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 28, 2020

    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?

    There is currently no vaccine to prevent COVID-19. 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. 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 happens if my child tests positive for Coronavirus?

    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. However, should they become more acutely symptomatic please contact us ASAP.

    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 Coronavirus Disease 2019 (COVID-19) to patients and physicians?

    To further protect the health of our patients, workforce and the community, and prevent the potential spread of Coronavirus Disease 2019 (COVID-19), Blue Fish Pediatrics is asking that at this time only one caretaker and the patient needing to be seen come to the office when at all possible – we understand this is not always feasible. Additionally, to reduce exposure to healthy children we will be 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
    • Decreasing People in Office

      Updated on May 26, 2020

      Here is how we are currently decreasing the number of people who come to the office as much as is logistically possible and sustainable:

      • Website and internet resources to inform parents when to be concerned
      • Triage and education to help patients avoid medically unnecessary visits
      • Triage to phone and telemedicine visits
      • Efforts to limit visits to one adult accompanying a patient into the office (we realize this is not always possible)
      • Education and encouragement on how to manage mild illnesses at home
      • When necessary and clinically indicated, testing outside of the office
      • Minimizing non-urgent visits in the office
      • Allowing only critical staff and patients in the office

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

    • Reducing Risk of COVID-19 Transmission in Office

      Updated on May 21, 2020

      Here is how we are reducing the risk of COVID-19 transmission in the office:

      • Well child checks and sick visits will be done during separate segments of the day. We will call you to reschedule if needed.
        • Newborns visits will be seen first thing in the morning
        • Well visits will be at designated times with no sick visits scheduled during this period
        • Sick visits will be at designated times. The waiting room will be separated into those with respiratory issues and those without
      • Patients will be moved quickly into exam rooms, bypassing the waiting room, when space allows.
      • Patients will be required to stay in their exam rooms
      • Patients will go directly to the exit, bypassing checkout. We will be doing as much as logistically possible at check in. We will also be contacting parents after the visit to schedule any recommended follow-up visits.
      • Patients with cough will be required to wear a covering of their nose and mouth. Due to a shortage of masks, please bring a bandana or piece of cloth from home. We realize that most of our little patients will not cooperate with this part of the plan.
      • Staff will be wearing masks at all times

      As families are heeding the city’s stay-at-home order and as we see an increase in telemedicine visits, our in-office visits have significantly decreased, resulting in less patients than usual in the waiting room.  There are also far fewer patients of other practices in the buildings where our suites are located.

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

    • Screening Patients

      Updated on April 9, 2020

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

      • “Has your child or anyone in the household tested positive for COVID-19 or had direct contact with a positive confirmed case of COVID-19?”
      • “Does the child or the accompanying caretaker have both a fever and cough?”

      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
    • Blue Fish COVID-19 Testing Philosophy

      Updated on May 21, 2020

      Dear Blue Fish patients and families:

      After much study and deliberation, at this time, Blue Fish Pediatrics has decided not to offer testing for COVID-19 in our offices for the following reasons:

      • Testing is not likely to alter patient treatment. Fortunately, children with COVID-19 usually exhibit mild symptoms or none at all. Like other viruses our families have experienced, there is currently no established treatment available other than supportive care. Our patients know that we usually do not order tests without knowing how the test results will change our treatment plan.
      • Testing is not likely to change how our patients are triaged in an outpatient pediatric setting. Because most of our patients will experience mild illness, a positive test for COVID-19 would not change our recommendation for you to monitor your child’s condition at home. While a positive test might inform you how diligent to be with isolation efforts, the CDC currently recommends aggressive social distancing for everyone. This is especially true if your child is ill. In other words, if you are concerned that your child has COVID-19, you should consider at isolating them even without a positive test result. On the other hand, a negative result, while reassuring, does not eliminate the ongoing risk of your child contracting or spreading the illness.
      • In the event that the child is having frequent contact with an individual over 60 years of age or with an individual with underlying health issues, there may be some value in testing the child to know how strict to be with isolation.

      For all of these reasons, we expect that the majority of our patients, even those who have been exposed to or are experiencing symptoms consistent with COVID-19, will not require testing in our office at this time. As always, if your child is ill and you are concerned about their condition, please call our office for guidance.

      If you desire to have your child tested or testing is required prior to participation in an organized activity (e.g. summer camp), the preferred test is the nasopharyngeal swab which can be accessed via www.readyharris.org.  After sampling multiple testing sites, we recommend this resource because it is efficient, free, and there are multiple testing sites around Houston.  A doctor’s order is not necessary to access this resource.

      Some parents have inquired about antibody testing, which we do not recommend at this time.  To learn more, please read our statement on antibody testing.

      Thank you for understanding and please let us know if you have any questions or concerns.

      Sincerely,

      Blue Fish Pediatrics

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

    • Harris County / Houston COVID-19 Nasopharyngeal Swab Testing

      Updated November 2, 2020

      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.

    • COVID-19 Antibody Testing

      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.

  • Family and Patient Guidance
    • Student Symptom Decision Tree

      Updated 11/20/2020

      Student Symptom Decision Tree

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

    • Family Member Has COVID-19 Guidance

      Updated November 20, 2020

      As new research comes out, the recommendations on COVID-19 are constantly changing. Thus, in order to provide the most up-to-date information on the pandemic, we have provided helpful answers and links to some of our most frequently asked questions.

      If a parent tests positive for COVID-19, should my child be tested?

      As children typically do well with COVID-19, whether they are symptomatic or not, there is relatively low value in having your children tested. If they are symptomatic, and there is a positive test in the household, you can presume the child has COVID-19 and they will likely recover without complications.

      However, if the child develops more severe symptoms such as trouble breathing, poor activity, or not eating or drinking then please call our office for a possible at-your-car visit or telemedicine visit. If it is severe and the child is getting worse they will need to go to a children’s emergency department.

      The take-home message is that our decision-making is guided more by your child’s symptoms more than the result of a COVID-19 test.

      There may be some value in having your child tested to inform the family of the infection to make child-care, school, and family living situation decisions.

      Should you desire a test for your child, please use this helpful chart: Harris County / Houston COVID-19 Nasopharyngeal Swab Testing

      If a child tests positive for COVID-19, should the parent be tested?

      The safest thing is to contact the physician of the parent for advice.

      This chart may also be helpful: Exposure to COVID-19 Triage Chart

      How should we care for someone with COVID-19 at home?

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

      https://healthblog.uofmhealth.org/wellness-prevention/14-things-to-do-if-someone-you-live-has-covid-19

      Specifically, how should we care for our children if a parent (or both) develop COVID-19?

      https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/getting-real-when-covid-19-enters-a-busy-household

      If I have confirmed or suspected COVID-19, when is it safe to be around others?

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

      https://www.cdc.gov/coronavirus/2019-ncov/downloads/COVID-19-Quarantine-vs-Isolation.pdf

      If someone at home has COVID-19, but other family members are not symptomatic, when it is safe for asymptomatic family members to be around others?

      https://bluefishmd.com/wp-content/uploads/2020/07/Home-IsolationQuarantine-Release-Graphic_FINAL_2nd_Chart.pdf

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

    • Primary v Secondary v Tertiary Exposure Triage Chart

      Updated 11/20/2020

      Primary v Secondary v Tertiary Exposure Triage Chart

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

    • Quarantine Scenarios

      Updated 11/20/2020

      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.

    • Chart: Your Risk for COVID-19

      Updated on July 7, 2020

      Chart: Your Risk for COVID-19

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

       

    • Daycare Guidance

      Updated August 31, 2020

      At a minimum, daycares should maintain social distancing, wipe surfaces, enforce hand washing frequently and adhere to the recent guidelines laid out by the Centers for Disease Control and Prevention (CDC). If cases of COVID-19 in Houston are rising significantly, it may be better not to send your child to daycare. TMC.edu is a great resource for tracking cases in Houston.

      Some questions to ask yourself:

      1. How healthy is your child? Do they have any chronic health conditions that would put them at an increased risk of significant illness from coronavirus, such as diabetes, asthma or immune deficiency?
      2. How healthy are your other household members? Is there anyone who your child (upon returning from daycare) would have frequent contact with who is elderly or at increased risk of severe illness from COVID-19?
      3. If your child gets sick at daycare, it could potentially mean the child or family would need to be on home quarantine for two weeks. What impact would this have on your household?

      The following is an epidemiologist’s summary of the 8/21/20 CDC report on Rhode Island daycare COVID transmission.

      Punchline: In areas of low community prevalence, if you follow strict guidelines, daycares can operate with minimal spread.

      On June 1, Rhode Island opened up daycares with strict guidelines.

      As of July 31, 666 of 891 (75%) programs were approved to reopen, with a capacity for 18,945 children. This represents 74% of the state’s January 2020 childcare program population.

      So, from June 1 to July 31, what happened in terms of COVID19 cases and spread?

      • VERY few cases: 33 confirmed cases and 19 probable cases in the entire state.
      • Among the 52 cases, 58% were children and 42% were adults.
      • 39 (75%) cases occurred from mid- to late July, when incidence in the state was increasing.
      • 4 daycare programs had spread beyond a single case. 20 programs had a single case with no secondary transmission.

      The 4 programs with spread basically did not follow state guidelines:

      • 1st program: 10 confirmed cases (five children, four staff members, and one parent).
      • 2nd program: 3 confirmed cases were identified from a single classroom.
      • 3rd program: 2 cases with symptom onset dates indicating potential transmission; however, no epidemiologic link was identified.
      • 4th program: 2 cases (one staff member and one child). The staff member moved among all the classrooms, exposing adults and children in the entire program, which was subsequently closed.

      Translation: Non-pharmaceutical public health interventions work! Especially when community transmission is down. The cases slightly increased as community spread increased, but this is expected. The key is to ensure that daycares and schools are not creating NEW hotspots.

      The following guidelines seemed to work to reduce spread in daycare:

      1. Reduced enrollment (initially max 12 persons; increased to 20 on June 29)
      2. Stable groups (staff and students did not switch between groups) in physically separated spaces
      3. Universal use of masks for adults
      4. Daily symptom screening of adults and children
      5. Enhanced cleaning and disinfection

      Hope this helps while making daycare decisions!

      Link to CDC study:

      https://www.cdc.gov/mmwr/volumes/69/wr/mm6934e2.htm?s_cid=mm6934e2_e&deliveryName=USCDC_921-DM35954&fbclid=IwAR0g5IK8jr6Qtpu4ZODuiVG1RGdeiCkAhVC7W4CLIApPNko7m9ipvkG2_x8

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

    • Spending Time With Family and Friends Guidance

      Updated on May 22, 2020

      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 June 9, 2020

      1. Consider the risk

      Until there’s a vaccine, 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.

      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.

    • Summer Camp Guidance

      Updated on May 22, 2020

      At a minimum, camps should maintain social distancing, wipe surfaces, enforce hand washing frequently and adhere to the recent guidelines laid out by the American Camp Association.

      Some questions to ask yourself:

      1. How healthy is your child? Do they have any chronic health conditions that would put them at an increased risk of significant illness from coronavirus, such as diabetes, asthma or immune deficiency?
      2. How healthy are your other household members? Is there anyone who your child (upon returning from camp) would have frequent contact with who is elderly or at increased risk of severe illness from COVID-19?
      3. How important is this camp to your child? If it is something they feel ambivalent about, it is probably not worth the exposure. If they have been looking forward to it since last year, it may deserve a serious family discussion.
      4. What safety measures is the camp taking? Is there a screening process? Are there attempts at some degree of distancing? What happens if someone gets sick during camp? It is very possible, if someone gets sick at the camp, everyone will be sent home. It’s for this reason if you do send your child, it’s best that your family plan to be available for an unexpected pick-up.
      5. If your child gets sick at camp, it could potentially mean the child or family would need to be on home quarantine for two weeks. What impact would this have on your household?

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

    • Travel Guidance

      Updated on May 26, 2020

      Cases of coronavirus disease (COVID-19) have been reported in all states, and some areas are experiencing community spread of the disease. Travel increases your chances of getting and spreading COVID-19.

      CDC recommends you stay home as much as possible, especially if your trip is not essential, and practice social distancing especially if you are at higher risk of severe illness. Don’t travel if you are sick or travel with someone who is sick.

      Considerations if You Must Travel

      CDC recommends you stay home as much as possible and avoid close contact, especially if you are at higher risk of severe illness. If you must travel, there are several things you should consider before you go.

      Protect yourself and others during your trip:

      • Clean your hands often.
        • Wash your hands often with soap and water for at least 20 seconds especially after you have been in a public place, or after blowing your nose, coughing, or sneezing.
        • If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol. Cover all surfaces of your hands and rub your hands together until they feel dry.
      • Avoid touching your eyes, nose, and mouth.
      • Avoid close contact with others.
        • Keep 6 feet of physical distance from others.
        • Avoiding close contact is especially important if you are at higher risk of getting very sick from COVID-19.
      • Wear a cloth face covering in public.
      • Cover coughs and sneezes.
      • Pick up food at drive-thrus, curbside restaurant service, or stores. Do not dine in restaurants if that is prohibited by state or local guidance.

      For more information about traveling during the pandemic, please visit these websites:

      US Department of State – Bureau of Consular Affairs: www.travel.state.gov
      Centers for Disease Control and Prevention (CDC) website: http://www.cdc.gov/travel 

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

    • Patient and Parent Return to Clinic Guidelines

      Updated July 23, 2020

      Patient and Parent Return to Clinic Guidelines

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

    • Newborn and Breastfeeding Guidance
    • Return to School Guidelines

      Updated July 23, 2020

      Blue Fish Pediatrics supports the recommendations of the American Academy of Pediatrics (AAP) in regards to children returning to school this fall.

      This article summarizes the AAP recommendation for returning to school:

      https://www.healthychildren.org/English/health-issues/conditions/COVID-19/Pages/Return-to-School-During-COVID-19.aspx

      This article is the full AAP recommendation:

      https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/covid-19-planning-considerations-return-to-in-person-education-in-schools/

      Dr. Peter Jung’s blog post on returning to school:

      http://peterjung.blogspot.com/2020/07/post-50-school-reopening-during-covid.html

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

    • 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.

  • COVID-19 and Flu

    Updated August 11, 2020

    https://www.cdc.gov/flu/season/faq-flu-season-2020-2021.htm

    Flu and COVID-19

    What is the difference between Influenza (Flu) and COVID-19?

    Influenza (Flu) and COVID-19 are both contagious respiratory illnesses, but they are caused by different viruses. COVID-19 is caused by infection with a new coronavirus (called SARS-CoV-2) and flu is caused by infection with influenza viruses. Because some of the symptoms of flu and COVID-19 are similar, it may be hard to tell the difference between them based on symptoms alone, and testing may be needed to help confirm a diagnosis. Flu and COVID-19 share many characteristics, but there are some key differences between the two.

    While more is learned every day, there is still a lot that is unknown about COVID-19 and the virus that causes it. This table compares COVID-19 and flu, given the best available information to date.

    To learn more about COVID-19, visit Coronavirus (COVID-19).

    To learn more about flu, visit Influenza (Flu).

    Will there be flu along with COVID-19 in the fall and winter?

    While it’s not possible to say with certainty what will happen in the fall and winter, CDC believes it’s likely that flu viruses and the virus that causes COVID-19 will both be spreading. In this context, getting a flu vaccine will be more important than ever. CDC recommends that all people 6 months and older get a yearly flu vaccine.

    Can I have flu and COVID-19 at the same time?

    Yes. It is possible have flu, as well as other respiratory illnesses, and COVID-19 at the same time. Health experts are still studying how common this can be.

    Some of the symptoms of flu and COVID-19 are similar, making it hard to tell the difference between them based on symptoms alone. Diagnostic testing can help determine if you are sick with flu or COVID-19.

    Is there a test that can detect both flu and COVID-19?

    Yes. CDC has developed a test that will check for A and B type seasonal flu viruses and SARS CoV-2, the virus that causes COVID-19. This test will be used by U.S. public health laboratories. Testing for these viruses at the same time will give public health officials important information about how flu and COVID-19 are spreading and what prevention steps should be taken. The test will also help public health laboratories save time and testing materials, and to possibly return test results faster.

    The Food and Drug Administration (FDA) has given CDC an Emergency Use Authorization for this new test. Initial test kits were sent to public health laboratories in early August 2020. CDC will continue to manufacture and distribute these kits.

    More information for laboratories is available.

    Will the new test that detects both flu and COVID-19 replace other tests?

    No. This new test is designed for use at CDC-supported public health laboratories at state and local levels, where it will supplement and streamline surveillance for flu and COVID-19. The use of this specialized test will be focused on public health surveillance efforts and will not replace any COVID-19 tests currently used in commercial laboratories, hospitals, clinics, and other healthcare settings.

    CDC’s first viral test for SARS-CoV-2 (the CDC 2019-nCoV Real-Time RT-PCR Diagnostic Panel (ER-34)) will still be available for qualified laboratories to order through the International Reagent Resource (IRR). The new multiplex assay can also be ordered through the IRR. Check the IRR website for details.

    For additional questions, please visit: Clinical Questions about COVID-19: Questions and Answers: Testing, Diagnosis, and Notification

    Is COVID-19 more dangerous than flu?

    Flu and COVID-19 can both result in serious illness, including illness resulting in hospitalization or death. While there is still much to learn about COVID-19, at this time, it does seem as if COVID-19 is more deadly than seasonal influenza; however, it is too early to draw any conclusions from the current data. This may change as we learn more about the number of people who are infected who have mild illnesses.

    Will a flu vaccine protect me against COVID-19?

    Getting a flu vaccine will not protect against COVID-19, however flu vaccination has many other important benefits. Flu vaccines have been shown to reduce the risk of flu illness, hospitalization and death. Getting a flu vaccine this fall will be more important than ever, not only to reduce your risk from flu but also to help conserve potentially scarce health care resources.

    What is CDC doing to promote flu vaccination during the COVID-19 pandemic?

    To address the importance of influenza vaccination, especially during the COVID-19 pandemic, CDC will maximize flu vaccination by increasing availability of vaccine, including purchasing an additional 2 million doses of pediatric flu vaccine and 9.3 million doses of adult flu vaccine, by emphasizing the importance of flu vaccination for the entire flu season, and by conducting targeted communication outreach to specific groups who are at higher risk for complications from flu. These same groups are often at higher risk for COVID-19 too, so protecting them from influenza is important to decrease their risk of co-infection. Communication strategies for providers and the public will include:

    • Educational outreach activities by CDC, including social media, press conferences, web page spotlights, radio media tours, op-eds, and other publications,
    • A digital campaign to educate the general public and people with who are at increased risk from influenza and COVID-19 complications,
    • Special educational efforts to inform the general population, people with underlying health conditions, and African American and Hispanic audiences about the importance of flu vaccination, and
    • Updated vaccination websites for the public and providers that highlight the safety precautions being implemented in healthcare facilities during the pandemic.

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