Coronavirus (COVID-19)

(updated 06/09/21)

Dear Hirsch Pediatrics Families,

As we support each other though these unprecedented times, I want to share with you important Hirsch Pediatrics COVID-19 updates and resources. Please know we are working hard to stay apprised of the most up-to-date recommendations form national, state, and local information sources to ensure we continue to provide our families the safest and highest quality care possible.

**  COVID-19 PARKING LOT TESTING IS NOW AVAILABLE AT HIRSCH PEDIATRICS MONDAY – FRIDAY**: Safe, convenient, and expedited parking lot drive-up testing is now available for both patients and parents. All COVID-19 testing is by appointment only and must include a video telemedicine appointment before testing is done. See below for more information.

COVID-19 TOPICS COVERED BELOW:

1) Telemedicine – Hirsch Pediatrics ZOOM waiting room
2) COVID-19 Testing
3) Sick visits
4) Check-ups
5) Hirsch Pediatrics Extensive COVID-19 Safety Precautions
6) Special Message for Pregnant Moms and Our Newborns
7) COVID-19 FAQ (fever management, MIS-C, attending daycare/preschool, return to daycare/school letter, and more)
8) COVID-19 Mental Health Resources
9) COVID-19 Vaccine!!!

1) TELEMEDICINE
Here are the three easy steps to complete your telemedicine visit from the comfort of your home:
STEP 1: Contact our office by phone or portal message if you would like to set up a telemedicine visit.
STEP 2: Please review the Hirsch Pediatrics telemedicine consent form before scheduling your appointment.
STEP 3: At the time of your appointment please enter the Hirsch Pediatrics ZOOM waiting room. Please contact us if your appointment has not started within 10 minutes of your scheduled start time.

2) COVID-19 TESTING
Hirsch Pediatrics COVID-19 testing is NOW AVAILABLE through our safe, convenient, and expedited parking lot drive-up testing for both patients and parents. COVID-19 testing is by appointment only and must include a video telemedicine appointment before testing is done.

When is your parking lot drive-up testing available?
Monday – Friday, by appointment only

How do I make an appointment for COVID-19 testing?
Please send a portal message and a team member from Hirsch Pediatrics will contact you to reserve your testing slot and schedule a brief telemedicine video with Dr. Hirsch that must be completed before testing.

In order to travel we need a negative COVID-19 PCR test within 72 hours of travelling . . . can you guarantee a 72 hours turn-around time?
Though we cannot guarantee a 72 hour turnaround time, the vast majority of test results are available in 24-48 hours. In the rare event that your test result is not available within 48 hours then you can also seek out local same day testing (https://www.sameday-testing.com/) as well as many airports and airlines are offering rapid PCR testing. Note: These rapid PCR testing locations are usually cash only and require up front payments between $100 – 200.

How much does COVID-19 testing cost?
Most insurances will cover the cost of COVID-19 testing done at Hirsch Pediatrics at no charge without any copay or cost sharing. For send out COVID-19 PCR testing, you may receive a separate bill from an outside lab for the COVID-19 PCR tests. Please contact your insurance ahead of your appointment to answer any questions about your out-of-pocket costs. For self-pay patients the appointment fee is $95 which includes your telemedicine video appointment and collecting a COVID-19 nasal PCR specimen to send to an outside lab. (There is an additional $30 charge if you also need a COVID-19 office antigen test.)

Can PARENTS also get COVID-19 testing at Hirsch Pediatrics?
Yes. If testing supplies are ample for children then Hirsch Pediatrics will also do COVID-19 testing for asymptomatic parents of current patients. At this time, we are unable to test other non-parent adults (i.e. nannies or other relatives) or parents that have any symptoms of COVID-19. Adults with any potential symptoms of COVID-19 who need testing should contact their personal physician for guidance.

What type of COVID-19 testing is offered at Hirsch Pediatrics and which test is right for my child?
Hirsch Pediatrics currently offers the COVID-19 SEND-OUT NASAL PCR TEST and the BD-VERITOR OFFICE BASED NASAL ANTIGEN TEST. Dr. Hirsch will discuss the test options with you during your video telemedicine appointment and help determine if one or both tests should be done. When available at Hirsch Pediatrics the main advantage of the office based nasal antigen test is that the results will be reported to you within a few hours or less time but are less accurate (especially for asymptomatic patients) than the send-out nasal PCR test which can take 2-5 days to get results.

When to do the office based nasal antigen test:
SITUATION 1: If your child is symptomatic or had a high risk exposure to COVID-19 (i.e. household or daycare classroom COVID-19 positive contact), then the antigen test can be done to give a quick PRELIMINARY result in addition to doing a second send-out nasal to have a more accurate final result.
SITUATION 2: If your child’s school requires periodic surveillance testing and accepts the less accurate antigen test as proof.

When to do the send-out nasal PCR test:
SITUATION 1: ALL symptomatic children or those with a high risk exposure to COVID-19 (i.e. household or daycare contact) will need a send-out nasal PCR for a definitive test result.
SITUATION 2: All positive office antigen tests need a second send-out nasal antigen test to verify results. Note: If your office based antigen test is positive but your follow-up send-out PCR test is negative then it may mean you have no current evidence of infection, and Dr. Hirsch will discuss with you if you need a third test.

3) SICK VISITS
For non-contagious conditions (i.e. suture removal, head injuries, chronic symptoms, etc) and LOW-RISK COVID sicknesses, your child can be seen IN-OFFICE while maintaining our extensive safety precautions.

For HIGH-RISK COVID contagious conditions (i.e. child with symptoms after a known COVID-19 exposure) we will first do a parking lot drive-up COVID-19 test and then a follow-up video telemedicine appointment or in-person appointment once the COVID rapid parking lot test is confirmed negative. See above for more details.

4) CHECK-UPS
Hirsch Pediatrics has resumed all check-ups IN-OFFICE while still following extensive safety precautions.  Understandably, some families may wonder “Is it safe to bring my child to your office for a check-up?” We can assure you that your family’s safety is our number one priority. We will continue our COVID-19 extensive safety precautions indefinitely including full PPE, mask requirements for everyone in the office, consistent disinfecting, no waiting outside of your room and more. Also continuing with well-child exams for all ages is strongly recommended by the American Academy of Pediatrics so we can monitor every child’s essential physical, emotional, and social well-being during the pandemic as we continuously adjust to our “new normal.”

5) HIRSCH PEDIATRICS EXTENSIVE COVID-19 SAFETY PRECAUTIONS
Hirsch Pediatrics takes this issue very seriously!
To ensure you and your child’s safety and limit any potential spread to the community we want to reassure your family that we will not let up on our commitment to your safety when you visit the office and will continue to take the following eight step precautions:

Step 1) All staff and providers at Hirsch Pediatrics will be wearing personal protective equipment (PPE) that meets or exceeds CDC guidelines.  

Step 2) When you enter our office you will notice that our large greeting/waiting area limits any crowding and after a brief check-in you will be escorted directly to your disinfected room. (Sorry our coffee machine and water bottles are in hibernation!) As a small practice with reduced patient traffic and an open space office design, you will not be crowded anywhere and will have minimal exposure to anyone other than our staff. Furthermore, patients and their families enter our first floor office directly from our building’s large open atrium without having to use public elevators or hallways.

Step 3) All adults and children 4 and older must wear a mask while in the office. We are happy to provide you and your child with a mask if needed when you arrive.

Step 4) All potentially contagious sick visits can be conducted by telemedicine appointment rather than in-person to ensure our office remains a safe environment for our patient to continue receiving important check-ups and vaccines. Note: Patients that still need an in-person evaluation for a sick visit will have a confirmed negative COVID-19 test before entering our office.

Step 5) All patients and visitors to our office will be screened upon arrival for any potential COVID-19 concerns.

**Please notify us as soon as possible if any person coming to the check-up (parent or child) or anyone at home has any of the following so we can reschedule your appointment:
– fever, cough, or sore throat within the last 10 days
– any other new or unusual symptoms
– known direct exposure in the last 14 days to anyone who tested positive for COVID-19

Step 6) Visitors are limited to two caregivers per patient and siblings under 12. We know this is stressful but thank you for your understanding and helping us to enforce this policy to keep your family and our employees safe!

Step 7) We will continue to disinfect your exam room before your appointment and other common areas frequently throughout the day.

Step 8) Throughout our office you will see multiple “touchless” features including our office main door, bathroom sink/soap dispenser, and multiple touchless Purell dispensers in the greeting and garden area.

6) SPECIAL MESSAGE FOR PREGNANT MOMS AND OUR NEWBORNS
Certainly nine months ago there was no way to predict you would have a baby at such a stressful time! However, please take comfort knowing that at Hirsch Pediatrics your safety and peace of mind is paramount so we are taking precautions and steps that go above and beyond the recommendations of the CDC and the American Academy of Pediatrics. In addition to our extensive safety precautions noted above, to keep you and your baby safe we have made the following changes. Please contact us if you have any specific questions on how to best manage your baby’s first few months at home.

** Practice interviews will continue every other week but will be conducted by Zoom video conferencing rather than in-person.  Participants will receive a link from the office to join in.

** All lactation consultant appointments will be conducted by individual telemedicine video appointments.

** Loaner baby scales will be given to families with newborns so follow-up weight check appointments and lactation consultant appointments can be done by telemedicine with accurate weight measurements.

7) COVID-19 FAQ (fever management, MIS-C, attending daycare/preschool, visitors, testing, etc)
 **Please note that this advice is based on current CDC and state of Maryland guidelines and is subject to change daily. Also your school or employer may have guidelines that are more cautious.**

What are symptoms of COVID-19?
People with COVID-19 have had a wide range of symptoms reported – ranging from mild symptoms to severe illness. Possible symptoms of COVID-19 may appear 2-14 days after exposure to the virus and can include:
-Fever or chills
-Cough
-Shortness of breath or difficulty breathing
-Fatigue
-Muscle or body aches
-Headache
-New loss of taste or smell
-Sore throat
-Congestion or runny nose
-Nausea or vomiting
-Diarrhea

What should I do if my child has a fever? Will he/she need COVID-19 testing?
If your child has a short term fever for 2-3 days but is otherwise well-appearing (still playful, talkative, interactive, etc) after fever treatment with ibuprofen for age 6 months and older, then your child likely does not need an in-person evaluation. Please see the Hirsch Pediatrics Medical Advice website page for additional advice on managing fevers and contact us if you still have any concerns so we can set up a same day telemedicine sick visit if needed.

Your child does not automatically need COVID-19 testing as long as everyone in your house remains quarantined according to the CDC guidelines noted below. However, you may be able to reduce your quarantine duration if your child has a confirmed negative COVID-19 RNA PCR test and all of your child’s symptoms including fever have resolved for over 24 hours.

If my child has a fever but the parent has no symptoms, can the parent go to work?
Please check with your employer on return to work guidelines since this recommendation may vary depending on your unique work circumstances. This is a situation where having your child tested for COVID-19 at Hirsch Pediatrics may be helpful because a confirmed negative COVID-19 PCR test for your child may decrease your family quarantine time.

If my child or I have COVID-19 (or likely have COVID-19) and have symptoms of COVID-19, when can we be around others?
According to CDC guidelines, your child can be around others after his/her fever has resolved for 24 hours AND at least 10 days since symptoms first appeared AND all other CDC COVID-19 symptoms (see list above) have resolved.

When can I be around others if I have tested positive for COVID-19 but I have NO SYMPTOMS?
If you continue to have no symptoms, you can be around others after 10 days have passed since the test.

If my child has a fever when should I worry about Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19?
MIS-C is a newly described condition in children of unknown cause that causes multiple body parts to be inflamed and require management in an ICU. Usually lab tests done in the ER will show significant abnormalities. Though fortunately MIS-C is still very rare, you should seek emergency care for your child right away if your child is sick and showing any of these emergency warning signs of MIS-C or other concerning signs:
– Trouble breathing
– Pain or pressure in the chest that does not go away
– New confusion
– Inability to wake or stay awake
– Bluish lips or face
– Severe abdominal pain

My daycare is now open. Can my child go back to daycare or pre-school?
Since the vast majority of children who get COVID-19 have mild disease, I think it is okay for your child to resume daycare if the county and state officials allow it and if attending daycare or pre-school is beneficial for your family and/or your child’s development. The Maryland Department of Health has very detailed guidelines on the criteria the daycare or pre-school need to follow to open and minimize risk. One of the State of Maryland guidelines to keep in mind is that the daycare may have frequent closures of 2-5 days or longer if and when any child in the daycare has a fever to give time for the local health department to determine the best course of action. Note: Once you are using daycare you will want to limit your exposure to grandparents and older relatives for now until the risk from daycare or pre-school becomes clearer over the upcoming weeks and months.

My child was recently sick and the daycare/school is requiring a letter from my doctor to return. Can I get that from Hirsch Pediatrics?
 Yes. We are happy to provide a letter when it is safe for your child to return to daycare/school according to CDC quarantine guidelines:

    • If your child is COVID-19 positive or COVID-19 status unknown: Your child can return to school when it has been 24 hours from the last fever AND 10 days from the initial symptom date with no ongoing symptoms.
    • If your child is COVID-19 negative confirmed by a PCR test: Your child may return to school 24 hours after the last fever and still has no ongoing symptoms.

8) COVID-19 MENTAL HEALTH RESOURCES
To help you and your family manage this unprecedented stressful time, we have added the following online and local mental health resources.

Hirsch Pediatrics in-office therapy

How to Talk to Your Child about Coronavirus (COVID-19)

Dr. Dan Shapiro, a well-known local developmental/behavioral pediatrician continues to offer free Zoom weekly support groups as well as many weekly parenting courses.

9) COVID-19 VACCINE!!!
Dr. Hirsch strongly recommends that all children age 12 and older receive the COVID-19 vaccine without delay in accordance with the recommendations of both the American Academy of Pediatrics and CDC. The Pfizer vaccine which has been approved for 12 and older is readily available for convenient appointment sign-ups at multiple locations: CVS pharmacies, Montgomery County sites, and large Maryland state mass vaccination centers. Note: Hirsch Pediatrics currently does not have the COVID-19 vaccine in our office.

Also we strongly agree with both the CDC and professional OB-Gyn organization (ACOG) that nursing moms and pregnant moms should receive the COVID-19 vaccine as soon as possible as it has been shown to offer protection both to the mom and to the baby before and after delivery.

AS ALWAYS THANK YOU FOR YOUR PATIENCE AND UNDERSTANDING AS WE WORK THORUGH THIS UNIQUE SITUATION!

Sincerely,

Steven F. Hirsch, MD, FAAP