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Covid 19 Update

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5/11/20 Update

Dear JCP Families: 

We hope you enjoyed a beautiful weekend and were able to honor all mothers, near and far, with us in person or only in spirit.  Thanks especially to our JCP moms.  You all work hard each day, loving and caring for your children and giving of yourselves.  Here’s to all our great moms!

I am happy to receive feedback on my emails and while most of it is positive and encouraging, I have received some great constructive criticism. A journalist reminded me that journalists are hardworking professionals dedicated to bringing us facts.   Another reminded me that I am a pediatrician and to stick with information about children’s health.  Agreed!

Here is what you need to know this week:

  • Atypical Kawasaki Syndrome or Multisystem Inflammatory Syndrome and COVID-19 in Children

Researchers in the UK published a report in The Lancet, a respected medical journal, that identified a series of 8 children with atypical Kawasaki syndrome, when in a similar time frame only 1 or 2 cases would have been expected.  One of these children died.  They urged pediatricians worldwide to be on the lookout for such cases.  

Last week the New York Times reported that at least 50 children in NYC and Long Island developed an inflammatory syndrome resembling Kawasaki or toxic shock syndrome.  As these cases occurred about a month after the initial surge in cases in NYC, it is postulated that it may be an after effect of COVID-19 infection.  Most of these children tested negative for COVID-19 antigen, but some tested positive for coronavirus antibodies, suggestive of past infection.  No children in the NY report died.  Other cases that are similar have been described throughout the US and Europe.

  1.  What is Kawasaki Syndrome?  Kawasaki Syndrome is a multisystem inflammatory syndrome that was first described in 1967 in Japan.  Typically affecting young children this disease presents with 5 days or more of high fever, characteristic rash, red eyes, and cracked, swollen lips.  Untreated, it can cause cardiac complications.  It is on our pediatrician list of “Though Shalt Not Miss This.”  
  2. What is Atypical Kawasaki?  It does not meet all the criteria for the full syndrome but can cause cardiac complications.  In the cases recently reported, patients were aged 4-14 years and had prolonged fever, swollen eyes, conjunctivitis, gastrointestinal symptoms and cardiac complications.  
  3. What do pediatricians think?  There is concern that this severe inflammatory syndrome is a complication of previous, mild COVID-19 infection.  We await more information about the NY series in terms of lab testing, clinical features, etc.  
  4. What should parents keep in mind?  COVID-19 infection is rare in children and almost always mild.  Kawasaki Syndrome may be a rare complication of a rare infection.  Inform us about fevers lasting more than 3 or 4 days.

Getting back into the world

Is it safe to return to work, daycare, summer camp, tennis lessons, etc.?  These are great questions, not simply answered.  We all take risks every day.  A switch will not flip and say it is safe.  We will each need to make our own judgement about returning to activities.  Trust your judgment and do what is right for your family.  Keep an eye on case rates, which continue to decline.  Keep an eye on hot spots, such as Gainesville.  Wear your mask, wash your hands and don’t touch your face.  Stay 6 feet away from those outside your home.

IT IS SAFE and IMPORTANT TO COME TO OUR OFFICE for well checks, sick visits, minor injuries, behavior concerns, etc.  

We are here for you!

Dr. Dewling and JCP Staff




4/29/20 Update

We Have Flattened the Curve!

Dear JCP Families:

Thank you for the opportunity to keep you informed and aware of the facts and not the fear about COVID-19.  We welcome questions and concerns.

Congratulations!  Our extreme social distancing is working.  We have flattened the curve.  Data continues to show declining rates of infection and ICU admissions among Georgians and in much of the United States.  While data models predicted a peak of cases in late April in Georgia, the numbers indicate that our peak occurred in early April.  Models are models and data is data.  We are not out of the woods yet, and by no means should let down our guard.  Our high-risk populations continue to see significant disease, particularly the elderly and nursing homes.  But it is time to move into the next phase of pandemic management.  

We have learned much about this unseen enemy SARS CoV-2, the virus that causes COVID-19.  

How it is spread:  This virus behaves similarly to other respiratory viruses such as influenza.  The predominant means of spread is via respiratory droplets.  These droplets are expelled with an uncovered cough or a sneeze that propels infected virus particles for up to about 6 feet for a very brief time (about 20 minutes).  These nasty little bundles of RNA rapidly sink to nearby surfaces, where they may be detected for some time (hours to days) but are unlikely to be contagious after a short time (hours).  Virus particles are also found in much tinier aerosolized particles that linger in the air for a much longer time and can be produced by asymptomatic or mildly symptomatic people with normal talking and especially with singing.  While these tinier particles may be contagious, it appears that it takes prolonged close contact, such as in a home setting or other group settings involving hugging, hand shaking, kissing and sharing food.  

So, in public, we are worried about the more difficult to spread respiratory droplets.  At home or in social settings particularly groups of 10 or more, we are concerned with both respiratory droplets and aerosolized particles.  To prevent viruses that are spread through respiratory droplets (think influenza, cold viruses) we practice droplet precautions.  These are

  • Cover mouth and nose with inner elbow with cough and sneeze.
  • Stay home when sick.
  • Wash hands often, preferred soap, water and friction.  Hand sanitizer is an option if soap and water are not available.
  • Don’t touch your face.
  • Stay 6 feet away from anyone overtly ill.  And for COVID-19, I am going to add on wear a mask in public in case you have asymptomatic infection to protect others, or you unexpectedly come closer than 6 feet to someone to protect yourself.

At home

  • Do all the above, except no mask needed.
  • If you are ill, self-isolate from other household members, especially those at higher risk of illness.  Stay home.  Call your doctor if your symptoms are concerning to you.

Symptoms of illness and transmission:

Typical symptoms of illness are fever, dry cough and chest pain or difficulty breathing.  Symptoms usually worsen several days into the illness.  The illness lasts about a week.  Virus particles can be found from several days prior to symptom onset to 2-3 weeks from symptom onset.  Contagious particles are thought to be present from about a day prior to symptom onset to 7 days after symptom onset and when fever has resolved, and cough and chest pain are significantly improved. Remember that these tests are PCR (polymerase chain reaction) technology which amplifies the presence of the viral genetic material and therefore detects very tiny amounts of virus that may not be contagious.  

Like ALL viruses, manifestations can be different in different people.  COVID-19 can cause minimal illness in some and SARS (Severe Acute Respiratory Distress Syndrome) especially in older adults and in people with chronic health problems.  This syndrome is the result of an overactive immune system unleashing inflammatory changes in the lungs that cause fluid to leak into the lungs and severe respiratory disease.  ICU admission and fatality are high in this small sub population.   Yes, the rare young person in good health can also get serious disease.  Other symptoms can also occur such as sore throat, chills, headaches, nausea, vomiting and diarrhea.  Again, this myriad of manifestation of severity and type of symptoms is typical for viruses.

Recent reports talk about risk of sudden stroke in otherwise healthy young people.  Keep in mind that there are a few case reports amid millions of cases.  More study is needed to determine cause and effect, who is at risk and why.

While there are still clinical features of the disease that we are learning about, our knowledge has advanced significantly in the last 2 months.

Questions that remain:

  • Effective treatment.  In medicine and science, it is essential to study treatments in terms of safety and efficacy before presenting them as recommended therapies.  We have always had compassionate use medications in which we attempt to try everything for someone severely ill, pulling out all the stops to save a life, and an unproven treatment may be tried.  Researchers continue to study cholorquine, hydroxychloroquine, azithromycin, remdesivir (an antiviral) and hyperimmune globulin to name a few.  These drugs are being used in investigational and compassionate use protocols at this time and are not routinely recommended.
  • Testing.  Testing is not widely available in Georgia, especially for children.  At this time, since children are NOT getting severe COVID-19, the only ones we are testing are hospitalized, severely ill children, and they are few, thankfully.  There are questions about reliability of the commercially available tests with estimates of up to 30% false negative rates.  That means, you have the virus but the test is negative.  Therefore, testing is NOT necessary unless you have severe illness.  Exceptions to this rule of testing include health care workers and perhaps family members who have at risk people in the home.  If you are sick, but not sick enough to need a doctor or emergency room visit, assume you have COVID-19, stay home, self-isolate until your fever has resolved for 72 hours and you are feeling better.  If you have risk factors, difficulty breathing or other symptoms that worry you, call your doctor (or us!).
  • Immunity, Antibodies and Vaccination.  How many of us had infection and never knew it?  Could many of us be immune?  What level of antibodies is protective?  How long do protective antibodies last?  Are vaccinations under study now safe?  Effective in producing protective antibody?  How long lasting is that protection?  WE HAVE NO IDEA.  All these areas are under investigation and are fast tracking to get information.  While commercial labs have antibody tests available, they are not FDA approved.  We do not know how to interpret the results.  We do not recommend routine antibody testing YET.  We will keep you aware of changes.

As you know, our governor has opened our state and our shelter in place order expires on May 1. We are in a public health emergency through May 1st and people over 65 and with chronic medical conditions have shelter in place orders through May 15th.  These orders can be renewed, so we will see what happens.  

Editorial by Dr. Dewling:  While the news media tried to portray us as country bumpkins intent on going bowling, the truth is that it is time to restart our economy.  As one parent put it, “My job is essential.  It is how I feed my family.”  The relaxation of the shelter in place order allows hospitals to begin performing “non-essential procedures.”  Our practice has several patients waiting for these procedures that are rapidly becoming more essential, including ear tube procedures, sinus surgeries, and even heart procedures.  CHOA is now beginning to perform these necessary procedures.  Why doesn’t the media report this benefit?   They love to create drama, conflict and fear.  Let us stick to the facts.

Our economy is suffering.  CARES Act funding gives a temporary respite to those small businesses fortunate enough to procure funds.  However, if we do not start returning to frequenting those businesses, they will ultimately fail and this money will be wasted.

We are seeing increasing emotional impact to children and adults as shelter in place orders limit our enjoyment of life.  Anxiety occurs when we watch excessive amounts of sensationalized news and news that is partial truth with opinion “spun” in.

We do not worry about going about life during cold and flu season.  For healthy young people, the risk is likely on the same order as the risk of influenza if you are not vaccinated.  Now that we have flattened the curve, it is time to gradually and with an eye on possible resurgence start getting back out there.

A harmful side effect of fear of COVID-19 infection involves delaying necessary medical visits.  Emergency rooms and hospitals are seeing patients with traumatic injuries that delayed seeking care due to fear of catching the virus.  People are fearful of seeking care for appendicitis and are coming in with progressed symptoms that have potential for much worse outcome.  Patients are skipping needed wellness visits that address mental and physical wellness.  Importantly, vaccination rates have decreased.  We do not want to set up the next public health crisis of a resurgence of vaccine preventable diseases like measles, chicken pox, and meningitis.  

Our emergency rooms and hospitals are safe.  Our office is safe.  Infection control policies are in place, staff is well trained, patients are not sitting in waiting rooms.  PLEASE do not put off seeking medical care that is important.  Our facilities are not busy and social distancing is easy.  We are extremely comfortable with the idea of respiratory droplet precautions and have always practiced them.  Yes, they are more robust now than ever.  We are calling patients who are due in the coming weeks to get you scheduled.  Please care for your child and trust us to keep you safe.

Our Practice Policies:  We are scheduling sick visits in the afternoon at Johns Creek only.  We see very few sick children each day and they are being seen in a designated space with designated staff.  They continue to use the rear door/employee entrance.  We will be scheduling well checks in the morning and afternoon at both Johns Creek and Cumming.  Again, we will use a separate part of the office for sick children in the afternoon in Johns Creek.  If you prefer to avoid the office when sick children are there, we can accommodate that in the morning at Johns Creek and all day at Cumming.

We are frequently sanitizing exam rooms between patients and high touch surfaces throughout the office.  Our staff are screened for illness each day and are masked.  We ask patients to limit the number of people coming to the office to essential caregiver(s) and patient only when possible. We understand siblings may need to come along.  Our waiting room is closed, and waiting is in car (preferably not at all!).   And all registration is done online We understand siblings may need to come along.  If you have masks, please wear them while in the office.  We have hand sanitizer and soap and water throughout the office.  

We continue to offer virtual visits through telemedicine.  We can do procedures such as strep tests, lab tests and ear checks, lung checks in the parking lot, curbside.  And importantly, we are always here for you to help with questions and concerns.  Call us!  

We look forward to seeing everyone in the coming weeks.

Love,

Dr. Dewling


4/14/20 Update

Dear JCP Families: 

 We hope you are settling into your new normal.  Please continue to stay home and avoid all but essential errands in public.  If you are sick, please stay home.

When you do go in public: 

 1.  Wear a mask.  See our website https://www.johnscreekpediatrics.net/corona-virus-update our Facebook page https://www.facebook.com/JCPSuwaneeandCumming/ and our Instagram feed https://www.instagram.com/johns_creek_pediatrics/for tips on how to wear a mask correctly and other helpful videos and posts.

2.  Stay 6 feet from others.

3.  Wash hands and avoid touching your face.  

4.  Avoid taking children with you on errands if possible.

 

Doctor’s appointments are considered essential.  Please do not let your children fall behind on important wellness visits, especially those that include vaccinations.  Follow up appointments for asthma, headaches, and chronic concerns are also important.  We see ONLY well checks and non-illness related visits in the morning in Johns Creek and all day in Cumming.  We have same day appointments for non-illness related concerns either in the office or telemedicine.  Telemedicine visits are a great option for many concerns.  If your child needs an ear check, listen to heart/lungs, or throat swab, we are happy to come to the car to do these procedures and exams after a telemedicine visit.  We see illness visits in the afternoon in Johns Creek.  We continue to clean vigorously and practice enhanced infection control.  YOU ARE SAFE IN OUR OFFICE.  We see emergencies as needed, so please call for immediate needs at any time.

Our current hours are

Johns Creek Location:  Monday through Friday 8:30am-5pm

Cumming Location:  Tuesday, Wednesday, Friday 8:30am-5pm

Please call before coming as our hours may be adjusted based on patient need.

 

On COVID-19 Testing  

Testing options remain limited.  Children continue to be at very low risk for serious infections and therefore testing is not recommended until it is more widely available.  CHOA is now able to test patients in the hospital, but they are not doing widespread testing in the ED or Urgent Care.  CHOA reports only 15 positive tests out of 131 tests performed. They also state that less than 1% of COVID-19 admissions are in children.  This is great news!

We agree that it would be helpful to know if someone is infected even if they are not at high risk to know about quarantining the patient, their household contacts and tracking possible exposures.  We will let you know when the recommendations for testing children change.

Parenting Resources:

What you are experiencing right now is extremely difficult.  Please reach out to us if you have any difficulties with emotional or behavioral problems.  We are hearing about so much stress and anxiety.  We can help.  Here are some helpful resources:

A very smart mother directed me to this interesting course that is free.  From Angry to Aligned, Helping Our Strong-Willed Kiddos Feel Safe in Uncertain Times. http://www.randirubenstein.com/  I haven’t vetted it myself, but I am going to watch it.

CHOA has a resource page dedicated to COVID-19 concerns.  There is a hotline and an assessment tool/symptom checker to see if you need to be concerned about being seen for COVID-19 infection.  Click here https://www.choa.org/medical-services/wellness-and-preventive-care/covid19.

Also from CHOA, https://www.strong4life.com/en has great tips for parents regarding discussion about the pandemic and quarantine with your children and many great strategies for parenting during difficult times and building emotional health in general.

Please pass along any other great suggestions and we will share.  I have heard so many great ideas.  You all continue to take care of us with food and treats and good wishes.  Thank you for trusting us with the health of your most precious children.  It is truly a privilege.

Love,

Dr. Karen Dewling and all the staff at Johns Creek Pediatrics


4/6/20 Update

Dear JCP Families:
Thank you for your kindness and support during the COVID-19 pandemic. We have had families bring us lunch, offer support and make us masks.
Fortunately, children are not getting ill in large numbers. There have been NO pediatric deaths in Georgia from COVID-19. A transcription error in the GA Public Health Department report last week showed an 11-year-old as a fatality, but his was not true.
What we are seeing in terms of illness right now, we are assuming is largely COVID-19. Most people, especially children, continue to have mild illness with a few days of fever and cough. The people who have gotten sicker seem to worsen several days into the illness with increasing fever and shortness of breath. We have seen a few children with viral pneumonitis and pneumonia. Testing is still not available, including at CHOA. Even hospitalized patients with respiratory symptoms are not being tested unless they have underlying medical problems or are in the ICU. CHOA has had 5 patients test positive as of 4/3 and 4 had been discharged home.
PLEASE stay home! Children should not go to public places if possible.
The American Academy of Pediatrics still recommends well checks, especially in the first 2 years of life and if vaccines are due.
We continue to keep well and sick visits separate, sanitize the office frequently, offer in car waiting with short wait times, telemedicine and curbside care.
If you go out, wear a mask and continue to practice social distancing, hand washing/sanitizer, and don’t touch your face. Wearing mask is an additional barrier and should not make you feel more comfortable about being in public.
We ARE seeing an increase in injuries, anxiety and depression and marital discord as well as child abuse.
Please call us if we can help you in any way with these concerns. We do minor injuries and laceration repairs in the office. We would rather that you didn’t get hurt, of course!
Because of our low volumes, we are limiting our staffing and hours.
Please do not seek walk in care but call us before coming into the office. We can direct you to the appropriate place for care and be prepared when you arrive. Someone will be in our office Monday to Friday 8:30-5pm.
I am proud of our JCP team for their hard work and personal sacrifice to care for the families in our practice. We will get through this and emerge with more kindness and compassion with a focus on what is right, true, good and beautiful.
Remember, stay home and healthy and calm is contagious!


Dr. Karen Dewling, M.D.



4/3/20 Update

Dear Johns Creek Pediatrics Families: 

 We hope this update finds you well, sheltering in place at home per orders of Governor Kemp, effective today.  Following the guidelines.  

  • Stay home except for essential activities (medical, food/fuel, banking and other essential activities).
  • If you do go out, practice social distancing and consider wearing a mask (see our video on Facebook and Twitter with guidelines about masking in public).  A mask is not a substitute for other measures, but rather an ADDITION to these established guidelines.
  • Continue to wash your hands, avoid touching your face, stay home when ill, cough into your elbow.

The American Academy of Pediatrics continues to recommend the following:

  • Children due for well checks with vaccines should keep appointments.
  • Guidelines are to cluster well visits by time, staff and space in the office, sanitize high touch surfaces, avoid waiting in waiting rooms, all of which we are doing.
  • We have sick visits in the afternoon, including curbside visits.  We can see you via telemedicine and you can come to the office for a parking lot ear check or throat swab, etc. as needed.
  • We are seeing an increase in visits for anxiety and can talk to you and your child about anxiety, depression and other behavior concerns by a virtual telemedicine visit.  We have same day availability.
  • We are always available for you after hours by calling our main number.  Our answering service will get you in touch with the on-call person for the practice.

IMPORTANT:  As of Monday, April 6th, CHOA announces the following temporary closures (through April 30th).  If you need assistance with scheduling any lab or radiology procedures, please call our office.

  • Urgent Care Centers: Children’s at Cherokee, Children’s at Hamilton Creek and Children’s at North Point
  • Outpatient imaging and lab services: Children’s at Satellite Blvd., Children’s at Town Center and Children’s at Webb Bridge
  • Outpatient rehabilitation: North Druid Hills
    • Note, patients will be rescheduled as needed. Children’s Medical Office Building and Children’s at Town Center Outpatient Care Center will remain open.
  • Orthotics and prosthetics: Forsyth
  • Sports physical therapy: Cherokee, Ivy Walk and North Druid Hills
  • Children’s Physician Group: Select locations and services will be consolidated

 

Additionally, our outpatient surgery centers at Children’s at Meridian Mark and Children’s at Satellite Blvd. will remain closed through April 30.

Stay home and healthy and remember that CALM IS CONTAGIOUS!

The Providers and Staff at Johns Creek Pediatrics


3/31/20 Update

Dear JCP Families:

Please remember we are here to answer your questions and see your children.  We continue to see well checks at both offices.  Our patient volumes are very low, so it is easy to practice social distancing.  We have strict infection control practices in place including deep cleaning rooms between patients and frequent disinfection of high touch surfaces.  Children with respiratory symptoms are being seen in one area of the office apart from non-illness visits with designated staff and using the back entrance.  We have telemedicine visits for behavior, ADHD, asthma, dermatology and minor sick visits.  If your child needs a strep test or ear check, we are happy to come to your car and have curbside service.  We want to share some resources with you.  Please visit our website www.johnscreekpediatrics.net for a video of Dr. Dewling talking to the kids about the COVID-19.  You can view this on our Instagram and Facebook page as well (Johns Creek Pediatrics).

CHOA has a helpful resource:

COVID-19 Pediatric Assessment Tool:  COVID-19 Pediatric Assessment Tool on choa.org to help parents determine how to care for their child if the child has a fever and/or cough, or if the child may have been around someone with COVID-19 but has no symptoms.

Parents:  If you are interested in being happier now and after COVID-19 (and who isn’t?), here are 2 interesting and free studies to consider.

  • The Science of Well-Being by Dr. Laurie Santos, Yale University.  She is a researcher on happiness and teaches the most popular course of all time at Yale University.

                               https://www.coursera.org/learn/the-science-of-well-being

3/30/2020 Update

Dear JCP Families:

We would like to update you as we head into our 3rd week of COVID-19 isolation measures.  Please go to our website (www.johnscreekpediatrics.net) for more frequent and complete updates.

The social distancing recommendations have been extended through April 30th.  

We have heard from patients expressing concerns about ability to pay for medical care if they have lost their insurance or have high deductibles.  Please know that we are here for you.  If you cannot pay, please let us know.  We still want to see your child.

The American Academy of Pediatrics (AAP) Reaffirms Recommendation for Well Child Visits.

Your children’s wellness visits are important to keep up to date on vaccinations, assess growth and development, monitor for health concerns, follow up on chronic conditions and answer your questions.

We are clustering well check appointments in the morning at our Johns Creek Office and at our Cumming office we are seeing only well checks.  Dedicated staff are seeing well patients only.  We practice strict infection control policies including sanitizing exam rooms between patients, frequent sanitizing of high touch surfaces, hand hygiene, use of protective equipment in compliance with recommendations.  We screen all employees for illness daily.

Please continue to bring children in for these important visits. We don’t want them to be vulnerable to vaccine preventable disease when we get back out there!

For children:

This illness in kids:  Thankfully, children appear to be mildly affected by coronavirus overall.  They are an important part of spreading this infection so KEEP THEM HOME.  Any virus can cause more severe illness in otherwise healthy people of any age.  We will hear of children getting more severe disease, but these are relatively unusual.

If your child gets sick:  Please call us if you have concerns about your child’s health.  We are available 24 hours a day to help.  Call our office at 7700 814-1160 to reach our on-call provider.  AVOID going to adult facilities (urgent care, hospitals, retail clinics).  Ill adults are much more likely to transmit this infection.  If your child needs to be seen after hours, CHOA facilities are a great option.  They are not busy right now.

Be safe:  CHOA is not seeing much illness at this time, but they are seeing an increase in trauma.  Trampolines, hoverboards, ATVs and dirt bikes are associated with severe injuries.  Remind kids to wear bike helmets when biking and helmets, wrist guards, knee and elbow pads when scootering.  Avoid riding bikes and scooters around cars.  Avoid climbing higher than twice your height.  Closely supervise children around water and wear life jackets.  You don’t want to have to go to the ED right now!

Online school has many challenges!  Keep positive and avoid getting frustrated with technology glitches.  Teach kids that nothing is perfect, and students, schools, teachers and parents are doing the best they can.  Try to keep a routine as you would during a regular school week.  Wake up, get dressed, eat breakfast and sit down in your “office” at start time.  Help them organize their time.  Take regular breaks and get outside when possible.  Use reward systems (this is not bribery!) such as earning time on devices.

Let your kids connect with each other by group chats, online gaming, Facetime, Skype and other applications.  Social connections are critical for all of us and we are fortunate to have these platforms available to kids and families.  Check in with elderly family members and others with video calls.  Of course, always monitor kids’ screen time.

Mental health concerns such as depression and anxiety are possible problems during a period of isolation and fear of getting sick and economic loss.

  1. Avoid watching the news all day.  Spend 30 min morning and evening and then turn it off.  Repetition of bad news tends to increase anxiety and depression as was seen after 9/11.
  2. Teach children coping skills.  Check out www.strong4life.com.  The section on resiliency is excellent with several different strategies.
  3. Check in with us if you have concerns.  We offer telemedicine consultations for anxiety and depression as well as other problems.
  4. Discuss all the things you are grateful for each day.  Enjoy nature together.  Make art and music.  Savor the slower pace.

AAP has new parent resources, www.HealthyChildren.org has a constantly updated page on coronavirus and a new resource on social distancing. We also offer new tips for helping parents find ways to occupy children during these challenging times. 

Of note:  Due to lack of demand, we will not be open on Saturdays for sick visits anymore.  We hope to resume this service when the crisis passes.

We are hopeful that testing will become more widely available in the coming weeks.   Our infectious disease consultants are recommending testing of hospitalized patients only currently.  We will let you know when it is available.  Test results for mildly ill patients may help us inform need for quarantining and avoiding family contact and get an idea of the true number of cases, not just the most severe.

We invite questions and concerns.  Our goal is to keep you informed. 


3/23/2020 Update

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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