(updated 04/19/23)

Dear Hirsch Pediatrics Families,

As we support each other though these unprecedented times, we 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 from national, state, and local information sources to ensure we continue to provide our families the safest and highest quality care possible. As always thank you for your patience and understanding as we work through this unique situation!

Sincerely,
Steven F. Hirsch, MD, FAAP
Gloribel Olexa, MD, FAAP
Kristina Kissiova, MD, FAAP

PFIZER COVID VACCINE AVAILABILITY FOR AGE 6 MONTHS AND OLDER

Who can get the Pfizer bivalent omicron booster at Hirsch Pediatrics?

* If your child recently had COVID-19 we recommend waiting at least 90 days after the positive test to receive the COVID vaccine.

* Children age 6 months – 4 years who already received two or three doses of Pfizer monovalent COVID vaccine can receive the Pfizer COVID bivalent omicron vaccine as their or fourth COVID vaccine if it has been 8 weeks from your most recent COVID vaccine. Note children age 6 months – 4 years who received two doses of Moderna COVID vaccine may only receive a Moderna bivalent omicron vaccine.

* Children 5 years and older who already received at least 2 doses of either Pfizer or Moderna COVID monovalent vaccine can receive the Pfizer COVID bivalent omicron vaccine at Hirsch Pediatrics if it has been 2 months after your most recent COVID Pfizer or Moderna vaccine .

* Common parent questions about the safety and effectiveness of the COVID-19 vaccine are discussed below in the COVID-19 Vaccine section of our website.

What is the dosing interval for COVID vaccine for age 6 month – 4 year olds with the Pfizer vaccine series?
Dose 1 to dose 2 interval is 3-8 weeks. ** (see CDC website note below) **
Dose 2/3 to omicron bivalent is 2 months.

**Per CDC website: mRNA COVID-19 vaccines are safe and effective at the FDA-approved or FDA-authorized intervals, but a longer interval may be considered for some populations. While absolute risk remains small, the risk for myocarditis is higher for males ages 12-39 years, and this risk might be reduced by extending the interval between the first and second dose. Some studies in adolescents (ages 12-17 years) and adults have shown the small risk of myocarditis associated with mRNA COVID-19 vaccines might be reduced and peak antibody responses and vaccine effectiveness may be increased with an interval longer than 4 weeks. Extending the interval beyond 8 weeks has not been shown to provide additional benefit. In summary, an 8-week interval may be optimal for people who are not moderately or severely immunocompromised and ages 6 months-64 years, especially for males ages 12–39 years. 

** COVID-19 PARKING LOT RAPID PCR TESTING AVAILABLE AT HIRSCH PEDIATRICS MONDAY – FRIDAY MORNING AND AFTER SCHOOL**
Safe, convenient, and expedited parking lot drive-up testing is available for BOTH PATIENTS AND PARENTS. All COVID-19 testing is by appointment only and must include a video telemedicine appointment. See below for more information. Both rapid antigen testing (results in hours) and send out PCR (results in under 12-24 hours!) are available. Click here to get your PCR results sent directly to you ASAP.

** COVID-19 TOPICS COVERED BELOW**
1) Telemedicine – Hirsch Pediatrics ZOOM waiting room
2) COVID-19 testing NOW available for patients and parents with rapid antigen and PCR
3) Check-ups
4) Hirsch Pediatrics Extensive COVID-19 Safety Precautions
5) Special Message for Pregnant Moms and Our Newborns
6) OMICRON VARIANT/COVID-19 FAQ (fever management, MIS-C, attending daycare/preschool, return to daycare/school letter, and more)
7) COVID-19 Mental Health Resources
8) 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 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 will include a video telemedicine appointment.

When is your parking lot drive-up testing available?
Monday – Friday, by appointment only – please send portal message to request an appointment
morning and after school slots available most days

** When arriving at our building please proceed to our designated parking spot marked by an orange cone. The parking spots are next to the sidewalk and in front of the landscaped courtyard that is between our building and the next building. Please move the orange cone to the curb so you can pull fully into the spot and then call us. We will be at your car with our testing equipment within 10-15 minutes.

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, Dr. Olexa, or Dr. Kissiova that must be completed with the testing.

How quick will I get COVID results?
Hirsch Pediatrics is pleased to offer both immediate test results with  BD Veritor antigen testing and rapid turnaround PCR results available in 12-24 hours or less. Click here to get your PCR results sent directly to you ASAP.  

How much does COVID-19 testing cost?
Your insurance may require a co-pay or deductible payment for COVID-19 testing. Note that for adult (non-patient) testing your co-pay may be a higher out-of-network or specialist copay. For send-out COVID-19 PCR testing, you may receive a separate bill from an outside lab for the test. 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, office rapid antigen test, and collecting a COVID-19 nasal PCR specimen to send to an outside lab.

Can PARENTS also get COVID-19 testing at Hirsch Pediatrics?
Yes. Hirsch Pediatrics will also do COVID-19 testing for parents of current patients that are asymptomatic or minimally symptomatic. We are unable to test other non-parent adults (i.e. nannies or other relatives) or parents that have any significant symptoms of COVID-19. Adults with any potential moderate or severe symptoms of COVID-19 who need testing should contact their personal physician for guidance.

3) CHECK-UPS
Hirsch Pediatrics continues all check-ups IN-OFFICE while still following extensive safety precautions. We will continue our COVID-19 extensive safety precautions indefinitely including having a fully vaccinated medical team, mask requirements for everyone in the office when community transmission rates are elevated, consistent disinfecting, and no waiting outside of your room and more.

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 at Hirsch Pediatrics are fully vaccinated against COVID-19.   

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) When community transmission rates are elevated then 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. Note: As of 04/12/23 due to very low local community transmission rates masking is now optional for families and well-children. Though masking is optional please let us know upon arrival if you prefer that our medical team wear a mask during your appointment. 

Step 4) All high-risk COVID-19 positive sick visits (i.e. direct exposure to COVID-19 contact) 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.

Step 5) Patients that are high-risk COVID-19 who still need an in-person evaluation for a sick visit will have a confirmed negative COVID-19 test before entering our office.

**Please notify us as soon as possible if any person coming to the check-up (parent or child) or anyone at home has a known direct exposure in the last 10 days to anyone who tested positive for COVID-19

Step 6) We will continue to disinfect your exam room before your appointment and other common areas frequently throughout the day.

Step 7) 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.

5) SPECIAL MESSAGE FOR PREGNANT MOMS AND OUR NEWBORNS
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.

6) COVID-19 FAQ (virus variants, 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 frequently. 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? Does my child need an appointment or 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. To establish when your child can return to school/daycare or be around other people we do recommend COVID-19 testing for any child with a fever either with a home antigen test and/or our office PCR test.

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?
Pleae refer to the CDC  website for the most recent guidelines on COVID-19 quarantine and isolation.

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

Even with the prior delta and omicron variant surges can my child still be in daycare and school?
YES!!! Since the vast majority of children who are exposed to COVID-19 have mild or no disease, even with the prior circulating delta and omicron variant I think it is okay for your child to continue in-person daycare and school if the county and state officials allow it (especially if attending daycare or pre-school is beneficial for your family and/or your child’s development). However during extreme community COVID-19 surges such as what we saw in 12/2021 – 01/2022 then you may choose to keep your child home from non-essential daycare to avoid the high risk of exposure that can lead to extensive disruptive quarantining of your child and your family. Also especially during surges I would avoid indoor contact with unvaccinated adults since adults are much more likely to carry and spread COVID-19.

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 will schedule a brief appointment (video telemed or in-person) to review your child’s symptoms and discuss the care plan including a letter for daycare/school.

7) 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.

8) COVID-19 VACCINE
Dr. Hirsch strongly recommends that all eligible children receive the COVID-19 vaccine without delay in accordance with the recommendations of both the American Academy of Pediatrics and CDC. Please see the note at the top of this page regarding vaccine availability for our patients.

Still have additional COVID vaccine questions or concerns? No problem – these links copied below have extensive COVID-19 vaccine information from two independent organizations: 1) American Academy of Pediatrics, an independent organization representing over 67,000 pediatricians and health care providers across many countries, and 2) Children’s Hospital of Philadelphia Vaccine Education Center, a world renowned children’s hospital.

The Science Behind COVID-19 Vaccines: Parent FAQs

Was the COVID vaccine rushed?

Common Parent Questions and Answers about COVID-19 Vaccines

COVID-19 Vaccine Information Fact Sheet: Pfizer Vaccine Age 6 months – 4 Years

COVID-19 Vaccine Information Fact Sheet: Pfizer Vaccine Age 5 – 11 Years

COVID-19 Vaccine Information Fact Sheet: Pfizer Vaccine Age 12 Years and older

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

Sincerely,

Steven F. Hirsch, MD, FAAP
Gloribel Olexa, MD, FAAP
Kristina Kissiova, MD, FAAP