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Corona Virus Update

Corona Virus Update 3/23/2020

Dear JCP Families:

We hope you are all well and adjusting to the new, temporary normal. So far, we have not seen a significant increase in illness in our patients.  We know it is crucial to continue practicing the extensive or extreme social distancing. This article clarifies how staying home, even if you are well, is crucial.  Don’t be a RED DOT!

 https://apple.news/AWTPfZ4rMQwmOos2PRsrVRw

We continue to see well check appointments and are isolating well patients from sick patients both by time and by location and staff in the office.  Our Cumming office continues to see well children only. Keeping up with routine well care, especially vaccinations, is crucial. Once we are released from captivity, we want our kids to be safe from vaccine preventable diseases.  This recommendation is endorsed by the American Academy of Pediatrics.

We offer TELEMEDICINE appointments, IN CAR WAITING, CURBSIDE APPOINTMENTS and PHONE ADVICE.  Please avoid using urgent care and emergency rooms for non-emergency problems. We need them to be available for the sicker patients.  CALL US FIRST! Someone is available to help you 24/7.

Common questions this week:

Can I get tested for COVID-19?  Testing is still quite limited and should be reserved for the sickest, hospitalized patients at this time.  As testing becomes available, we will let you know. Since there is not a specific treatment for this virus, it doesn’t change our management to know if a patient has it or another virus.

What are the symptoms of COVID-19 in children?  Children have cold like symptoms, cough, fever, congestion and sometimes vomiting and diarrhea.  It appears that children are more likely to have asymptomatic infection and transmit it to at risk household contacts.  Hence, the need for isolation at home.  

Can children get severe COVID-19?  Children do not seem to be at risk for acute respiratory distress syndrome that is causing severe illness in adults.  However, any virus can cause secondary infection or other complications. Pneumonia is a common and potentially serious secondary infection.   We want to see your child if you notice frequent coughing, chest pain, fever (lasting more than 2 days or more than 102), persistent symptoms (cough that is not improving in a few days), shortness of breath or a fever that returns after improving for a few days.  As always, call if you need advice. We understand your anxiety and are happy to listen to your concerns.

I heard that ibuprofen makes this disease more serious.  Is that true? There is a small series of young adult patients in Europe noted to have more severe disease.  The only common feature of these patients was that they all took ibuprofen. In no way does this mean that the ibuprofen caused the severity of illness.  You cannot assume cause and effect here. Many people who are ill take ibuprofen. We still recommend either acetaminophen or ibuprofen for fever and pain.  

Are there any treatments for COVID-19?  Currently, treatment is supportive and symptomatic.  Most people can be managed at home with fever control, fluids and rest as well as monitoring for the complications outlined above.  For people sick enough to be admitted to the hospital, typical treatment is oxygen, IV fluids and close monitoring for deterioration.  Some people require a ventilator (machine that breathes for you) if they get severely ill.  

What about hydroxycholoroquine and Remdesivir?  Hydroxychloroquine is used for lupus and decreases inflammatory responses.  Its cousin, chloroquine, is used for malaria treatment and prevention. While both drugs are generally well tolerated, they do have potentially serious side effects.  The reports have not been well studied enough to understand who might benefit and who could actually be harmed. There are clinical trials in progress and these medications may be used off label in severely ill patients.  Remdesivir is an antiviral medication that shows promise and is in clinical trials. It is also available on a compassionate care basis for those hospitalized with severe disease.

When is this going to be over?  Public health officials do not think we have seen the peak yet.  We may see additional states curtailing all but essential activities.  This is to enforce extreme distancing. It will work if people do it, but many are not following the recommendations.  China enforced this policy and the outbreak lasted for about 4 months.

I don’t know what I can do safely, there is so much conflicting information.

Lower risk:  Walking, hiking, golfing, boating (with family).  Ordering food, groceries and supplies for pick up or delivery.  Boxes from delivery are far safer than going into a store. Porous surfaces such as cardboard are unlikely to transmit a virus.  Run necessary errands when stores are not crowded – you should be able to practice social distancing of 6 ft from others or else go home.

Higher risk:  Going into a store or restaurant, getting gas, going to work if you can’t practice 6 ft of distancing, children in day care settings.  High touch surfaces are the riskiest – shopping carts, credit card machines, gas pump handles. Make sure to use hand sanitizer containing 70% isopropyl alcohol or 10% bleach after touching surfaces and avoid touching your face and other people.

What can I do?  

  • STAY HOME.  This enemy is best fought passively – avoid it.  
  • Limit time watching the news and social media to an hour in the morning and an hour in the evening.  There is so much fearmongering and blame and shame going on, it only increases stress.
  • Focus on your family.  Do fun things together and rediscover each other.  Watch family videos and organize photos, sharing memories.  Have a joke telling contest. Get outside.
  • Keep a routine.  Bedtime, wake up time, get dressed, eat breakfast.  Plan the school day. Be positive and encourage kids to find the good in doing online school.  
  • Eat healthy and exercise.
  • Remind your children and yourself that this is a temporary situation, though it may be a marathon. 

Why don’t people follow the social distancing guidelines?  No idea.

Why do people want to get tested?  No idea unless they are very ill in the hospital or are healthcare providers who need to know when it is safe to return to work.

What about a vaccine?  Best estimates from the experts is 12 to 18 months.  There are currently safety trials underway. Next will be larger trials to determine effectiveness.  Then will be manufacturing.

What do you expect to see this week?  We will likely see increasing numbers of cases both due to transmission and to increased testing.  We will see an increase in people seeking care for illness. The first confirmed COVID-19 patient has been admitted to Children’s Healthcare of Atlanta.  More states will enforce the “essential only” policy.  My hope is that as we start testing more people, we see more mild illness.  Our statistics are skewed toward severe disease right now because we are only testing the sickest people.  Another hope is that most of us are following the rules and the result will be the flattening of the curve.

Please check our website often.  We have a new button on COVID-19 on the home page and will put daily updates there for you.

Stay home and healthy!


Corona Virus Update 3/19/2020

We care about your safety. We want to update you on the precautions we are taking to keep you and your family safe concerning covid-19:

At our Cumming location, we are only seeing well child visits.

At our Johns Creek location, we are clustering our well visit appointments in the mornings and sick visits later in the day. We are also having sick patients use a separate entry and exam rooms in the office. Additionally, we are clustering staff so that staff who are seeing sick patients are not then going to see well patients.

If your child is sick and you think they need to be seen please call us, WE ARE OFFERING TELEHEALTH VISITS FOR SICK PATIENTS.

During this time, we are encouraging our patients to KEEP THEIR WELL CHILD VISITS, especially those with VACCINES. It is crucial that we keep our patients vaccinated to prevent additional disease outbreaks of vaccine preventable illnesses.

If you are concerned about bringing your child in to the office for their well child check you can call and ask to speak to a nurse to see if your child qualifies for a telehealth well visit.



Covid-19 Testing

We are having many parents calling and asking about covid-19 testing. The real question is “should I be tested.” Testing is becoming more widely available, but at this time public health and CDC are recommending that only patients sick enough to be hospitalized in the ICU should be tested. Testing by outpatient labs is not recommended by the infectious disease specialists at Children’s Healthcare of Atlanta (CHOA) at this time. These tests are not finished the FDA approval process, have possibility of false negative results, and require very specific collection techniques to be valid. Quest and LabCorp do not collect specimens. CHOA Urgent Care, Emergency Department and outpatient labs are NOT doing testing unless the patient is admitted to the ICU. CHOA is not collecting specimens to send to commercial labs. DO NOT GO TO CHOA TO GET TESTED.

 


Covid-19 Update 3/13/2020

Dear Concerned Johns Creek Pediatrics Families:

Our goal is to keep you all updated regarding the current guidelines for caring for patients during the COVID-19 pandemic. Please check back often as we will update this information regularly. We are staying informed through regular contact with infectious disease specialists at CHOA and the health department as well as the CDC website.

CDC describes the current effort as moving from containment (trying to halt the spread of the virus) to mitigation (slowing the spread to protect those at highest risk and to avoid overwhelming our medical delivery system).

We will see more of this infection in the coming weeks and probably months.

The good news:

  • It is a mild or even asymptomatic illness in most people, especially in children.
  • The symptoms are fever and cough. The cough is described as dry and there is little nasal drainage or congestion if any.
  • The treatment is supportive and the same as any other virus. Manage fever with acetaminophen (ages 3 months and above) or ibuprofen (ages 6 months or above). Dosing guidelines are on our webpage. Encourage fluids, nasal saline and blow nose or suction, cool mist humidifier, Vicks rub, honey for children over one year of age. Rest at home until fever free without medication for at least 24 hours, manageable and significantly improved cough, normal appetite, energy and sleep.
  • You can protect yourself by practicing good handwashing (with soap and warm or cold water for minimum of 20 seconds) or use hand sanitizer if soap and water are not available. Stay 5-6 feet away from anyone who is actively coughing and sneezing. Avoid touching your face (this is really hard) and sanitize surfaces that others have handled.
  • You can protect others by covering nose and mouth when coughing or sneezing (elephant trunk style into the elbow). Dispose of dirty tissues in the trash. STAY home if you are sick. DON’T hoard medications, hand sanitizer, etc. Just get what you need so everyone can care for their family members.
  • Most respiratory viruses circulate in the fall and winter, so there is hope that the coming spring will shorten the outbreak.

The bad news is

  • No one is immune to this new strain of coronavirus, so it will circulate freely.
  • When many people are susceptible, we hear of many severe cases even if the percentage of severe illness is very low. (0.5% of the entire US population is a large number). Slowing the spread of infection is essential so we can care for everyone.
  • Certain populations are at high risk for severe disease especially the elderly and people with
  • weakened immune systems or underlying chronic medical problems. We will learn more about this disease in the weeks ahead as more information is obtained.
  • Antivirals do not work against COVID-19.
  • There is no vaccine for COVID-19.
  • Travel history and exposure to a known case are no longer considered the only risk factors as “the horse is out of the barn” so to speak.

THE BIGGEST QUESTION WE ARE GETTING RIGHT NOW: CAN I BE TESTED?

The real question is “should I be tested.” Testing is becoming more widely available, but at this time public health and CDC are recommending that only patients sick enough to be hospitalized should be tested. Testing by outpatient labs is not recommended by the infectious disease specialists at CHOA at this time. These tests are not finished the FDA approval process, have possibility of false negative results, and require very specific collection techniques to be valid. Quest and LabCorp do not collect specimens. CHOA Urgent Care, Emergency Department and outpatient labs are NOT doing testing unless the patient is admitted to the ICU or to the regular hospital with certain conditions. AND CHOA is not collecting specimens to send to commercial labs. DO NOT GO TO CHOA TO GET TESTED.

Most importantly, test results do not change management of this illness. The care is symptom relief, rest and surveillance for severe disease.

What should you do?

Live your life as normally as possible. Take reasonable precautions. Elderly people and people with chronic underlying illness or immune suppression should be more cautious.

If you or your child become ill, treat symptoms and monitor for secondary complications. If your child has a high fever (more than 103) or a fever that lasts for more than 2 days, please call our office. Monitor for signs of rapid or labored appearing breathing (skin pulling in between the ribs with breathing, shortness of breath, in infants and toddlers poor feeding). Ear infections, pneumonia and sinus infections can complicate COVID-19 just like any other virus.

If you are concerned about your child’s condition, please call us. We now have separate entrance and areas in the office for sick and well children and a strengthened infection control policy that is in accordance with recommendations from CDC and CHOA.

WE OFFER TELEMEDICINE VISITS FOR ILLNESS AND FOR OTHER REASONS. WE ARE EXPANDING THIS ACCESS IN RESPONSE TO REQUESTS FROM PATIENTS WHO WOULD LIKE TO AVOID COMING IN TO THE OFFICE.

Keep your child’s wellness visits as scheduled. It is critically important that they stay up to date on routine vaccines so we don’t have to worry about those diseases too. There was a recent measles case in Atlanta in an unvaccinated traveler, not to cause more fear.

Stay informed by reliable sources (Johns Creek Pediatrics, CHOA, CDC, GA State Public Health Department). All have frequently updated websites.


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