common cold or an influenza. Can you talk a little bit about that?

Rob (06:21):

Sure. I think this is a great time to talk about some viruses with which we're familiar and then how this compares in contrast to this. So yes, coronavirus is a cold and flu virus. This virus happens to be particularly nasty. So first varicella, that's the virus that causes chickenpox. We are aware through our experience with this virus that it's very easily transmitted from one person to the next. Pretty much one child in a family or in a classroom has chickenpox. Then pretty much everyone in that household or classroom is going to have chickenpox. The transmissibility rate is about 90% so it's very high. The upside is that it's not very deadly, although we probably all bear scars. The older ones of us from chickenpox, the lethality rate is pretty low, so post vaccination era, I have some data here from 1996 to 2013 there were 83 deaths, so very few and far between. So that's one virus, highly transmissible, really not that deadly. And now we talk about influenza. Influenza is something that is, we have huge numbers of cases. This is very pervasive. It's estimated by the CDC. We have somewhere between 34 and 49 million cases of influenza this season and the season's not over. It's still highly active with a transmission rate and it differs. I average it about 20% so approximately that would maybe extrapolate to 150 million people have been exposed to influenza this season depending upon how one looks at the data. Twenty thousand fifty two thousand deaths have been attributed to influenza with 136 of those thus far being pediatric cases. So the mortality rate is somewhere around 0.1% we have varicella, highly transmissible, not deadly. We have influenza much more transmissible, but again, not very deadly. That's good in as much as we are exposed to those. Now with COVID-19 currently in the US 1,135 cases last I looked this morning with a 30 some deaths for a mortality rate of about 3% so that's where the hubbub comes from is that the rate of mortality is pretty high compared to both of those 0.1% for influenza, 3% for COVID-19 and if there is a shiny lining at any of this, it's that uh, the transmission rate is still being worked out, but somewhere between one and 5%. So an exposure 95% of the time or more does not equal an infection. So that's good to know.

Meredith (09:00):

That's surprising. I feel like what I hear on the news is if you've been exposed, you're going to get it.

Rob (09:05):

Maybe that's just not born out in the data as it stands and that's going to continue to change probably because we are getting new data every single day, but it's not as advertised if you will. And the other upside certainly would be the fact that whereas influenza has been particularly troublesome for the pediatric population this year, especially influenza B, that there's only 2% of the cases of COVID-19 that are occurring in our pediatric population.

Meredith (09:35):

So who is at most risk for COVID-19

Rob (09:38):

Definitely those that are older and those that have comorbidities and that term that maybe some people don't know comorbidities would be you have some underlying health disease already. Diabetes being very commonly quoted, one other respiratory ailments like CUPD, asthma, cardiovascular disease, hypertension and so forth.

Meredith (09:59):

So those of us who have children with asthma, do we need to be taking extra precautions with them?

Rob (10:04):

Certainly the risk it would seem if you were to extrapolate would be higher, but for whatever reason we're unsure yet why the number of cases of folks that have been infected do not really include that children population. That's great to hear.

Amy (10:20):

You've talked a lot about how we can keep our ourselves healthy through hand-washing and blowing your nose and immediately disposing of the tissue, et cetera. Are there other things that we can do to boost our immune system or protect ourselves?

Rob (10:32):

That's a great question. As you had already heard that I was interred in functional medicine, I didn't really flesh out what that was. Medicine in general attempts to treat symptoms that someone is having and functional medicine is trying to look deeper as to why someone's having symptoms and then spend time, energy to help those underlying issues so that the symptoms go away as opposed to influenza and varicella, both of which we have immunizations to boost our immunity against and medications to treat. We have no such thing for COVID-19 so it's a novel virus. There is no medication, although other antiviral medicines have been used in an inpatient basis for people that are very ill. just because we have nothing else to offer and there's no current vaccination, although there are feverish efforts, sorry, the pun, to have that come to fruition. What can we do is increase our own innate defenses, right? So I see our immune system sort of like a castle. I talked to kids all day, so excuse the maybe simplicity of this. A castle with its outer walls has openings, right? It has a door that things can come in and out so that there's free commerce and so forth between the people and things inside the castle and that outside of the castle. And that's sort of like our immune system and lets things in samples things and decides what is okay and what's not, what's a pathogen and what's something that's normal. There's only so many defenders though on the walls. So the walls are defended by our immune system day and night, except they've got something else they're working on. Unfortunately, there can come times in which our defenders are doing other things, taking care of other inflammatory responses, and so there are less folks on the wall to potentially fight against something incoming. What can we do to make sure our defenders are there on the walls? They're awake and they're ready to go. So one would be to avoid other things that are inflammatory. For instance, food, we put food in our body by the pound every day, and so avoid things that might increase inflammation such as trans and saturated fats, sugars and processed foods. Another way to combat other types of inflammation might be to make sure we're having plenty of antioxidants. So vitamin C is a great thought. You can think if in your diet foods like citrus, strawberries, Kiwi, um, selenium is very good in helping us with our immune response. An excellent source of that is Brazil nuts. Zinc is very important. Vitamin E is also a very important antioxidants and so you can find that in things like almonds and hazelnuts, green leafy vegetables, and to ensure those vegetables are bruised or wilted because the nutrients within them will be more bioavailable. Vitamin D is a really great kind of measure of your immune system and over the years I've found that there are so many of us that are vitamin D deficient. Probably supplementing for almost anyone is going to be safe and helpful. So for children, maybe one to 2000 units of vitamin D a day. And for adults, 5,000 units a day will be a very good way to boost your immune response. Curcumin or turmeric, especially in the fight a zone, a form a that's most bioavailable is an another excellent way to boost our immune response and decrease inflammation. So again, it helps on both sides of that. It helps make sure our defenders are active and it also keeps them from being sidetracked with other inflammatory conditions. Let me talk about just a couple other things about how we can boost our immune system. We might not think about, uh, one is exercise.

Rob (14:24):

Exercise is excellent as an antiinflammatory and way of boosting our immune system. When we talk about being quarantined potentially, please remember that you can go outside, in my estimation, there's no further exposure if you're on a bike ride in your neighborhood than there is at your house. Exercise is going to be, I think an important part of not only keeping some of our mental sanity but also allowing our immune system to be most effective. Uh, stress reduction. Okay. This is a very stressful time. I get it. Understood, but that works against us when it comes to our immune system. The cortisol is the main, uh, chemical we're talking about when it comes to a stress hormone. So try to do things that decrease your stress. So for children, things like routines, normalcy, making sure you have a schedule. Those are all very reassuring for children.

Rob (15:18):

One of my personal favorites is meditation. It's definitely been shown to help and you can do that as a family, I've been shown to help decrease our levels of stress. Two more thoughts. One would be adequate sleep. Sleep is underrated when it comes to medicinal value. Unfortunately, we think of medicine as something which we get in a bottle from the pharmacy, but sleep and all these other things we talked about are definitely medicine. They're medicinal and sleep decreases our inflammation by a large extent, so our children should probably getting somewhere in the order of nine to 10 hours of sleep a day or night and that we have to make sure that things don't interrupt the sleep, especially smartphones because if the child has them, they're often in their bedrooms and that decreases their ability to get into deep sleep, and studies have shown that taking that out actually does help sleep. Whether or not they're sleeping, they still may not be getting deep sleep. That's restorative and that's what we want.

Amy (16:13):

Does that mean what if the phone is put on do not disturb or not going off?

Rob (16:18):

Sure. Good question. I get that. All, all kinds of rationalizations for my teenage patients for sure.

Amy (16:23):

Oh, I, I might've been talking about adults.

Rob (16:25):

We have this great ability to anticipate, for instance, you've sent a text message or you've posted on Facebook or if you've snapped someone, the anticipation always is what's coming back? When is it coming back? What will they say? And so the heightened anticipation comes from having your phone nearby is part of what keeps us from having deep restorative sleep. My patients say, well, it's my alarm clock, it's how I get to sleep. I'm like, have your mom buy an alarm clock. It's not that expensive. And we have this anxiety that comes from sort of addiction really by way of our phones. And if we lost, lose our phones, how anxious are we? It's because they're on our minds. They're just as addictive as anything else. So taking a break from your phone every night is a good way to put that in a positive and helpful respect towards life. So does that sound like that? Answer your question?

Amy (17:30):

Absolutely. I was just imagining what it would look like if my phone wasn't on the nightstand next to me knowing that even though it's on do not disturb, my sister could call, my head of school could call. There could be anybody who interrupts. Especially in this heightened time, the awareness of having that it happened, but thinking about putting it downstairs where its impossible I wouldn't hear it calms me just thinking about it. So I think it's probably a balance if there is an emergency or what possibly could there be an emergency about that I really need to respond to at 2:00 AM when my immune system is lowered in self-care. Is that okay?

Rob (18:06):

It should be at its at its height so that's good point. I mean there is a life work balance but I don't think that's so much the case in our children.

Amy (18:15):

Absolutely.

Rob (18:16):

The final thing I wanted to mention was that of the our microbiome, I would say that we have within us and upon us a host of bacteria that are normal, that are part of our immune system. We're actually outnumbered that our trillion or so human cells is dwarfed by the 10 or maybe a hundred trillion of other cells that are innocent, honest. These bacteria mainly are very helpful to help us monitor and make a balanced immune response. So just a couple of thoughts about how to have a healthy microbiome because when that's healthy, then we're healthy. Good sources of soluble fiber. And so, uh, this could come in the form of prebiotics or phytonutrients and best gotten in a brightly colored fruits and vegetables. Organic if possible. Pesticides sprayed on these fruits and vegetables are all antibiotic related so they will kill our microbiome. Also, good sources of soluble fiber. [inaudible] going to help our good commensal organisms grow. And part of why they're important, those commensal organisms, the ones that are supposed to be there, cause they don't allow territory to be taken over by things that are bad. So we want just like our lawn, we want it to be a beautiful lawn. We want it to be all grass. We don't want any dollar weed, weed only. Crabgrass we don't anything else growing there. And if there's no space for that to grow and there's a good root system, then things won't have a chance to get in there and grow. So that thing, it's really important to have a healthy microbiome just by way of not only our immune response, but not giving other things, pathogens, a place to grow. And then the last thing would be as a placeholder and to help things grow that our are good by way of our microbiome is probiotics. And certainly the most powerful of these is not what you'd find in a capsule but in fermented foods. So whereas in a capsule you might have two or three or 10 strains of different bacteria, you would have hundreds of strains of bacteria, fermented foods, naturally fermented foods like pickles or sauerkraut or kimchi and so forth. So that's just something to think about when we're trying to rebuild our immune response by way of having a healthy microbiome.

Meredith (20:24):

I want to go back, you mentioned being outside, going for a bike ride. If we're on self quarantine, if that happens. I'm really glad you brought that up because I think a lot of anxiety and fears are coming from this idea that I'm going to be stuck inside with my kid for one week, two weeks. So you're saying if self pointing happens, getting outside is not a bad thing.

Rob (20:44):

Well, it's about congregating, right? It's about trying to make sure that we're not cross contaminating. That was one of the reasons why teachers are going to be moving to classrooms rather than the classes here at Parish. Moving to the common areas and that's why it's so years, no increased exposure to someone who might be sick or is in the window of having been exposed but not yet showing symptoms that could still transmit the virus to someone else. Think about a bike ride. Just imagine you're on your bike with your kids. It's your bike, your germs on the bike. There's no more germs on the bike than is in your house and you are taking a ride in your neighborhood. You're on sidewalk and your guys are just taking a ride around the pond or to the woods or just down the street, wherever you might live, and there's no more close contact with other people than there is in your house. Now, if you go to the dog park and there's 10 other people, then you know that's the idea of keeping your distance, especially when it comes to sneezes and coughs. We talked about the fact these particles are airborne, but not for long. Okay? They don't transmit from across the park. They're not going to be in your neighborhood because someone's coughing whose next door. This is within feet of this airborne droplet, a lifespan, if you will. We can safely do a lot of things as a family that doesn't increase our exposure. You're just worried about getting to places that have more people or they have more contact with surfaces that might be contaminated. We just don't know.

Amy (22:09):

So you talked a lot about sneezing and coughing. What about drool or spit or any of these peers or any of these other things that come with life

Rob (22:18):

Certainly anything that's oral secretions or nasal secretions we would want to be aware of. So a little baby, you know, drool. Sure there is evidence the virus can, um, also be in stool of people that are infected. If you think about any stomach bug that you don't want, it's the same type of issue right after using the restroom. You wash your hands and you might spend a little time disinfecting the common things that people touch, the handles on the toilet, the handles on the doors and so forth. But once you're in the house or once you're just with your family, or once you're just with your class, you know, if everyone's healthy in that class, then there's no further exposure if we're not meeting new people or getting in round other groups of people, which is why the whole idea of having large groups of people is being shut down.

Amy (23:09):

And when you talk about disinfecting, what actually disinfects especially when there's a run on hand sanitizer and Clorox wipes.

Rob (23:17):

Okay. Well, I'm not a microbiologist, but this is my understanding. Okay. So a dilute bleach would be great. Certainly a hand sanitizer, anything with alcohol based hand sanitizer, hydrogen peroxide is great for surfaces. It breaks down the water and oxygen. So it's, you know, although it can, you know, potentially change the color of clothing just like bleach could, right? So don't spray it on your clothes. That's also another good disinfectant. The upside is that this virus is more easily killed and say rhinovirus. Rhinovirus is another cold virus and that we don't think much about. So the upside if there is one is that the virus is fairly unstable in that yeah, cold and flu viruses don't typically like warmer, more humid weather. And so the increase in temperature, the increase in humidity is helpful when it comes to the decrease in the activity of these viruses. So that's good. You know, having some nice weather living in the South in during the humidity is actually something that is helpful when it comes to these buyers or that just don't like those conditions.

Amy (24:20):

And is it accurate that you can wash your hands and just the simple act of the water going over your hands knocks the germs off? Or does it have to have antibacterial or alcohol properties?

Speaker 2 (24:30):

Most important activity when it comes to hand washing is that a friction? So when we think about washing our hands, a lot of times people just use the, get the palms of their hands. I'm rubbing my hands together. The palms of your hands clean. But we don't think about in between our fingers and certainly our fingertips. So rubbing your fingers, say in your Palm, rubbing your thumb in your Palm, something that is a give a little friction. Actually that's more helpful. So what I'm saying is that if you had nothing but water, um, do it and use some friction.

Meredith (25:01):

It's better than nothing by far.

Rob (25:03):

And better than just using soap and having the water just go all over your hands and thinking that is adequate, that's not adequate. Or having hand sanitizer and just kind of patting and on her hands, that's not adequate. We need to put some friction to this. Get to know.

Meredith (25:17):

At the end of every episode we ask our guests one question. We put them on the spot. If you had one piece of advice to give our listeners, what would it be?

Rob (25:25):

My advice would be to do things that are in your power to change and not to stress about what you can't.

Meredith (25:33):

That's good advice. Thank you so much. Thank you for listening to the Unbabbled Podcast. Be sure to subscribe to Unbabbled in the podcast platform of your choice as we will be releasing an additional episode featuring our directors of early childhood and elementary discussing ways to keep your child engaged in learning in the event of an extended school closure. We hope you found today's episode informative. For links to some of the resources we talked about in this episode, please see our episode description for more information on how The Parish School is handling COVID-19 visit parishschool.org/coronavirus and if you like what you're hearing, be sure to leave a rating and review a special thank you to Stig Daniels, Amy Tanner, Amanda Arnold, and Stella Limuel for all their hard work behind the scenes. Thanks again for listening.