Coronavirus (COVID-19)

(updated 11/18/20)

Dear Hirsch Pediatrics families,

As we support each other though these unprecendented 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.

** SPECIAL HOLIDAY MESSAGE 11/18/20: After an encouraging several month lull in regional cases we are now seeing a rapid increase in local COVID-19 cases and resulting hospitalizations. Thus with the upcoming holidays for the safety of your family and our community I strongly recommend limiting any indoor gatherings to your immediate household. Hirsch Pediatrics will continue to follow our strict COVID-19 precautions noted below and make patient care adjustments based on evolving local and state recommendations.**

COVID-19 TOPICS COVERED BELOW:

1) Telemedicine
2) Sick visits
3) Check-ups
4) Hirsch Pediatrics Extensive COVID-19 Safety Precautions
5) Special Message for Pregnant Moms and Our Newborns
6) COVID-19 FAQ (fever management, MIS-C, attending daycare/preschool, return to daycare/school letter, and more)
7) COVID-19 Testing
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 following website address: https://doxy.me/hirschpediatrics. Please contact us if your appointment has not started within 10 minutes of your scheduled start time.

Having trouble connecting? Try a different web browser or a new computer/phone. In our experiene connections with your phone often work the best. Make sure you allow camera and microphone access when checking in.

2) SICK VISITS
For non-contagious conditions, such as suture removal, head injuries, or chronic symptoms, your child can be seen IN-OFFICE while maintaining our extensive safety precautions.

For possible contagious conditions, such as fevers, vomiting, or cough, appointments will be done the same day via TELEMEDICINE. If additional in-person testing or follow-up care is needed we will refer you to PM Pediatrics or Shady Grove Pediatric ER where your child can be safely seen and COVID-19 RNA PCR point of care testing can be completed if needed.

3) CHECK-UPS
As of 06/01, 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.”

4) 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 with direct patient care contact will be wearing full personal protective equipment (PPE) at every appointment including face masks, gloves, and gowns.

Step 2) When you enter our office you will notice that our greeting/waiting area and indoor garden have been cleared of all furniture since you will be escorted directly to your disinfected room. (Sorry our coffee machine and water bottles are in hibernation!) As a very 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 are now conducted by telemedicine rather than in person to ensure our office remains a safe environment for our patient to continue receiving important check-ups and vaccines.

Step 5) All patients and visitors to our office will be screened before the appointment and 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 with the patient are limited to one parent.  The only exception when we can allow two parents is for newborn infants through age 2 months of age. We are happy to include other caregivers in the appointment through a phone or video call during the appointment. 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 (Coming soon!), bathroom sink/soap dispenser, and multiple touchless Purell dispensers in the greeting and garden area.

5) 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 Wednesday 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.

6) 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 RNA PCR through a nasopharyngeal test at PM 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 3 days 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 by RNA PCR 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, even if we did not do the initial COVID-19 testing, 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 3 days 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.

Please let us know by portal message with a summary and dates of your child’s symptoms if you need a back to school letter. In some cases, we may need to do a brief telemedicine appointment before writing a letter.

7) COVID-19 TESTING
For patients with active symptoms of COVID-19 who need testing either to return to daycare/school or to better understand your risk to other family members, we will refer you to PM Pediatrics urgent care for the COVID-19 RNA PCR test. If your child is asymptomatic and does not also need an exam, there are multiple testing only sites for PCR testing which be found on the Maryland COVID-19 website (Maryland resident only) or by calling 240-777-1755.

Note: Hirsch Pediatrics at this time does not offer COVID-19 office point-of-service antigen testing due to the lower accuracy of the point of service antigen test (as opposed to the more accurate send out PCR test). The new COIVD-19 antigen office test is similar to a rapid strep test and will become available to many office practices in the upcoming months. However, though promising when used on a large-scale basis as a screening tool for large groups of people, early data has shown that the antigen test result is less reliable than the “gold standard” PCR test that is sent out to an outside lab. Thus even if you have a negative office antigen test, due to the false negative rate of 20%, you would still need a send out PCR test to confirm that you are truly negative.

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.

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.

SoulScience Health and Wellness Center in Germantown offers family friendly and affordable “mindbody healing modalities” including yoga and meditation classes.

Hirsch Pediatrics in-office therapy

Other Community Behavioral Health In-Office and Telemedicine Providers

9) COVID-19 VACCINE
Based on very encouraging data from the leading vaccine candidates it is expected that a very effective and safe COVID-19 vaccine will be available to select groups in early to mid-2021. The initial recipients of the COVID-19 vaccine will be the high risk population which likely does not include most children since most children are low risk from COVID-19 hospitalizations and complications. Furthermore additional data will have to be collected on the safety and effectiveness in children before it is approved for children. Once the safety and effectiveness of a COVID-19 vaccine has been demonstrated in children through rigorous scientific analysis from multiple agencies then Hirsch Pediatrics will resister with the state of Maryland to be a COVID-19 vaccine provider. Until then Dr. Hirsch still strongly recommends everyone receive the flu vaccine.

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

Sincerely,

Steven F. Hirsch, MD, FAAP