Yes, everyone is tired of worrying about COVID-19, and with rising cases across the US it's difficult to see evidence that the population in general is trying to be any more careful now that recommendations have replaced mandates. Pediatric healthcare providers still need to be vigilant.
Another Note on Monkeypox
No, it's not the next pandemic in terms of massive transmission like SARS-CoV-2, but it is a global problem. This past week I was involved with 2 events illustrating that front-line providers need to be prepared.
First I fielded emails and calls from a pediatric practice in Maryland. A toddler who had returned from a stay in West Africa had presented to the office with sores around the mouth. The clinical history including progression of lesions and associated symptoms, plus the rash appearance, was strongly suggestive of monkeypox in my assessment. How to go from there?
First step: ensure patient is medically stable, not needing emergent care, and child and parent are in an exam room with the door closed. Don't allow staff to enter without permission, and anyone who does need to enter must don gown, gloves, and mask, preferably N95 mask. Then, call for help/advice. I was able to help a bit by calling the Maryland DOH provider phone line, and after a few minute wait got a call back. The DOH took it from there and last I heard was going to arrange for sample collection at the family's home. The child and parent exited through the back door of the office, not through the waiting room. I don't know what happened subsequently, but I did provide the pediatrician with links to information about exposure management for the office staff, while they await word on whether preliminary evaluation determines that this is truly a monkeypox PUI (Person Under Investigation).
The second instance, 2 days later, was a text from one of my ID colleagues, again regarding a toddler in a pediatric office in Maryland. The photo looked very much like monkeypox to me, although the exact epidemiology and other details weren't available at that time. My colleague was planning to go through the same procedures as above.
I mention this not to alarm but to reinforce to providers to be prepared to act on this type of scenario. Have in mind how you would "phone a friend" for advice and be sure you know your local health department's provider access details. This will save you and your staff a lot of worry and ensure your patients and families get the care they need.
Omicron Subvariants Continue to Spread
I shouldn't be surprised by now, but it is quite remarkable how SARS-CoV-2 variants continue to evolve to evade prior immunity and spread so easily. Consider the most recent US data:
In spite of all the US cases and rapid spread, we still aren't seeing a large uptick in hospitalizations:
The same seems to be true in South Africa, where BA.4 and BA.5 reign, and also in the UK. This at least is encouraging. Let's hope we continue to receive relatively good news about hospitalizations and deaths.
Oh, and I learned something new about the whole ostrich/head in sand thing. It turns out that is a complete myth, dating back to Pliny the Elder!
