Coronavirus Disease 2019 (COVID-19) Information

Dear Blue Fish patients and families,

We are sorry that the threat of COVID-19 to you, our children, our families, and our loved ones is adding more of a burden to our already busy and sometimes stressful lives. None of us really have much extra bandwidth to spend on such an ominous threat to the whole world especially when it affects our children. We would like to give you an update on how we are addressing the threat.

First, we have some encouragement.  Given the limited and evolving data set we have, so far it seems that most healthy children infected with COVID-19 have a mild, self-limited illness similar to other viruses you are all used to navigating.

Currently, we have decided to interact with all people as if they might have COVID-19. After much study and deliberation, we have come to the realization that the epidemiological criteria that have been used early on in the pandemic are not sensitive enough to determine accurately who is most likely to have the illness. Geographic and symptomatic criteria have become an ineffective means of risk stratification.

What was once a short list of “at risk” travel destinations now includes our entire community. What was once a short list of symptoms such as fever and cough does not address the data showing that asymptomatic or nearly asymptomatic people are spreading the virus perhaps as much as those with obvious symptoms. In addition, we now know that a few pediatric patients present with predominantly vomiting and diarrhea.

Therefore, we are currently focusing our efforts on three main concepts:

  • Decreasing the number of people who come to the office as much as is logistically possible and sustainable
  • Reducing the risk of COVID-19 transmission in the office
  • Screening by questioning all people coming to the office

Please click the toggles below to examine more closely how these and other concepts are being brought into action.

  • COVID-19 FAQs

    Updated on May 5, 2021

    What is the Coronavirus Disease 2019?

    The Coronavirus Disease 2019 (COVID-19) is a new respiratory virus first identified in Wuhan, Hubei Province, China. This virus was not previously known to cause human illness until the recent outbreak. It is believed that the virus was initially transmitted to humans from a wild animal. Human-to-human transmission is now the most common route of transmission.

    What are the symptoms of COVID-19?

    Similar to many viral respiratory illnesses, the symptoms of the virus mimic the common cold and include mild to severe respiratory illness with fever, cough, chills, muscle aches, sore throat, new loss of taste or smell, and difficulty breathing. Symptoms may appear between two to 14 days after exposure to the virus. Also be mindful that there are many causes for upper respiratory and allergy symptoms that are much more common than COVID-19.

    How does COVID-19 spread?

    As with any viral respiratory illness, COVID-19 can spread from person to person through small respiratory droplets, which are dispersed when a person with the virus coughs or sneezes and are then inhaled by another person. These droplets can also land on objects and surfaces around the infected person. Other people then catch the virus by touching these objects or surfaces, then touching their eyes, nose or mouth.

    How do I protect myself from getting COVID-19?

    When eligible, receive the COVID-19 vaccine.  Otherwise, the best way to prevent the spread of germs is proper hand hygiene and cough etiquette. Below are some other tips:

    Wear a mask around other people
    Avoid close contact with people who are sick.
    Avoid touching your eyes, nose and mouth.
    Stay home when you are sick.
    Cover your cough or sneeze with a tissue, then throw the tissue in the trash and perform hand hygiene immediately.
    Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.
    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 readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. Always wash hands with soap and water if hands are visibly dirty.

    What do I do if I think I have COVID-19?

    Based on CDC guidelines, if you think you may have COVID-19 and are experiencing minor symptoms, Blue Fish Pediatrics recommends you self-quarantine at home for at least 14 days and check our website for more information. For shorter quarantine information, click here. And please call us if you have additional questions. For severe symptoms, call ahead to your local Emergency Center prior to arriving or dial 911 if you need emergent care.

    How can I be tested for COVID-19?

    Please click the ‘Blue Fish COVID-19 Testing’ toggle on our COVID-19 page.

    What if my child is exposed to COVID-19?

    If a patient is confirmed with COVID-19, reassuringly the pediatric population has fared very well with the illness. Most will only require a 14-day quarantine or a period of isolation at home and will not require hospitalization. For shorter quarantine information, click here. However, should they become more acutely symptomatic please contact us ASAP.

    What happens if my child tests positive for COVID-19?

    If a patient is confirmed with COVID-19, reassuringly the pediatric population has fared very well with the illness. Most children will only require a minimum 10-day isolation at home and will not require hospitalization. For more information, click here.

    What about Multisystem Inflammatory Syndrome in Children?

    MIS-C stands for multisystem inflammatory syndrome in children. Formerly called pediatric inflammatory multisystem syndrome, or PIMS, it describes a new health condition seen in children who have been infected with novel coronavirus, recovered from it and later have an immune response that results in significant levels of inflammation in organ systems and symptoms. MIS-C is similar to other inflammatory conditions like Kawasaki disease and toxic shock syndrome. Children who have MIS-C generally did not have obvious symptoms when they were infected with novel coronavirus, like cough, and generally were healthy prior to developing MIS-C. Fortunately, MIS-C is quite rare and to date most children have fared very well with proper treatment.

    Will taking Tamiflu help me protect myself from getting COVID-19?

    No, Tamiflu will not protect you from getting the novel coronavirus. Tamiflu is a drug to treat the flu, not a vaccine. The virus is so new and different that it needs its own vaccine. Researchers internationally have been working to develop antivirals, but at the present time, there is no specific treatment or vaccine.

    How long does COVID-19 survive on surfaces?

    Studies suggest that coronaviruses may persist on surfaces for a few hours or up to several days. If you think a surface may be infected, clean it with simple disinfectant to kill the virus and protect yourself and others.

    How does COVID-19 compare to other Coronaviruses?

    There are several common coronaviruses that typically cause respiratory illness, like the common cold. Symptoms of COVID-19 can range from mild infection to severe respiratory illness.

    Is it safe to receive mail from any areas with confirmed cases of the Coronavirus?

    Yes. The likelihood of an infected person contaminating commercial goods is extremely low and the risk of catching the virus from a package that has been moved, traveled and exposed to different conditions and temperatures is also extremely low.

    How is Blue Fish Pediatrics protecting patients and staff from Coronavirus?

    Blue Fish Pediatrics continues to take proactive steps to protect our employees, physicians, patients and community by implementing a workforce protocol based on CDC guidelines. These protocols includes screening our workforce daily, wearing masks at all times, and following CDC recommendation for sterilizing the exam and waiting rooms.

    What is Blue Fish Pediatrics doing to prevent the potential spread of COVID-19 to patients and physicians?

    To further protect the health of our patients, workforce and the community, and prevent the potential spread of COVID-19, Blue Fish Pediatrics is using a modified scheduled for the time being.

    Whom may I contact with questions on Coronavirus Disease 2019 (COVID-19) when my physician is not available?

    If you have questions regarding Coronavirus Disease 2019 (COVID-19), the Houston Health Department call center is available weekdays from 9 a.m. to 7 p.m. and Saturdays from 9 a.m. to 3 p.m. They will also return voice messages left after hours on the following day.

    Houstonians can call the center at 832-393-4220 and talk to department staff to obtain information about Coronavirus Disease 2019 (COVID-19).

    For additional counseling, please call the office for a telemedicine visit with your doctor.

  • In-Office Safety Measures
    • Screening Patients

      Updated on August 5, 2021

      Here is how we are screening every patient before they come to our office. Our receptionists will be asking each family the following questions:

      “Is anyone in your household currently under isolation or quarantine for COVID-19?”

      “Does anyone in the household have a pending COVID test performed due to symptoms or exposure?”

      If they answer yes to either question, our staff will redirect them following our COVID-19 triage protocol.

      For additional counseling, please call the office for a telemedicine visit with your doctor.

    • For Our Asthma Patients

      Updated March 20, 2020

      If you are coming in to the office for an asthma related issue, please bring your rescue inhaler (albuterol) and spacer with you.

      For additional counseling, please call the office for a telemedicine visit with your doctor.

  • COVID-19 Testing
  • Family and Patient Guidance
    • New CDC Quarantine Guidelines for 7-10 Days

      Updated May 7, 2021

      New CDC Quarantine Guidelines for 7-10 Days

      If you are vaccinated and have no symptoms, you do not need to be tested following an exposure to COVID-19, per the CDC.

      https://www.cdc.gov/coronavirus/2019-ncov/more/scientific-brief-options-to-reduce-quarantine.html

      The risks and our understanding of the disease have not changed. The gold standard and the safest way to quarantine is to complete the full 14 days.

      The CDC is essentially gambling that if the guidelines are less onerous, more people will comply and this will lead to overall safer public health.

      The exact risks for shorter quarantines are detailed by the CDC in the information below.

      1. CDC recommends the following alternative options to a 14-day quarantine:
        • Quarantine can end after Day 10 without testing and if no symptoms have been reported during daily monitoring.
          • With this strategy, residual post-quarantine transmission risk is estimated to be about 1% with an upper limit of about 10%.
        • When diagnostic testing resources are sufficient and available (see bullet 3, below), then quarantine can end after Day 7 if a diagnostic specimen tests negative and if no symptoms were reported during daily monitoring. The specimen may be collected and tested within 48 hours before the time of planned quarantine discontinuation (e.g., in anticipation of testing delays), but quarantine cannot be discontinued earlier than after Day 7.
          • With this strategy, the residual post-quarantine transmission risk is estimated to be about 5% with an upper limit of about 12%.
      2. Persons can discontinue quarantine at these time points only if the following criteria are also met:
        • No clinical evidence of COVID-19 has been elicited by daily symptom monitoring during the entirety of quarantine up to the time at which quarantine is discontinued; and,
        • Daily symptom monitoring continues through quarantine Day 14; and,
        • Persons are counseled regarding the need to adhere strictly through quarantine Day 14 to all recommended non-pharmaceutical interventions (NPIs±, a.k.a. mitigation strategies), especially. They should be advised that if any symptoms develop, they should immediately self-isolate and contact the local public health authority or their healthcare provider to report this change in clinical status.
      3. Testing for the purpose of earlier discontinuation of quarantine should be considered only if it will have no impact on community diagnostic testing. Testing of persons seeking evaluation for infection must be prioritized.
      4. Persons can continue to be quarantined for 14 days without testing per existing recommendations. This option maximally reduces risk of post-quarantine transmission risk and is the strategy with the greatest collective experience at present.

      For additional counseling, please call the office for a telemedicine visit with your doctor.

    • Quarantine Scenarios

      Updated March 12, 2021

      https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine.html

      For additional counseling, please call the office for a telemedicine visit with your doctor.

    • Spending Time With Family and Friends Guidance

      Updated on May 7, 2021

      CDC: What You Can Do Once You Have Been Fully Vaccinated

      Please note that the following CDC guidelines are changing regularly. Visit cdc.gov for the most up-to-date information.

      • “Indoor visits between fully vaccinated people who do not wear masks or physically distance from one another are likely low risk.”
      • “Unvaccinated people can visit with fully vaccinated people indoors, without anyone wearing masks, with a low risk of SARS-CoV-2 transmission.”
      • So, if you’re vaccinated you can be unmasked around an unvaccinated, low-risk family member. However, please note, even if someone is low risk, that doesn’t necessarily mean there is NO risk; they can still end up in the hospital from COVID19.
      • “If any of the unvaccinated people or their household members are at increased risk of severe COVID-19, all attendees should take pre-cautions.”
      • You need to be careful if you’re vaccinated and visiting an unvaccinated older adult, pregnant friend, or someone with underlying medical conditions.
      • “If unvaccinated people come from multiple households, there is a higher risk of SARS-CoV-2 transmission among them. Therefore, all people involved should take precautions.” Individual risk between two unvaccinated people from two households is still high. As a rule of thumb, everyone still needs to be careful when mixing households.
      • “All people, regardless of vaccination status, should avoid medium- or large-sized in-person gatherings and to follow any applicable local guidance restricting the size of gatherings.”

      1. If cases of COVID-19 in Houston are rising, it is probably better not to meet in person. TMC.edu is a great resource for tracking cases in Houston.
      2. If you do meet, meeting outdoors in a well ventilated area is ideal. If meeting indoors, good air circulation is important: turn on the AC/ceiling fan and open windows when possible. Maintain appropriate social distancing.
      3. Try to keep any indoor portion of any get together no longer than 30 minutes (the shorter the safer).
      4. Do not hug or shake hands. Elbow bumps are ok 🙂
      5. 10 people (including kids) should be the max number of people meeting. The smaller the group the safer.
      6. Anyone who is possibly sick should NOT join.
      7. Anyone who is or is living with someone who is awaiting a COVID-19 test or has recently been diagnosed with COVID-19 or is displaying COVID-19 symptoms should NOT join.
      8. Anyone who cannot afford a two-week quarantine period should they later find out someone in the group tested positive for COVID-19, should NOT join.

      Remember when you get together, you are not only potentially sharing germs with the people in your group, but you are also sharing germs with everyone they live with and everyone they live with may be sharing germs with you. The larger the group, the greater the risk to everyone at the meeting.

      For additional counseling, please call the office for a telemedicine visit with your doctor.

    • Grandparents Visiting Newborns Guidance

      Updated May 7, 2021

      CDC: What You Can Do Once You Have Been Fully Vaccinated

      Please note that the following CDC guidelines are changing regularly. Visit cdc.gov for the most up-to-date information.

      • “Indoor visits between fully vaccinated people who do not wear masks or physically distance from one another are likely low risk.”
      • “Unvaccinated people can visit with fully vaccinated people indoors, without anyone wearing masks, with a low risk of SARS-CoV-2 transmission.”
      • So, if you’re vaccinated you can be unmasked around an unvaccinated, low-risk family member. However, please note, even if someone is low risk, that doesn’t necessarily mean there is NO risk; they can still end up in the hospital from COVID19.
      • “If any of the unvaccinated people or their household members are at increased risk of severe COVID-19, all attendees should take pre-cautions.”
      • You need to be careful if you’re vaccinated and visiting an unvaccinated older adult, pregnant friend, or someone with underlying medical conditions.
      • “If unvaccinated people come from multiple households, there is a higher risk of SARS-CoV-2 transmission among them. Therefore, all people involved should take precautions.” Individual risk between two unvaccinated people from two households is still high. As a rule of thumb, everyone still needs to be careful when mixing households.
      • “All people, regardless of vaccination status, should avoid medium- or large-sized in-person gatherings and to follow any applicable local guidance restricting the size of gatherings.”

      1. Consider the risk

      Unless you have been vaccinated, the safest recommendation is for the most vulnerable people to stay home if they can. This includes grandparents over 60 and people with chronic illnesses.

      Meaningful connections are very important, but seeing a loved one means you’ll interact with people you haven’t seen in weeks who’ve spent their isolation in a different environment than you.

      You have to decide whether that risk is worth it to you.

      Risk of grandparents passing COVID-19 to the baby:

      There is some risk that this could happen but it is low, given that when they visit, grandparents wear a mask, wash their hands, and are asymptomatic. If you want to be extremely conservative, you can ask grandparents to quarantine themselves from meeting other people for 14 days prior to visiting the baby.

      Risk of family passing COVID-19 to the grandparents:

      This is probably the greater risk, but it is also reasonably low if all people – 2 years and older – wear a mask, wash their hands, and are asymptomatic. If you want to be extremely conservative, you can have your family quarantine themselves from meeting other people for 14 days prior to visiting with the grandparents.  For shorter quarantine information, click here.

      2. Discuss the plan

      Discuss and acknowledge the risk involved.

      • Have you been staying home and limiting your exposures?
      • Have you had to work daily in environments that could expose other people to the virus?

      If the answer to the second question is yes, a virtual visit would probably be best.

      3. Follow the safest protocol

      There’s no way to ensure total safety. But there are steps you can take to keep the risk as low as possible.

      • Be well. Make sure no one is sick when they plan to visit, whether that means a runny nose, fever or stomach ache — any form of illness.
      • Wear masks. Keep it on for the duration of the visit, if you can.
      • Wash your hands. As soon as you meet, wash your hands for 20 seconds with soap and water.
      • Greet without touch. Try not to greet with a kiss or hug.
      • Keep your distance. When possible keep at least six feet of distance.
      • Meet outdoors. Meet at a park or garden where you can stay safely socially distance yourselves from other groups (not in your party).

      Grandparents may want to re-up their vaccinations, particularly against the flu (seasonally in the fall/winter), whooping cough (can be done year round) and pneumonia (can be done year round).

      For additional counseling, please call the office for a telemedicine visit with your doctor.

    • Newborn and Breastfeeding Guidance
    • Mask Exemption Note Policy

      Updated August 27, 2020

      Mask Exemptions During the COVID-19 Pandemic—A New Frontier for Clinicians

      July 10, 2020; JAMA Network

      Doron Dorfman, LLB, JSD1; Mical Raz, MD, PhD, MSHP2,3

      Author Affiliations | Article Information

      The Centers for Disease Control and Prevention (CDC) has recommended face covering in public to avoid the spread of COVID-19. This recommendation applies broadly to all people older than 2 years, unless they have difficulty breathing or are incapacitated.

      Best current evidence shows that masking is effective at preventing viral spread, protecting primarily the public, although it likely offers protection to the mask wearer as well.1,2 Thus, a delicate balance arises between the public health interest and individual disability modifications. Inappropriate medical exemptions may inadvertently hasten viral spread and threaten public health.

      Beyond the CDC’s recommended exemptions—children younger than 2 years, people with difficulty breathing, and anyone unable to place or remove the mask—there are certain categories of disability that warrant medical exemptions:

      • Some individuals, particularly children, with sensory processing disorders may be unable to tolerate masks.
      • Facial deformities that are incompatible with masking are an additional category of exemption.
      • Other situations, such as chronic pulmonary illnesses without an active exacerbation, are less clear. An individual with a chronic pulmonary illness is at higher risk for severe disease from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19. Conversely, if that same individual were infected with SARS-CoV-2, he or she would likely also be at higher risk for spreading viral illness because many pulmonary illnesses are associated with a chronic cough. There is a risk-benefit ratio that must be carefully considered. Professional societies would provide a valuable service to clinicians if they could provide clear guidelines that include objective measures, such as a decrease in pulse oximetry results, to guide determinations. It is likely that chronic pulmonary disease in itself is a compelling reason for masking, rather than a category of exemption.

      In evaluating an individual patient, clinicians should seek to balance appropriate accommodations with public health. It is crucial that individuals with disabilities be integrated in public spheres, a right that could be curtailed by withholding appropriate exemptions. But for many individuals seeking exemption, the risk of participating in public spheres during a pandemic may be high. For those with underlying pulmonary disease, if masking cannot be tolerated, sheltering in place is a reasonable and safe medical recommendation. Public health experts have cautioned that masking cannot replace social distancing, and avoidance of indoor spaces should remain our medical recommendation, particularly for individuals who cannot tolerate a mask or do not desire to wear one for any reason.

      Clinicians have no obligation to provide a mask exemption to patients if it is not medically warranted. They do, however, have a clear obligation to address individual patients’ concerns, discuss appropriate alternatives, and offer clear recommendations for risk-reducing measures when patients are venturing into the public sphere.

      References

      1. Lyu  W, Wehby  GL.  Community use of face masks And COVID-19: evidence from a natural experiment of state mandates in the US.   Health Aff (Millwood). Published online June 16, 2020. doi:10.1377/hlthaff.2020.00818PubMedGoogle Scholar
      2. Chu  DK, Akl  EA, Duda  S, Solo  K, Yaacoub  S, Schünemann  HJ; COVID-19 Systematic Urgent Review Group Effort (SURGE) study authors.  Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis.   Lancet. 2020;395(10242):1973-1987. doi:10.1016/S0140-6736(20)31142-9PubMedGoogle ScholarCrossref
      3. de Chavez-Lau  J, Stein  JA. No mask, no service? ADA considerations for business owners requiring face masks in retail stores. National Law Review. Accessed July 6, 2020. https://www.natlawreview.com/article/no-mask-no-service-ada-considerations-business-owners-requiring-face-masks-retail
      4. Americans With Disabilities Act, 42 USC §12111(9) (1990).
      5. O’Fallon  E, Hillson  S.  Brief report: physician discomfort and variability with disability assessments.   J Gen Intern Med. 2005;20(9):852-854. doi:10.1111/j.1525-1497.2005.0177.xPubMedGoogle ScholarCrossref
      6. Dorfman  D.  Fear of the disability con: perceptions of fraud and special rights discourse.   Law Soc Rev. 2019;53(4):1051-1091. doi:10.1111/lasr.12437Google ScholarCrossref

      For additional counseling, please call the office for a telemedicine visit with your doctor.

5/17/2024 Greater Heights Office Closed Today

Due to the weather, our Greater Heights office is closed all day on Friday, 5/17. GH patients can be seen at our Memorial location. Memorial phone: 713-467-1741 or email bluefishmemorial@bluefishmd.com. All other offices have regular business hours today.