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“When the public was made aware of the risk of transmitting the virus and the far-reaching measures of social distancing, closing schools, and lock-down, most Americans willingly complied. After all, they became aware, for the first time, of the risk of aerosolized viral particles present in theatres, churches, restaurants, and classrooms. But we physicians already knew that. We knew that when we went into the operating room or the bedside to repair a laceration in the emergency department, we wore masks to protect our patients from the microorganisms living in our noses and mouths. We already knew that the spread of norovirus and other food-borne illness can be mitigated by the use of hand-washing and the use of sanitizing cleaners. Physicians already knew that the world was a rather naïve and scary place in terms of infectious disease.”
Joan Naidorf is an emergency physician.
She shares her story and discusses her KevinMD article, “Influenza: a deadly risk in schools before COVID.”
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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.
Transcript
Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Joan Naidorf. She’s an emergency physician, and she wrote the KevinMD article “Influenza: a deadly risk in schools before COVID.” Joan, welcome to the show.
Joan Naidorf: Thanks for having me, Kevin.
Kevin Pho: We’ll get into the article in a little bit, but first off, can you share your story and your journey to where you are today?
Joan Naidorf: I’d love to. I grew up in Highland Park, New Jersey, which is in central New Jersey, and then I went to the University of Virginia to do my premed studies. While I was there, I also started my interest in writing. I wrote for a weekly news magazine there, my future husband. From there, I attended Philadelphia College of Osteopathic Medicine, and while I was there doing my clinical rotations, I fell in love with the specialty of emergency medicine.
I feel like we get to have the most challenging job ever. We have to have a short-term relationship with patients, and we get to have all the fun and excitement of the first hour of most of the other specialties, and then we get to play with lots of toys. From an intellectual standpoint, I feel like we’re the first ones who get to solve the problem that the patient comes to us with, and go through all the signs and symptoms and order all the right tests, and I feel like a lot of the time we’re on the right track.
I did my emergency medicine residency at Albert Einstein Medical Center in Philadelphia, and then after training, I moved to Northern Virginia and took a job at Inova Alexandria Hospital. I worked for about 22 years. Then, during that time, I transitioned to be a civilian contractor at a military hospital near my home called Fort Belvoir Community Hospital, and I also did some nonclinical work, working on patient overturns of hospitalization denials.
During that time also, and this is very important, I had three children. I actually had three children in two years, which I considered quite a feat, and so I would actually go to the busy emergency department to get out of the house, so I didn’t have to take care of my premature twins. That worked out really well.
Over the last two years, the corporate job disappeared with some of the changes in that business, and I have been lecturing to emergency medicine groups and to emergency medicine residency programs. I’ve been doing writing for Doximity and The DO magazine, and I’ve been doing some CME conferences as well.
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Kevin Pho: So emergency medicine truly is at the front line of the pandemic. Over the past year, just through your lens, tell me how the pandemic has affected your career in terms of emergency medicine.
Joan Naidorf: What I am doing is providing resources in my community. I belong to a club, and they asked me, as a physician, to be the source of information. I went and took the contact tracing course through Johns Hopkins. I read everything I can. Now they’re trying to make the decisions about how to be safe in the club and as a workplace for their employees, so that they can continue to employ as many people as possible.
What I see from my colleagues, and from my husband, who is still practicing, is pulling back to more virtual visits. The census in the emergency department is down. Whatever was coming, and certainly was coming for most of the early spring and then again this fall, was COVID, COVID, almost everything. There have been changes that have been reported to me in terms of staffing. The staffing has gone down, and they haven’t really gone back up yet.
Kevin Pho: All right, so let’s talk about that KevinMD article that you wrote. It’s titled “Influenza: a deadly risk in schools before COVID.” Now, for those who didn’t read the article, can you just walk my audience through it and share the story of why you decided to write it?
Joan Naidorf: That KevinMD article I wrote in response to an article that appeared in the Washington Post on March 2. The Washington Post is my hometown newspaper, so I read it a lot, and they have a very good health section. Sometimes the health section has a lot of sensationalistic headlines and titles, and I realize that that’s part of what they have to do for clickbait and to get people interested in articles, to be very sensationalistic. The title of that article was “COVID-19 and flu: Influenza has killed one child so far this influenza season.” It was quite a reasonable article, discussing the potential reasons why there had only been one pediatric death so far this season from influenza.
The article quoted the CDC statistics, and it presented this graphic. What the statistics showed is how many deaths there were this year and then the number of deaths for the previous three years. What really struck me, what jumped off the page at me, was that last year there were 195 pediatric deaths from influenza. All I could think was that our colleagues and our neighbors thought that those were the good old days. Those were the days when we didn’t have to wear masks, and we weren’t worried about social distancing. We weren’t worried about packing kids into gyms or cafeterias or classrooms or school buses, and 195 families lost their child. All those things that we thought were safe, like sharing utensils at a salad bar. I think as physicians, we always knew that there was risk.
I wanted to write this article for two main reasons. The first one was that we as physicians know that there’s always been risk of infectious disease, and we’ve always done all we can to mitigate those risks and to protect ourselves while we’re seeing our patients. When I was in medical school, we started seeing patients who had HIV and AIDS, and we were not really sure what the cause was at first. We just saw that people were dying. And then, when we knew how to protect ourselves better, we did work through other epidemics and pandemics. There was Ebola, and then there’s MRSA, and I would rarely get sick during my days of training and clinical practice. And by the way, I did get sick when my kids would bring home stuff from school.
So now here we are. At the beginning of last year, there was this viral infection, COVID-19, that was highly transmissible, and it had a higher mortality rate than the yearly viral illness that we know, influenza, and we seem to think that there was this new risk. Now, what I just wanted to call attention to by what I wrote is for physicians and everyone else to realize there’s a pretty significant risk from influenza in schools and in the general population.
Just to be sure that I wasn’t giving any misinformation, I went to the CDC website just to check a few facts that they had written. What I was surprised to find out was that they said, even though in the 2017-2018 season the flu death rate was 188, the CDC estimated that the actual number of children who died was closer to 600. The other thing that they reported was that, since 2002, it was recommended that children get vaccinated yearly against the flu. Last year, it was estimated that only 21 of children eligible for vaccination were fully vaccinated against the flu. This was what I wanted to highlight.
I would say also, in the original Washington Post article, the statistics for adults were also stunning. There were only 450 deaths due to influenza this year, as opposed to 22,000 the year before. Now, I understand there may be some quibbling about how some of the deaths are recorded now during the COVID era, but I think that our take-home message should be this: This heightened awareness that we have of the transmission of viral infection, with vaccinations, handwashing, social distancing, and masking when indicated, would greatly diminish not only COVID-19 infections but also influenza in the future.
Again, the CDC is saying that only 21 of children are vaccinated every year, and I think that parents of school-aged children need to take special note of that. I’m definitely not suggesting that children stay home from school. I think children need to go back to school, but some of the lessons we learned this year about how to keep kids safer against COVID will also work to help keep them safe against influenza in the future.
I guess the second message was that our neighbors are looking for physicians, and physicians should be the source of information and guidance in our communities. We know that there’s a little bit of panic involved out there right now because of some of the information and misinformation that people are getting, and we can be the source of information. People came to me and said, “I can’t even speak with a mask on.” I’m like, “Believe me, you can.” Surgeons have been wearing masks for years and years and years, and they managed to make themselves understood to everybody in the operating room. We wear them in the emergency department. We want to protect you from all the microorganisms. I think children are very adaptable, and if we model mask wearing for them, they will graciously do it.
Kevin Pho: So what do you recommend parents do? Hopefully, after COVID-19 ends in the next three to six months, what do you recommend their course of action be going forward to help prevent some of the other diseases, like the flu, that are going to be persistent going forward?
Joan Naidorf: Everybody should be more aware of various flash points where kids are sharing things. I mean, I think that those days of everybody stopping at the drinking fountain in the hallway, that should be over. Everybody needs to carry their own water bottle and just use that exclusively. I think there has to be heightened awareness of handwashing and possible use of hand sanitizer. I think there needs to be a lot of emphasis on people not coming to school when they’re ill, or even in the kind of prodrome of illness when we know they can spread infection. I don’t know. Of course, the school nurses can take people’s temperatures and make sure that they don’t have an early fever. So I feel that parents, working in concert with the teachers in the school system, can carry out a sensible way of protecting kids more.
Kevin Pho: We’re talking to Joan Naidorf. She’s an emergency physician, and she wrote the KevinMD article “Influenza: a deadly risk in schools before COVID.” Joan, is there something that you know now that you wish you knew back before the pandemic started?
Joan Naidorf: I think that at the very early stages, when I would go to a different part of our state, I would see that some people would think that this was just a problem in the big city. My daughter was going to school in New York at the time, and they were afraid of just having her come home. I think that clearly we know everyone can get it. It’s a virus that doesn’t care where you live, as long as there are the means of transmission. We know what they are, and we can mitigate transmission with social distancing, mask usage, etc. That we know now.
Kevin Pho: My final question: What’s your take-home message that you want to leave with the KevinMD audience?
Joan Naidorf: There are two messages, really. Don’t forget that influenza is a tremendous danger, both to adults and to children, but mainly this article was about children, and that we can learn some valuable lessons and use them going forward. And also, I think it’s very important for the physicians reading this and listening to understand that they need to be the resource in their community and for their patients about managing risk. Everything in life is about managing risk. I mean, I live in Northern Virginia. If we’re really sensible about it, we would probably never get into our cars and travel on the Capital Beltway. It’s that dangerous, but we do. Every day we do. So when everyone gets vaccinated, or at a certain time when we decide it’s safe, we need to be able to go into public places and to send our kids back to school. I think that physicians need to be the source of information about what’s safe and where the science is based.
Kevin Pho: Joan, thank you so much for sharing your time and insight, and thanks again for being on the show.
Joan Naidorf: Thank you.
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