From left, 8 1/2-year-old Dan Barsi, Jennifer Barsi, Maggie Barsi (age 4), James Barsi, and Lily Barsi (age 7)
By Daniel Dunaief
Daniel Dunaief
If your children are under the age of 12 and the Food and Drug Administration soon approves a COVID-19 vaccine, you’ll have many people to thank for the opportunity to return them to a more normal, and safer, childhood, including four-year-old Maggie, seven-year-old Lily and eight-and-a-half-year-old Dan Barsi.
The three siblings, who live in East Setauket with their parents James and Jennifer Barsi, recently participated in a clinical trial for the COVID-19 vaccine at Stony Brook Hospital. While the children don’t know whether they received vaccinations for the virus or the placebo, they are three of numerous children who volunteered to test the Pfizer-BioNTech vaccine to make sure it was safe before health care providers administer it to the broader population.
Their children “knew what they were signing up for,” said Dr. James Barsi, a pediatric orthopedic surgeon. “It’s something to help other people.”
Indeed, the community benefits from volunteers like the Barsis, who participate in clinical trials that evaluate the effectiveness of the treatment, help determine the correct doses, and reveal potential side effects before the rest of the population gets the COVID-19 vaccine or any other medicine or therapeutic intervention.
“We would never make advances in medicine without families — adults and children — volunteering to participate in clinical trials,” said Dr. Sharon Nachman, Chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital.
Some treatments for a range of illnesses or conditions look promising in the earlier stages of clinical development, such as phase 1 or phase 2. When they reach phase 3, during which researchers provide medicine to a much larger volunteer population, they sometimes fall short of expectations.
“Companies will tout drugs as the next best thing,” Dr. Nachman said. “When they get into phase 3, they are not better than standard therapy.”
Clinical trials on even an ineffective drug or one that produces side effects, however, can help pharmaceutical companies and health care providers by signaling what these professionals should look for in future treatments, Dr. Nachman added.
While volunteers of any age take risks by participating in these studies, they also have considerable medical oversight.
“They are well protected,” Dr. Nachman said. “When you participate in a clinical trial, you don’t just have two sets of eyes on you; you have 100 sets of eyes.”
Volunteers for clinical trials not only take some risk before everyone else in the community, but they also experience regular testing and monitoring.
The Barsi children, for example, had to have blood work and nose swabs. “We call it a brain swab,” Jennifer Barsi said. “The kids are so excited about getting a treat afterwards, but they still have to do the hard thing.”
Health care professionals throughout Long Island shared their appreciation for clinical trial volunteers. Without them “none of these innovative therapies and drugs would exist,” said Stephanie Solito, Research Manager of the Oncology Service Line at Catholic Health, which includes Smithtown-based St. Catherine of Siena and Port Jefferson-based St. Charles Hospital.
When Daniel Loen, Catholic Health’s Vice President of Oncology Services, takes any medicine, he appreciates that patients were “willing to sacrifice something or take on some kind of increased risk to get on a trial for the good of humanity and medicine.”
As for the specific COVID-19 pediatric trials, Dr. Nachman said parents and children have to approve to participate. Doctors talk with children in an age-appropriate way about these clinical trials.
Dan Barsi was born at 25 weeks old. He stayed in the hospital for several months and is now a healthy child.
Jennifer and James felt that this was their opportunity to give back to the next generation. The children who participated in clinical research before Dan was born helped make it possible for him to get the best treatment, and now they feel they’re doing the same thing.
As we continue to battle against the coronavirus and approach flu season, it’s imperative that we know the facts about the vax. This Tuesday, August 17, join experts from Stony Brook Medicine as they discuss the importance of and science behind vaccines during a LIVE virtual event. Our experts will dispel misconceptions and address concerns surrounding key vaccinations, including those for COVID-19, the flu, and human papillomavirus (HPV).
The ongoing pandemic has created unprecedented challenges for healthcare providers and patients. A recent study showed a 71% drop in healthcare visits for 7 to 17-year-olds, when critical vaccines like Tdap, HPV, and meningitis are given. The HPV vaccine is recommended for boys and girls at age 11 or 12 because it works best when given before exposure to HPV. It can be given as early as age nine, and through age 26 for both men and women, if they did not get vaccinated when they were younger. The vaccine is safe with more than 270 million doses having been given worldwide since 2006. Even though the HPV vaccine can prevent many cancers caused by HPV infection, nearly half of adolescents in New York State are not getting the vaccine as recommended.
Every year in New York, nearly 2,600 people are diagnosed with cancer caused by HPV. To help educate those across Long Island about the importance of HPV vaccination for cancer prevention in adolescents, the Stony Brook University Cancer Center received a grant funded by the New York State Department of Health and Health Research Inc. This allows Stony Brook, the first and only institution on Long Island to be part of the Cancer Prevention in Action (CPIA) program, an opportunity to further promote the importance of the HPV vaccine as cancer prevention.
Sharon Nachman, MD, Professor of Pediatrics and Associate Dean for Research at the Renaissance School of Medicine, Stony Brook University & Chief of the Division of Pediatric Infectious Diseases, Stony Brook Children’s Hospital
PANELISTS:
Jill Cioffi, MD, FAAP, Assistant Professor of Clinical Pediatrics at the Renaissance School of Medicine, Stony Brook University and Medical Director of Ambulatory Primary Care Pediatrics, Stony Brook Children’s Hospital
Lauren Ng, DO, FAAP, Assistant Professor of Pediatrics at the Renaissance School of Medicine, Stony Brook University and Primary Care Pediatrics, Stony Brook Children’s Hospital
This program is supported with funding from the State of New York. The views expressed in this educational event and by speakers and moderators do not necessarily reflect the official policies of the State.
While there have been no reported cases on Long Island, five people in Connecticut recently were infected with flesh-eating bacteria. File photo
With reports of five people who have been infected with flesh-eating bacteria across the Long Island Sound in Connecticut, area doctors answered questions about the dangerous pathogen.
For starters, the bacteria in Connecticut is called Vibrio vulnificus, and even though it’s extremely rare, it is especially problematic for people who have open wounds and have gone swimming in warm, salty or brackish — a combination of fresh and salty — waters.
Smaller cuts aren’t as much of a likely entry point for these bacteria, but open wounds such as skinned knees or elbows are, said Dr. Sharon Nachman, chief of Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital.
Those residents with open wounds who have swum in salty or brackish water can lower the risk of infection by washing their wounds with soap and freshwater soon after coming out of the water.
“Soap and water work,” Nachman said. “If you have no access to soap, regular water would be great.”
Vibrio is a rapidly spreading bacteria and is often visible soon after swimming.
“If you swim and you have an open wound and it looks different an hour or two after you get home than it did that morning, seek medical attention quickly,” Nachman advised.
The wound tends to get hot, is tender and red, and makes people who contract the bacteria feel sick. Getting ahead of the spread is particularly important.
Residents who are concerned that their wound might be changing can take a picture of the area and then, an hour later, compare that picture to how the injury looked.
While everyone doesn’t need to race to an emergency room for a possible wound that may look different after a swim, Nachman suggested people approach possible exposure with “thoughtful concern.”
An untreated infection can become much more serious, sometimes leading to amputations and even death. The five Connecticut cases haven’t involved any such dire developments.
Residents whose wounds appear to have a Vibrio infection typically receive at least two antibiotics either orally or intravenously. Some other pathogens in the water also can look as bad as Vibrio, but they need different antibiotics, which include Aeromonas. These other bacteria also find their way into bodies through open wounds and can cause rapidly progressing infections.
“When you go to the hospital, [medical personnel] may say that it looks like one of these [bacteria], and we are going to give you two to three antibiotics and see what happens,” Nachman said.
Once the medical staff determines the cause of the infection, they will likely cut the antibiotics back to the one that’s more effective for that specific bacteria.
With fewer people on the beach as school has restarted and people are engaged in more fall activities, potential infections from Vibrio have decreased.
While antibiotics are effective, they take time to beat back the bacteria.
With over 25 years in practice, Nachman has seen several cases of children who have contracted Vibrio. The children have been very sick, but have recovered.
People who have certain conditions can be more vulnerable to Vibrio, including people who have diabetes, are obese, or have heart or kidney problems.
Vibrio typically appears through wastewater. Shellfish, which are filter feeders, effectively clean the water. Warmer temperatures, however, or a big storm can cause shellfish beds to get upended, where pathogens might be dumped back into the water.
For more information, visit www.cdc.gov/vibrio/wounds.
Dr. Sharon Nachman, chief of Division of Pediatric Infectious Diseases at the Renaissance School of Medicine at Stony Brook University. Photo from Stony Brook Medicine
The physical, emotional and financial strains that COVID-19 has thrust into our lives has left the average person physically and emotionally exhausted and overwhelmed. There has been a plethora of information for the public to absorb, and it can be bemusing. Dr. Sharon Nachman, chief of Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital, answered some general questions about the spread of COVID-19, the future of the pandemic and how we can all stay safe as restrictions are lifted.
Can you explain how COVID-19 spreads?
COVID-19, like other respiratory viruses, spreads from respiratory secretions. However, it also spreads by touching things that are recently contaminated with respiratory secretions and then touching your face. So, if you sneeze on your hand and touch the doorknob, and if I come by and touch that doorknob and then touch my face, I will spread infection. If you touch the doorknob and don’t touch your face, because say you were wearing gloves and disposed of the gloves, it is unlikely that you will pass infection from your hand, which is clean, by touching the doorknob.
Most of us, when we are around someone sick, think opening a window or being outside with them will help to prevent us from being infected. However, the general public has been told to wear masks or to social distance even when outside. Why is this?
The idea behind social distancing and wearing masks is cutting down on how much virus theoretically could pass from somebody talking, sneezing or breathing onto another person. The idea of being outside is that there is good air exchanged. You’re not in a closed room, and by keeping 6 feet distance, even if I’m talking loudly and I am getting some virus in my breath, and it’s passing out of my mouth, it’s not getting close enough to you. It’s important to realize there are measures for the population with the idea being, we don’t know who was infected, who is at risk for getting severe disease or has underlying issues. It’s the blanket protection for everybody.
There have been some conflicting reports on whether or not the virus can be spread in fresh air after the virus was found in stool stamples. Say somebody is walking down the street and sneezes and the next person is walking down the same street. Are they at risk? Do you believe that the virus is airborne?
We know the virus is a respiratory pathogen. What you’re referring to is some people have looked at studies of stool and found pieces of virus in stool. How did it get there? Was it a virus that you swallowed? Was it a virus that went into your GI [gastrointestinal] tract and excreted out from your stool? There are lots of different hypotheses. No one is saying that the virus that they found in stool is replicating virus. No one is saying that when they took that virus and put it into a viral media, it grew.
PCR [polymerase chain reaction] testing is testing for snippets of the virus’ DNA, or in this case RNA [ribonucleic acid]. It’s a good way of saying there was virus there, but it doesn’t translate into “that virus is contagious.”
Can you explain how a facial mask helps to slow the spread of the coronavirus?
A facial mask is a great barrier between you and the next person. If I’m wearing a mask, and I am infectious and I breathe into my mask, the facial mask is a barrier to prevent the virus from getting past the mask to the next guy. If I am infectious and wearing a mask and you are wearing a mask, the virus is [in theory] not passing my mask. If potentially, the virus is passing my mask, but you are wearing a mask and standing 6 feet away, none of the virus gets from the air to you and from the mask into you. This gives multiple layers of protection. One layer is I have the mask on, the second is we’re standing 6 feet apart, and the third is you’re also wearing your mask.
Why is the recommended distance 6 feet?
There are lots of interesting studies that have looked at how far these size droplets can spread. Every virus has a storybook to it. A viral particle that is a little heavier, spreads a shorter distance. A viral particle that’s a little lighter can spread out in the airwaves even further. The measles, for instance, can spread up to 60 feet away, and even after you go out of a room, it is still floating around in the room a couple of hours later. This virus is a bit of a heavier a particle, so it drops down quickly and doesn’t stay in the air.
Can you explain how someone who is asymptomatic can spread COVID-19?
Symptoms and having virus in your nose are not a one-to-one relationship. For example, let’s say I have the flu. I may have a little bit of a runny nose, or nothing, but I go to work and give all of my colleagues, who I’m breathing close to, the flu. They don’t know where they got it from because they look at me and say, “You had no symptoms, of course you came to work.” COVID-19 is the exact same scenario. We have lots and lots of people who have been infected by the virus and have no idea that they were infected because they are in fact well. This is true for children, as well as adults. More often children are asymptomatic, but we have seen quite a few adults that we’re getting positive testing for that say, “I don’t know what you’re talking about. I feel fine. I never lost my taste of sense of smell and taste. I never had a runny nose. I never had a cough, and I certainly never had a fever. Asymptomatic just says to you, “Good news, you got this infection and it’s sitting in your nose,” but it does not correlate with how sick you are.
What is the extent that you think the number of deaths would have been higher if stay-at-home and social-distancing orders weren’t put into place and why?
I can’t calculate that, but I can tell you it would have been extreme based on the number of people who came into the hospital who had no underlying immune issues, and they had no reason to think they would ever get hospitalized. Those numbers were high. We expect to see patients that have multiple comorbidities [additional conditions]. When they get a respiratory illness, we’re not so surprised. We did see more of them then I would have expected, but what we also saw is absolutely young, healthy adults, who in their lives have never been to a hospital. They take no medication. They are perfectly well, and they also got COVID and came in. I’m scared to think of how much worse this could have been because it was really pretty bad.
Do researchers believe this is the type of virus that once you get it or are given a vaccine you’ll be immune, or will it be like a herpes virus that it hides in the body and can be triggered in the future? Or will this be like the flu where it will be advised to get a new vaccine every year?
The answer is that I don’t know. Anything I say would be complete guesswork because I really don’t know. It’s more important to say, “I don’t know” then to put out ideas that I don’t have a basis to stand on right now. I think that we need the time. We need to put the work in, and then we need to look back and ask, “What did that change? What changed? How did it change?” I’d prefer to be cautious.
We hear about viruses mutating and sometimes they can reappear and infect people worse than before. What are your feelings on a second wave of the virus? Is it possible to mutate and be weaker than before?
We need the time to find out. These are just guesses. Do I think there will be a second wave? I’m certainly cautious that there might be a second wave. When will it hit? I don’t know. What are the background demographics of who will get it and how sick they will be? Again, we don’t know. We have to think about it. We have to be looking for it. We have to be in close observation of populations across the country for it. We need to be prepared for what we are going to do if it does happen.
Many historical accounts suggest that after the 1918-19 Spanish flu, society permanently altered. Do you foresee permanent societal changes, such as eliminating handshaking, post-COVID-19?
Every year society changes. It’s both big and little things, from cellphones to pandemics. I think this will have a big impact, but we are still too close to understand what it will be.
As the warmer weather hits and restrictions are lifted, people will be eager to get out. Is it safe to go to the beach or a friend’s house?
With warmer weather, it will be nice to be out. I hope people do continue to maintain social distancing. I think over the summer some families may decide to cohort together, after they are tested to prove that their behaviors are acceptable. Getting tested would be the gold standard, but we also need to think about ongoing risks like going shopping vs. staying isolated for the days and weeks before mingling. A fourteen-day isolation period would be keeping in line with the guidance that is out there.
How does a virus like COVID-19 change into an inflammatory syndrome that has been seen in some children? What symptoms should parents be aware of regarding their children? Are there any extra precautions parents should take to protect their children?
I think that the book of what that syndrome is has not been written. I think we’re all cautious. The best first line of defense is if a parent thinks their child has unusual signs and symptoms, they should start with their pediatrician or family doctor. They can say exactly what is going on with their child, how they are looking, and then step further. I think running to the emergency room when all [the child] has is a fever or no symptoms is probably not appropriate at this time. We don’t know. Is this syndrome only with COVID-19? Is it after getting better from COVID-19? There are too many unknowns. People, including the Centers for Disease Control and the World Health Organization, are looking at these cases. I think we’ll have more information in the next month. We are thinking about it, we are working [on it], and we are very cautious with these children, because they are quite sick. However, the vast majority of kids who have had COVID-19 have been asymptomatic or had a mild illness that is nothing like this inflammatory illness. I think the inflammatory disease strikes the very, very few. We don’t know why. We’re trying to understand exactly when it hits, who it hits and why it does so.
Local officials and health professional are urging residents to get this year's flu shot. Stock photo
State, county and area hospitals are bracing for this year’s flu season following reports of a sharp increase in recent weeks in the number of flu cases in New York state.
About 11,000 confirmed cases of influenza were reported by the New York State Department of Health for the week ending Jan. 11. That’s an increase of 10 percent over the previous week, according to the New York State Flu Tracker. There were 641 new cases in Suffolk County. The statewide total this season stands at almost 44,000.
Similarly, “widespread”’ flu activity was reported by health departments in 46 states as of the last week of December, according to Centers for Disease Control and Prevention data.
Stony Brook Children’s Hospital’s Dr. Sharon Nachman, division chief of Pediatric Infectious Diseases and professor of Pediatrics, said currently the hospital is in the midst of handling an influx of influenza cases.
“We are dealing with the children’s hospital being quite full,” she said. “We have a number of infants with the flu, and we are concerned about it.”
“Community protection is everyone’s job.”
– Sharon Nachman
The hospital hopes to see an improvement in the next couple of weeks.
Nachman points to a number of reasons why we have been seeing more flu cases in the state: People unwilling to get vaccinated; individuals believing that they are safe from getting sick if they haven’t in the past; a belief that cold and flu medications are better than the shot, among other things.
“I ask patients, ‘Is there a legitimate reason why you don’t want to be vaccinated?’” Nachman said. “You have to think of who is also living in your household, like young people and the elderly. Community protection is everyone’s job.”
The division chief said if everyone got their flu vaccine there would be less people to treat.
“You are 100 percent at risk without the vaccine,” Nachman said. “The vaccine will not prevent someone from getting the flu, but it can lessen the severity of it and shorten its duration.”
She said despite some misconceptions, you can’t catch the flu from the vaccine as it does not contain a live virus. If you happen to get sick after getting a flu shot, it’s a coincidence as there are a lot of viruses and illnesses circulating during the winter months.
In an effort to curb flu cases in Suffolk County, officials announced recently that the county would be offering free influenza immunization to residents 6 months of age and older who are uninsured or whose health insurance does not cover flu immunization.
“The health and wellness of our residents is of utmost importance,” said Suffolk County Executive Steve Bellone (D) in a statement. “The flu has been on the rise, and we want residents to know it is not too late to protect yourself and your loved ones from what can turn into a debilitating disease by getting immunized as soon as possible.”
The county’s health department has been providing flu immunizations at a number of locations including Suffolk County Department of Health Services at Great River in the Town of Islip and at Riverhead Free Library.
Nachman said it is important to constantly wash your hands and if you are sick, stay home to avoid exposing others to the illness.
Flu shots are also available at local pharmacies, pediatrician and health care provider offices, as well at county-affiliated health centers.
People who are having difficulty finding flu shots or community groups serving those who are in need of flu shots are advised to contact the county Department of Health Services Bureau of Communicable Disease Control at 631-854-0333.
After Rockland County declared a countywide state of emergency last week banning any person under 18 who is unvaccinated for measles from public spaces, Suffolk County issued a recommendation.
In a press release, Suffolk County Executive Steve Bellone (D) and Suffolk County Health Commissioner Dr. James Tomarken urged county residents to make sure they are immunized against measles. Despite the recent ban in Rockland County due to a reported 157 cases of measles since October 2018, there is no immediate public concern in Suffolk.
“In light of recent reports, residents should make sure to receive their measles shots to protect themselves,” Bellone said in the press release. “While there is no immediate public health concern in Suffolk County, this should serve as a reminder to do what is necessary out of an abundance of caution.”
Stony Brook Children’s Hospital’s Dr. Sharon Nachman, division chief of Pediatric Infectious Diseases and professor of pediatrics, said early symptoms of measles, which is a virus, can be mistaken for the common cold with a patient suffering from a runny nose, fever and red, watery eyes. She said even doctors can miss the signs of measles, that is until the typical rash of flat red spots appears.
The best protection against measles is the measles, mumps, rubella vaccine, the doctor said, and two doses of the MMR vaccine is needed. Measles is highly contagious, and a person could infect others even 60 feet away. She said an unvaccinated person can potentially catch the measles even if they were in the same supermarket or airport as an infected person.
“The reason for the isolation is to keep the kids who are at risk from the kids who are incubating the illness, or they don’t know they have measles,” she said, adding there are those who are unable to be vaccinated due to medical reasons.
The doctor said anyone born before 1957 more than likely had measles. After 1957, three different vaccines for measles, mumps and rubella were given, and now all are combined into one immunization called MMR. She said one should find their immunization records to see if they received two rounds of each when it was split, or two doses of the MMR vaccine. Once a person gets the measles or the proper doses of the MMR vaccine, they are immune to measles.
Nachman said it’s important to get the full doses, and if a person isn’t sure if they got two rounds of MMR, an extra dose will not hurt them.
When she talks with parents who are hesitant about the immunizations, Nachman said she tells them not to be fooled by what’s written on the internet, and to make sure any website they visit has a review process by professionals as anyone can write anything on a blog without checking facts.
The doctor also said it’s important to remember diseases such as measles are still in the environment, and just because we don’t have an outbreak right now, it doesn’t mean it’s not possible. She calls immunization “community protection” instead of using the common term “herd immunity,” which describes when the majority of the population is vaccinated, there is less likelihood of an unvaccinated person being infected.
“You have to do the same thing for your entire community that you expect your community to do for you,” she said. “That’s what community protection is all about. You don’t want your kid getting into a car unless the driver is wearing a seatbelt and your kid is wearing a seatbelt. That’s what a community does. It protects everyone in the community.”
According to the Centers for Disease Control and Prevention website, cases of measles have been confirmed in 15 states and is still common in many parts of the world. Measles has been brought into the United States by unvaccinated American travelers and foreign visitors, according to the website. Worldwide, an estimated 20 million people get measles. Out of those infected, 146,000, mostly children, die from the illness each year.
Prev
