As we continue to worry about the spread of COVID-19, now we hear that positive West Nile Virus mosquito activity is at record high levels in Tarrant County.

It seems 2020 is not quite ready to give us a break any time soon.

Tarrant County Public Health issued a warning to the general public at the end of last month. In its latest report (Aug. 2-Aug. 8, 2020), TCPH reported 302 positive tests in the region this year.

“We are continuing to see rapid increases in mosquito infection rates in Tarrant County, which means we have more human risk for West Nile Virus,” said Tarrant County Public Health Director Vinny Taneja at the end of last month. “To prevent outbreaks of West Nile, it’s very important that people remember to always use an EPA-approved repellent and wear long sleeves and pants when they go outside,” he said.

Fox4 reports one death related to West Nile this summer and "recent tests of mosquito traps in the northeastern part of the county show a 60% positivity rate."

Adding to the anxiety are how similar the symptoms of the West Nile virus is to COVID-19. About 20% of infected people will develop a fever with other symptoms such as headache, body aches, joint pains, vomiting, diarrhea or rash.

These are symptoms common in many viruses including COVID-19 and the flu.

But there are differences in COVID-19 and West Nile, beginning with how you contract the viruses.

“COVID is a respiratory virus spread between people’s secretions,” said Nicholas Rister, M.D., an infectious disease pediatrician at Cook Children’s. “West Nile virus is a blood infection spread by mosquitos. People with COVID, have symptoms that are primarily respiratory symptoms. West Nile virus is more fever, rash and joint aches.”

Dr. Rister said less than 1% of West Nile virus cases can cause central nervous system infections (meningitis/encephalitis for example), which is a bit more common in adults than kids, but still rare.

West Nile virus can affect anyone, although people age 50 and older run a higher risk of developing a severe infection.

Most people with this type of the disease recover completely, but fatigue and weakness can last for weeks or months. Less than 1% of infected people develop inflammation of the brain or surrounding tissues. The symptoms of neurologic illness can include headache, high fever, neck stiffness, disorientation, coma, tremors, seizures or paralysis.

Most children who are infected with this virus do not develop symptoms. West Nile virus has been circulating in mosquitoes in the United States for many years and is not new.

With heightened concerns of mosquito-borne illness, Tarrant County Public Health and County officials are asking for help to protect their community from mosquitoes such as:

• Wearing long sleeves and pants
• Dumping standing water
• Using EPA-approved insect repellent
• Keeping vegetation trimmed

Here is a list of mosquito repellents endorsed by the FDA and CDC. Tarrant County Public Health also has more information about West Nile Virus and other preventive measures residents can take at Be Mosquito Free.

“With a flu season that could be prolific, if that leads to greater hospitalizations coupled with the hospitalizations that we’re seeing for COVID-19, you can easily see how hospitals in this region, as well as across Texas, will be completely overrun,” said Abbott.

Thankfully, COVID-19 hospitalizations among children have remained low, but that doesn’t mean parents should let their guard down. Nicholas Rister, M.D., pediatric infectious diseases physician at Cook Children’s, says now is a good time to set a reminder to get the entire family vaccinated against the flu as soon as immunizations become available, likely mid-September.

“It is a little more concerning than your average flu season because COVID-19 is still very prevalent in our area,” Dr. Rister said. “Both of these viruses trigger respiratory illnesses and the symptoms are very similar so it’s going to be difficult to tell the two apart without testing.”

To add insult to injury, it is possible to get both COVID-19 and the flu at the same time. Dr. Rister says if that happens, it would likely make symptoms worse.

“By in large, children have luckily been spared from the most severe effects of COVID-19,” Dr. Rister explained. “Unfortunately, the same does not hold true for the flu. Kids can become very ill from the flu and end up in the hospital. That’s the last thing we want to happen.”

In addition to pushing Texans to get their flu shot, Governor Abbott said COVID-19 cases are decreasing in Dallas/Fort Worth. But he warned the illness is still spreading heavily among family and friend gatherings.

"There may be this sense that if you're gathering with family, you're not really transmitting COVID-19, but that has been disproven," Abbott said. "Anybody anywhere has both the ability to spread or contract COVID-19." 

So while we wait for vaccines to arrive for both viruses, these are steps you can take to protect you and your family:

• Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing or sneezing. If soap and water are not available, use an alcohol-based hand sanitizer with at least 60 percent alcohol.
• Avoid touching your eyes, nose and mouth with unwashed hands.
• Wear a mask.
• Avoid large gatherings.
• Keep social distance.
• Stay home when you are sick.
• Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
• Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe
  • Before disinfecting surfaces, clean with soap and water to remove dirt and other residue
  • Follow by using a household spray or wipe disinfectant that is labeled "Kills 99.9% of viruses and bacteria."
  • Wipe the surface down and allow 5 minutes to dry before using the surface.
  • The CDC offers alternatives to commercial disinfecting solutions on their website, as well as tips for cleaning your home. 

According to Nicholas Rister, M.D., an infectious diseases pediatrician at Cook Children’s, anecdotes of COVID-19 parties are circulating the medical community nationwide. While he says we have not seen any confirmed cases of COVID-19 from such gatherings here in Fort Worth, he wants parents to know that we do not recommend intentionally getting COVID-19 given the uncertain benefits and potentially high-risk for harm.

"Historically, getting exposed to a disease as a protective measure is rarely indicated, but has occurred in the not-too-distant past with chickenpox," Dr. Rister explained. “We don’t recommend chickenpox parties now that we have a vaccine, but immunity was lifelong with those antibodies. With COVID-19, the immunity could be temporary and incomplete, so the benefit is unclear and maybe not what families are wishing for.”

He says even though children typically don’t get as sick as adults, there’s still a severe risk that comes being exposed to the disease.

“Most children do well compared to adults, but some kids do very poorly,” he said. “Some kids need to be intubated and end up in the hospital and could die, so just because most kids do well doesn’t mean your child will.”

And knowing which children will do well is still a mystery. Dr. Rister says we still have a lot to learn about COVID-19 and doctors don’t always know why one child ends up extremely ill while another may have mild symptoms.

“It’s hard say your child is truly safe or completely healthy and when exposed to the virus will turn out fine,” he said. “There’s certain cases where we know your child is going to be at a higher risk, like if your child has cancer, but there’s other children, who as far as we knew were completely healthy, but they got very sick and needed to go into the ICU. There’s almost certainly more to that story, but we couldn’t tell there was any other major illness even with lab work being done, so we wouldn’t expect parents to know either.”

We assume parents who may consider sending their child to a “COVID party” may be trying to take some control of a situation that is truly out of their hands. But Dr. Rister says all of that assumed control will go out the window when their child is admitted to the hospital.

“You’re now at the hospital and things can get out of hand pretty fast,” he said. “Especially with the numbers so high right now, this is probably the worst moment to be engaging in that behavior.”

So bottom line is the risk of intentionally exposing yourself or your child to COVID-19 far outweigh any potential reward and should never be considered.

“What we are noticing is that the number of cases is ballooning over a short period of time,” said Nicholas Rister, M.D., pediatric infectious diseases physician at Cook Children’s Medical Center.

This rapid increase in COVID-19 cases is causing concern among physicians that we will see the virus spread even further, especially with the Fourth of July weekend ahead of us.

“We understood that as we re-opened Texas we would see more cases,” said Dr. Rister. “I think these numbers show that this disease spreads among all people, and that includes children.”

Ninety percent of the positive cases at Cook Children’s have been among symptomatic children. The most common signs parents should be aware of are cough, fever, mild respiratory symptoms, rash and stomach pain. More severe symptoms may require hospitalization and can progress to respiratory failure but thankfully remain uncommon in children.

At this time, the number of infected children needing hospitalization remains low, with six patients currently being treated at Cook Children’s Medical Center. But Dr. Rister says while the majority of children are able to recover on their own, some will need oxygen support and even a ventilator.

“It’s rare for a child to become so ill they need a ventilator because of the virus, but we have seen it and it’s something we want to prevent,” he said.

The ages of COVID-19 patients span from infants to 20 year olds, with no real concentration on one age group over another.

“It’s tough to say where someone gets the virus from, but big events with lots of people are a common way transmission occurs,” Dr. Rister explained. “We have seen children who we believe became infected at youth sporting events and summer camps.”

Dr. Rister says it’s important to limit your child’s exposure to large groups as much as possible, and always try to wear a mask, maintain social distance and wash your hands as much as possible.

“We know it’s hard to say all children should wear a mask, but as much as you can, it’s going to make a difference,” he said. “Every day we hear about COVID numbers on the news, but most families haven’t seen it despite how common it is. I think it’s important to remind people that the boogie man is real, this thing is out there and the precautions you are taking are very important.”

As for the Fourth of July, Dr. Rister hopes families will still find a way to celebrate while taking into consideration the risk for contracting and transmitting COVID-19.

“The question to ask yourself is ‘how many people are you going to be around and how exposed will you be?’. If you can effectively social distance, wear a mask and you’re in a smaller group, then I think those are very reasonable things to think about doing,” Dr. Rister said. “The larger group activities like being around big groups of people at pools, large cookouts, sporting events, large fireworks displays where you are close to other people; those events are what we’re worried about.”

For families trying to decide how many people to invite for Fourth of July gatherings, consider whose most at risk. If you have elderly grandparents or people who are ill, Dr. Rister advises you to be cautious.

“We’re not saying you can’t have a celebration, but we do think you need to have a real honest talk about how you can limit risks.”