Enter the Enterovirus D68

http://www.cdc.gov/non-polio-enterovirus/about/EV-D68.html?s_cid=cdc_homepage_whatsnew_001

Above is the link to the CDC website for enterovirus D68. Note that at least as of September 22, 2014 the CDC says it is not in North Carolina yet, but given its spread and proximity it is safe to say it is here and just undetected, or will be soon. A few salient urgent care points for this after reviewing the current information on EV-D68.

• Recall this is an enterovirus, which technically is the same grouping as polio. Recall that with these enteroviruses, while droplet spread is typical, a large amount of organism is shed in the stool.  As such, a valuable pearl for prevention in families is to remind family members to be especially diligent about washing hands (for at least 20 seconds) after diaper changes.
• Perspective is a key ally against the fear mongering in the news media. So far,  175 people in 27 states were confirmed to have EV-D68. Most of these patients were tested due to a need for hospitalization. For comparison, think how many children and adults are hospitalized in an average flu season.
• EV-D68 especially attacks babies, infants, children and teens. Most adult immune systems have already seen an immunologic plethora of enteroviral infections, and as such more immunity is present in older people. 
• MOST CRUCIAL POINT- FEVER, ESPECIALLY HIGH FEVERS, ARE NOT TYPICAL FOR EV-D68.  Almost subconsciously, like a pneumonia, one would expect respiratory severity to correlate with fever, but this is not the case. Yes, fever can cause tachypnea but EV-D6 can cause respiratory distress without fever.
• SECOND MOST CRUCIAL POINT: RESPIRATORY DISTRESS IS THE ATTACK MODE FOR THIS VIRUS. AS SUCH, IT IS IMMENSELY HELPFUL TO GAUGE THE CHILD'S RESPIRATORY STATUS BY SITTING AT THE BEDSIDE- SHIRT OFF (TO SEE ABDOMINAL BREATHING, NECK, AND RIB RETRACTIONS)- AND THEN TIME THE RESPIRATORY RATE FOR A FULL 30-60 SECONDS. USE A CLOCK, AS OTHERWISE YOU WILL STOP AT 15 SECONDS BECAUSE IT FEELS  LIKE 30 SECONDS.  This "old school" physical diagnosis pearl yields a veritable cornucopia of information. Plus, to the concerned parents this shows concern as this exam exudes thoroughness and an attention to detail. Try it- you will be amazed how a simple task can go so far. I have lost count of the number of times I thought a patient would need the hospital at triage, or conversely was unimpressed at triage, only to pull a "complete 180" after doing this maneuver. 

Obviously, much like Ebola, I suggest checking with the CDC website about every 2 weeks, especially as these are fluid epidemiological situations that are very much in the public mind.