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.

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.

Updated September 16, 2021

List of Harris County / Houston COVID-19 Nasopharyngeal Swab Testing Sites

Closest Testing Facilities by Blue Fish Location

Which test is best for COVID-19?

https://www.health.harvard.edu/blog/which-test-is-best-for-covid-19-2020081020734

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

Updated May 22, 2020

Blue Fish Statement on COVID-19 Antibody Testing

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

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.

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.

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.

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.

Updated May 5, 2021

https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/faqs-management-of-infants-born-to-covid-19-mothers/#:~:text=Currently%20we%20recommend%20the%20following,from%20her%20infant%20when%20possible.

https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/pregnancy-breastfeeding.html

https://women.texaschildrens.org/blog/pregnancy-breastfeeding-and-covid-19-vaccine

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

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.