Open Letter from the Clinic for Special Children to the Plain Community

March 20th, 2020

Dear Friends,

Ensuring your safety and well-being is at the heart of our mission at the Clinic for Special Children (CSC). In that spirit, we are taking steps to protect you and your community from COVID-19. I am writing to provide critical information about the virus, what it means for you, and how we can work together to protect our loved ones.

What is the COVID-19 Pandemic?

Coronaviruses commonly cause respiratory illness similar to influenza ("the flu"). In November 2019, a particularly dangerous strain of coronavirus called COVID-19 first appeared in China, and over just a few months has spread rapidly across the globe to infect 250,000 people and cause 10,000 deaths (World Map, red). The virus reached the United States in January 2020, and as of March 20th has infected more than 15,000 people in all 50 states. There are multiple centers of contagion along the Eastern Pennsylvania border, and now a few confirmed cases in Lancaster County (U.S. Map, red circles).

COVID-19 spreads quickly for three reasons: (1) It readily passes between people by either direct contact or shared objects (e.g. toys, hand towels, dinner plates), and is so contagious that it can be passed from one person to another through normal breathing; (2) It is a novel virus, never before see on Earth, which means that no one is immune to COVID-19 and nearly everyone who comes in contact with it will get sick; and (3) Once infected, a person typically has no symptoms for 7–14 days, during which he or she unknowingly infects others, who in turn pass it on to their close contacts, and so on.

COVID-19 is not "the flu." Although COVID-19 has been compared to influenza virus, there are three important differences between them: (1) Unlike the flu, which typically infects people during a few winter months, the COVID-19 pandemic could last 18 months or longer; (2) We have methods to prevent (vaccines) and treat (medications) the flu. In contrast, there are currently no effective treatments for COVID-19; and (3) COVID-19 is much more deadly than the flu. A person infected with COVID-19 is 15–times more likely to die than one infected with the flu, especially if elderly or medically fragile.

Understanding the pace of the pandemic is important. As of this writing, the number of people in the U.S. who

become infected doubles every three days. This means that if 15,000 people in the U.S. have the virus today, 30,000 will have it in three days, 60,000 in six days, and so on. Without protective measures, the entire U.S. population (330 million people) could be infected in less six weeks. In just nine weeks, the virus could spread to every person on Earth.

What does this mean for the medical system? There are one million hospital beds in the U.S. and about 70% of them are occupied at any given time. One in six people who contract COVID-19 need to be hospitalized. This means

that at the current rate of spread, every hospital bed in the U.S. will be filled by April 10th, 2020, just three weeks from now. Once this happens, doctors will not only run out of critical supplies and resources, but will be forced to make heart-breaking decisions about who does and does not receive medical care. People who do not have COVID-19, but suffer from other life-threatening conditions, may be excluded from hospitals operating at maximum capacity.

How Can We Control COVID-19?

Although there is no treatment for COVID-19, protective measures can limit its impact on communities worldwide (See the accompanying chart, modified from U.S. Centers for Disease Control). In the absence of protective measures, the number of people infected (red shaded area) quickly overwhelms total hospital capacity (gray dashed line). Implementing protective measures early in the course of the pandemic (gray shaded area) has two effects: (1) The peak of the outbreak is delayed, giving medical systems more time to respond; and (2) Fewer people become infected.

What Can You Do to Help?

• Wash your hands often with soap and water for at least 20 seconds, especially after visiting with people outside the home, shaking hands, using the bathroom, or before preparing food.

• Avoid touching your eyes, nose, or mouth with unwashed hands.

• Avoid shaking hands and sharing hand towels.

• Unless necessary, avoid close contact with people who are sick.

• If you or a family member is sick, stay home unless you need a doctor's attention.

• Cover all coughs and sneezes. If you use a tissue, throw it away. If you use your hand, wash it.

• Frequently disinfect common objects and surfaces in your home.

• Avoid large, non-essential gatherings, even if everyone appears healthy.

• Respect the government recommendation to cancel all public meetings and limit any gatherings to fewer

than 10 people. In Plain communities, this might include cancelling congregational worship, limiting marriage ceremonies to a few family members (could do meals and receptions at a later date) and keeping schools closed until the peak of the pandemic has passed and the government lifts restrictions. Countries that observe such recommendations have fewer infections and fewer deaths.

Protective measures save lives. This is our time to work together to protect our neighbors, our loved ones, and communities throughout the world Until COVID-19 runs its course, I encourage you to stay calm, stay safe, stay clean, and stay home.

Yours Sincerely,

Kevin A. Strauss, M.D.

Medical Director, Clinic for Special Children