EV68 and Associated Horrors

Remember when I said I was going to update and talk all about my awesome baby shower?

That'll happen. But first, let's rant about EV68.

This post is brought to you by the sign I saw in my OB's office this morning, which stated that siblings would not be able to visit their brand new baby sisters and brothers on the postpartum floor due to concerns over the rapidly-spreading virus. It's also brought to you by the 30 minute segment on NPR this morning. And also the fact that I saw twenty-eight patients yesterday, had at least one nebulizer running at all times, and didn't get home until about 9:00 PM.

I'd like to start by saying what this post is not about. It's not about how EV68 is not a big deal because it is. It's also not about how EV68 is a big deal and how everyone in the country needs to go to their doctors YESTERDAY because that's not exactly the case either. Mostly, its just me venting, but I'm hoping to also present some good info on both the virus and also on how we should be responding to it.

EV68 is an enterovirus. Do you know what else is an enterovirus? EVERYTHING. Polio is an enterovirus. The Common Cold is an enterovirus. Remember that huge outbreak of Hand Foot and Mouth Disease this summer? That's caused by something called coxsackie virus, which - you guessed it - is also an enterovirus. When we say something is an enterovirus, we're basically describing the viral structure (single-stranded RNA), how it reproduces (positive sense), and what types of hosts it tends to infect (mammals).

The media is calling EV68 a "respiratory illness," which is an incredibly vague description almost to the point of not being a real thing. Some people who come in contact with EV68 will have zero symptoms. Some will have a little runny nose and cough. Others will launch into full-blown respiratory distress. Generally speaking, this is no different from any other virus that can cause "respiratory illness." Things like croup, laryngitis, and bronchitis are all respiratory complications that are caused by viral infections. EV68 is just another name on the list of things that can cause these problems. And just like those other viruses, how likely you are to develop complications depends mostly on your age, your current health, and the state of your immune system.

That being said, EV68 is proving to be a particularly nasty virus, most likely because we haven't seen much of it in the past 30-40 years. That means that those of us under 30-40 years of age have little-to-no immunity, and are therefore that much more susceptible to infection. The medical world doesn't often do specific diagnostics for viral infections - exceptions being baddies like RSV and the Flu, which show up every year and consistently reek havok wherever they go - so it's difficult to know for sure that EV68 has been dormant. We're actually not really even testing for it now because the test takes forever to process and is therefore really only for epidemiological purposes. But all evidence seems to point to the fact that it's here and it's legit.

Case in point, my practice recently received word from our local area hospital that we could no longer directly admit patients with respiratory symptoms because there were no beds available. If we had patients who could not be stabilized outpatient, we would need to send them to the hospital vis-a-vis the emergency room. EV68 is a thing. And it's for sure making people sick.

But that doesn't mean that it's making you sick, or that it will make you sick, or that if it does make you sick, you automatically need to go to the hospital and start on supplemental oxygen.

Probably not you.

Our office received this memo from the DPH a few days ago. They summarize the situation brilliantly:

"...EV68 this year is behaving more like a [common cold], even to the extent of causing disease with little or no fever...No antiviral medications are currently available for treating of EV68 infections. Many infections will be mild and self-limited, requiring only treatment of the symptoms. Some people with severe respiratory illness caused by EV68 may need to be hospitalized and receive supportive care. There are no licensed vaccines for protection against...infection." (Bolds are mine)

In so many words, this memo explains that there is absolutely no need to panic, or even to seek medical attention, unless you are having severe respiratory symptoms such as wheezing, chest tightness, and/or shortness of breath.

So what should you do?

MegaHospital (the one that our practice and every other nearby pedi practice bows to), recently sent out the following information to give to our patients:

• At home, wash your hands often, using soap and water, and wash for at least 20 seconds. Carry hand sanitizer when you are out and about.
• Don’t share cups or spoons, knives and forks, and wipe down toys and frequently-touched surfaces like doorknobs often.
• Keep your distance from visibly sick people and don’t let sick people hold or care for your baby. And if you or a family member is feeling sick, stay home.
• Teach your children to cover coughs and sneezes with the inside of the elbow or a tissue, not the hand.
• If your child has asthma or any other lung disease, make sure he or she continues taking any medications as prescribed.
• If someone in your family starts with the sniffles and a cough, don’t panic. Chances are that it is just a common cold. Keep a close eye and, if the cough gets worse or the person looks weak or is having trouble breathing, call your doctor or visit your local emergency room.

So there you have it, folks. EV68 is real. It sucks. But mostly likely, it's not going to affect your life.

My life on the other hand...well...my 38-week-pregnant self gets the privilege of working this weekend. Let's hope I survive.

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Note: Sources are not cited to protect the anonymity of myself and my practice. As both sources were intended to be public service announcements, I feel that this action is in keeping with the purpose of the documents.