UPDATED: Important Coronavirus Questions and Answers

Frequently Asked Questions for Coronavirus Disease 2019 (COVID-19)

(Adapted from the website of the Centers for Disease Control and Prevention–Revised 3/13/2020)

How does COVID-19 spread? 

The virus spreads mainly from person-to-person

  • Between people who are in close contact (within about 6 feet)
  • Through respiratory droplets produced when an infected person coughs or sneezes

When are people with COVID-19 the most contagious?

  • People infected with the virus are most contagious when they are the sickest
  • Symptoms may take up to 2-14 days to appear after exposure

What are the symptoms of COVID-19? 

  • Fever
  • Cough
  • Shortness of breath

Who is at risk for severe disease from COVID-19?

  • So far, most  severe disease and deaths have occurred in elderly people and in people with underlying medical disease, especially that which compromises the immune system.
  • Infection in children appears to be asymptomatic or mild.  
  • While elderly patients have more severe disease, nearly 40% of US hospitalized patients were aged 20-54.
  • There have been a small number of deaths in children.  The risk of death is much higher in the elderly.

How can COVID-19 infection be prevented?

  • Avoid close contact with people who are sick.
  • Wash hands frequently.
  • Cover coughs and sneezes with your arm, not your hands.
  • Avoid touching your eyes, nose and mouth.
  • Stay home if you are sick.
  • Avoid large gatherings of people.
  • Postpone travel.

Should I wear a mask to prevent COVID-19 infection?

  • No – masks do not protect a person who does not have the virus from getting the virus.  Some evidence suggests that people who wear masks are more likely to touch their faces more frequently which could increase the risk of infection with COVID-19.
  • People who are infected with the virus should wear masks to limit the spread of the virus when they cough or sneeze.
  • Healthcare workers who are in contact with potentially exposed patients and especially when collecting swabs from potentially exposed patients should wear eye protection and mask.

Who should be considered for testing for COVID-19?

  • The CDC has opened up testing to physician’s discretion as the virus has spread throughout the nation and travel is no longer the primary cause of exposure.
  • Priorities for testing include:
    • hospitalized patients with severe respiratory disease,
    • older adults and people with chronic medical conditions, and
    • healthcare workers who have had direct contact with a confirmed case of COVID-19 or travelled to an area of risk in the past 14 days.

What advice are we giving to our patients?

  • Stay home if you do not need medical care.
  • If you are sick enough to require medical care, call your physician’s office to schedule an appointment.
  • Proceed to the emergency department ONLY IF YOU ARE SICK ENOUGH TO REQUIRE EMERGENCY CARE.

A Message About the COVID-19 Situation

The federal and state governments have taken judicious (not panicked) measures to protect us all from the spread of the novel coronavirus (also known as COVID-19).  We agree with the principles of reducing risk by not attending mass gatherings and practicing social distancing.

We also believe at this time, it is still important for your child to keep up on well visit care, particularly as it pertains to needed immunizations.  We feel it would not be wise to postpone these visits, particularly for children under the age of two.  This could make them susceptible to other diseases.  

At Pediatric Associates, we will be doing everything we can to make sure your child is NOT put at risk by coming to our offices.  We have a protocol in place that helps us identify patients who may be at risk for COVID-19, and will isolate these patients.  We will rearrange schedules to reduce the chances that well children are not exposed to ill children.  We value the safety and health of your family, and the safety and health of our staff.

Please stay tuned to our website and social media pages for more updates as the situation is going to be rapidly changing.

Thank you,

The Pediatric Associates Family

Novel Coronavirus (COVID-19) Frequently Asked Questions ANSWERED!

The following is adapted from the Centers for Disease Control (CDC) Website.  For more detailed information, please visit the site at this web address: https://www.cdc.gov/coronavirus/2019-ncov/faq.html

Who is at risk for exposure to COVID-19?

  • People who have had prolonged and close contact with a patient who has been confirmed to have COVID-19.
  • People who have travelled in the last 14 days to countries with high rates of transmission, including China, Japan, South Korea, Iran and Italy.

How does COVID-19 spread? 

The virus spreads mainly from person-to-person

  • Between people who are in close contact (within about 6 feet)
  • Through respiratory droplets produced when an infected person coughs or sneezes

When are people with COVID-19 the most contagious?

  • People infected with the virus are most contagious when they are the sickest
  • Symptoms may take up to 2-14 days to appear after exposure

What are the symptoms of COVID-19? 

  • Fever
  • Cough
  • Shortness of breath

Who is at risk for severe disease from COVID-19?

  • To date, the majority of severe disease and deaths have occurred in elderly people and in people with underlying medical disease, especially that which compromises the immune system.
  • Infection in children appears to be uncommon and generally mild.  
  • There have been no deaths from COVID-19 reported in children.

How can COVID-19 infection be prevented?

  • Follow the CDC advice on avoiding travel to countries with high rates of transmission, including China, Japan, South Korea, Iran and Italy.
  • Avoid close contact with people who are sick.
  • Wash hands frequently.
  • Cover coughs and sneezes with your arm, not your hands.
  • Avoid touching your eyes, nose and mouth.
  • Stay home if you are sick.

Should I wear a mask to prevent COVID-19 infection?

  • No – facemasks do not protect a person who does not have the virus from getting the virus.  Some evidence suggests that people who wear facemasks are more likely to touch their faces more frequently which could increase the risk of infection with COVID-19.
  • Healthcare workers and first responders who are likely to be in contact with people infected with COVID-19 should wear N-95 respirators which are not available to the public.
  • People who are infected with the virus should wear facemasks to limit the spread of respiratory droplets when they cough or sneeze.

Who should be considered for testing for COVID-19?

At this time, the only people who will be tested for COVID-19 are those who meet one of the following criteria:

  • Fever or respiratory symptoms in a person who has had direct contact with a confirmed case of COVID-19
  • Fever AND respiratory symptoms in a person who has travelled to a country of high risk in the past 14 days, including China, Japan, South Korea, Iran and Italy
  • Severe respiratory infection requiring hospitalization with no alternate cause identified

What should I do if I meet the above criteria for testing?

  • Call your physician if you meet the criteria above.   Note that fever AND respiratory symptoms are required for testing.   Your physician can give you further instructions on how to proceed.
  • Note that test kits are not currently widely available so you will NOT be tested in your physician’s office or at a local emergency room.  All healthcare providers will work with their state’s public health department to arrange testing if appropriate.

What should I do if I have a fever but do not meet the above criteria for testing?

  • Stay home if you do not need medical care.
  • If you are sick enough to require medical care, call your physician’s office to schedule an appointment.
  • Proceed to the emergency department ONLY IF YOU ARE SICK ENOUGH TO REQUIRE EMERGENCY CARE.

Stay tuned to our social media pages (and this website) as we expect the situation and recommendations to change frequently.

Cold vs. Flu: What can you do?

Both the common cold and the flu (influenza) are caused by viruses for which there is no definitive treatment.

Colds are typically mild and do not require a visit to the doctor. Medications such as Tylenol or Advil/Motrin can be used to reduce any pain or fever that occurs. Cold and cough medicines are not very effective and are not recommended in children younger than 2 years.

The flu can be quite severe. Medication for flu such as Tamiflu does NOT cure the flu. At best it reduces the symptoms of the flu by 1-2 days if given with the first 24-48 hours from the start of illness, and therefore is only indicated for people at very high risk for complications from flu, including children younger than 2 years old and people with conditions such as asthma or immune suppression. Patients with these conditions should be seen in the office in the first 1-2 days of fever onset.

You should call our office for a same day appointment if your child experiences persistently high fever (> 101 for more than 3 days), appears to have difficulty breathing, or is unable to keep down fluids such as water or Pedialyte. Your child’s pediatrician can determine what the cause of the symptoms is and if any additional treatment is appropriate.

The most effective treatments for any viral illness including both colds and the flu are drinking fluids and getting lots of rest. Drinking fluids prevents dehydration while the body is trying to recover from illness and the body heals best when resting.

Well Visits ARE Sports Physicals

Is your child planning to play a sport in school for the next academic year?  Is your child THINKING about playing a sport next year?  If so, we recommend you do two things as the current school year winds to an end:

  1. Schedule your child’s annual well visit as soon as possible to get it in before tryouts and/or practices start for the sport(s) he/she will be playing.
  2. Tell the nursing staff and the doctor that your child will (or may) need a sports clearance, either in the summer, or later in the year.  This will assure we ask the appropriate questions and add the appropriate parts of the physical exam to clear your student athlete.

Remember that a clearance for sports is good for a full 12 months.  So if your child has a well visit this summer, he/she can be cleared for the entire school year.  An injury could require a re-clearance post-injury, but in the absence of that, a well visit will count as a sports physical, and be valid for the entire 12 months.

New! Ways to keep your child with asthma out of the ER

We’ve added a new asthma self-management tool to help patients and families avoid expensive and lengthy trips to an ER or Urgent Care.  In addition to following your asthma action plan, click here to learn more helpful hints to keep asthma patients OUT of the ER.

Spring is a common season for flare-ups of asthma.  Be prepared.  Make sure your child has his/her controller medicine and all inhalers available.  Call our office if you need help!

Important Facts about School Sports Forms

Is your 7th-12th grade child going to play a school sport during the upcoming school year?  If so, they will need to have the most recent edition the OHSAA sports clearance form completed prior to the first day of practice or tryouts.  For most fall sports, that deadline is in early August.

We can complete the sports form during your child’s regular annual physical exam.  It is very helpful to have this form completed (at least partially) prior to the checkup visit.  We will have the forms available in the office, but you can also download and print the form from here to have before the appointment.

OHSAA 2018-19

The most important health questions to have answered for the checkup are Questions 5 through 16, about heart health in the patient and family history.

We look forward to seeing you this summer and hope you ALL have a great school year this year!

Warm Weather means Hand-Foot-Mouth (HFM) season

by Jumana Giragos, MD

Hand-foot-and-mouth (HFM) disease is a common childhood infection caused by a virus that results in a characteristic rash. The rash consists of small, blister-like bumps in the mouth (usually in the back near the tonsils) and a rash on the palms and soles. The rash also commonly appears on the legs, arms, around the mouth, and in the diaper area, especially the buttocks; in those areas, the rash can also appear as small red bumps rather than blisters.

As stated, HFM is caused by a virus, mostly commonly by specific strains of the enterovirus family. It is very common in children, especially those younger than 10. It is more common during warmer times of the year such as summer and fall. The virus is spread primarily through fecal-oral contact, although it may also be transmitted through other modes such as saliva. The rash itself is NOT considered contagious by contact.  To prevent the spread, it is very important to have good hand washing.

The signs and symptoms of HFM consist of the rash (described above), and fever. The oral lesions can cause pain, so affected children may not eat or drink well. Overall, children do not feel well with this illness. Due to the distinctive rash, the diagnosis is made based on the rash and associated symptoms, and usually no further testing is needed.

Symptoms typically last 5-7 days. Because it is caused by a virus, antibiotics will not help. The main goals of treatment are to make the child as comfortable as possible due to the pain associated with the oral blisters and to encourage the child to stay hydrated with fluids. Acetaminophen and/or ibuprofen can be used to manage the fever and also help with pain control. It is very important to make sure your child is hydrated as dehydration is the biggest potential complication of this virus. Frequent sips of fluids, popsicles, etc are different ways to make sure your child does not get dehydrated.

To prevent the spread, hand washing is very important. Also contaminated surface can be cleaned with disinfectants. The virus can be shed for a few weeks even after the rash is gone. For that reason, we do not limit children from attending daycare while they have the rash unless they also have a fever at the time.

Real Answers about Adolescent Contraception

Contraception & Why It Is Important

Dr. Molly Falasco

Adolescence is a magical time fraught with hormones, angst, and that feeling of invincibility.  Between the acne breakouts and school dances, however, teenagers have to figure out how to grow up.  More difficult still is “getting through” to a teen on his/her quest to independence.  Friends’ opinions tend to “rule the day.”  Parents never seem to be “cool enough” to even warrant the time of day.  Whether at home or the doctor’s office, topics especially dreaded by both parent and child pertain to puberty and sexual health.  Let’s face it, that stuff is awkward.  Luckily for you, Pediatric Associates has trained pediatricians, and our very own Reproductive Health Clinic, to educate families on reproductive health and contraceptive options.  While having a face-to-face encounter with your pediatrician is best, use this article as a guide to the basics of contraception.  This is not an easy subject, so discuss it with your family and/or your pediatrician.

Contraception (birth control) is any method, device, or medicine used to prevent pregnancy.  Especially for a busy teenager’s schedule, it is important to choose a method that is easy and effective.  There are three arms of contraception: abstinence, barrier devices, and medical interventions – all described below.

Abstinence is the decision to not have sex.  This is the most effective method of contraception, and always our first choice for teenagers.  While 100% effective in preventing pregnancy and STIs (sexually transmitted infections), abstinence may sometimes be difficult for an adolescent or young adult to practice in a mature, stable relationship, or in a “heat of the moment.”

Barrier devices block the sperm from meeting the egg.  These devices are less effective than medical contraception due to inconsistent use.  Barrier methods may be purchased over-the-counter.

Condoms: Made of latex or polyurethane, a male condom is unrolled over the penis and a female condom is inserted in to the vagina.  Condoms prevent bodily fluids from mixing when two people have sex.  Condoms provide the best protection against STIs.  Even when used perfectly, however, male condoms are only 82% effective while female condoms are only 79% effective in preventing pregnancy.

Cervical Cap, Diaphragm, Sponge, Film, or Suppository:  Usually used with spermicide (a chemical used to kill sperm), these devices are manually placed over or near the cervix (the muscular opening to the uterus at the end of the vagina).  These devices have a high failure rate (<80% effective) and are often the most difficult to use correctly.

Medical contraception (consisting of progesterone with/without estrogen) regulates hormone fluctuations in a woman’s body, thereby preventing the release of an egg from a woman’s ovary (ovulation) and thickening her cervical mucous, making it more difficult for sperm to meet egg (fertilization).  Additional benefits of medical contraception may include improved menstrual cycles, clearer complexions, and better moods.  Some forms of medical contraception even reduce a woman’s risk of ovarian and endometrial cancer!  All medical contraception requires a prescription from a healthcare professional.  Also, all medical contraception is reversible and has no lasting impact on fertility once stopped.

Long-Acting Reversible Contraception (LARC): The Implant* and the IUD* are the easiest, longest lasting, and most reliable forms of contraception recommended by the American Academy of Pediatrics (AAP).  With 99.9% effectiveness, LARCs are effective, hassle-free options for teenagers.

*The Implant (Nexplanon): A certified healthcare provider performs an easy outpatient procedure to insert a small plastic rod approximately the size of a matchstick underneath the skin of a woman’s inner upper arm.  The Implant slowly releases progesterone and lasts for 3 years.  Drs. Molly Falasco and Bill Long are certified Nexplanon providers at Pediatric Associates who are able to place Nexplanon the same day of consultation.

*The IUD, Intrauterine Device: Through an outpatient procedure akin to a pap smear, a certified healthcare provider places a small, flexible piece of T-shaped plastic in a woman’s uterus through her cervix.  The progesterone IUD (Mirena, Skyla, Liletta, Kyleena) lasts anywhere from 3-6 years, whereas the hormone-free, copper-based IUD (ParaGuard) lasts for 10 years.  A referral to Adolescent Medicine or Gynecology is necessary for administration.

The Shot (Depo Provera): Like a vaccine, a medical professional administers a progesterone shot in a woman’s arm once every three months (four times per year). When administered on time, The Shot is 94% effective.  A referral to Adolescent Medicine or Gynecology is necessary for administration.

The Pill, Oral Contraceptive Pill (OCP): A combination of estrogen and progesterone (or just progesterone alone), a woman takes one pill at the same time every day.  In a typical monthly pack, there are 21 hormone pills followed by 7 placebo pills, allowing for a shorter, lighter, less painful period in the final week of the month.  When administered on time, The Pill is 91% effective.  Even missing a dose by a few hours or taking certain other medication at the same time  might significantly reduce The Pill’s effectiveness.  Many OCPs exist on the market (Sprintec, Ortho Tri-Cyclen, Seasonique, to name a few), so an experienced healthcare provider should offer guidance in determining the ideal pill.  Any pediatrician may prescribe The Pill.

The Patch (Xulane): A combination of estrogen and progesterone, a woman places the patch anywhere on her body, replacing once per week for three weeks.  The woman then removes the patch for one week, allowing for a shorter, lighter, less painful period in the final week of the month.  Like a nicotine patch for smoking cessation, the body absorbs medication through the skin.  When administered correctly, The Patch is 91% effective.  Any pediatrician may prescribe The Patch.

The Ring (Nuvaring): A combination of estrogen and progesterone, a woman manually places a rubbery ring inside her vagina once every three weeks.  At the end of the three weeks, the woman then removes the ring, allowing for a shorter, lighter, less painful period in the final week of the month.  When administered correctly, The Ring is 91% effective.  Any pediatrician may prescribe The Ring.

Emergency Contraception or “The Morning After Pill” (Plan B, Next Choice, LNG, Ella).

Taken within five days of unprotected sex, Emergency Contraception (EC) prevents pregnancy in a number of ways.  EC delays ovulation, prevents sperm from meeting egg, and may even inhibit implantation (when a fertilized egg attaches to the wall of a woman’s uterus).  This is not an abortion drug.  Sometimes adolescents may purchase EC directly from a pharmacist, but EC usually requires a prescription from a healthcare professional.  Any pediatrician may prescribe Emergency Contraception.

As you can see, an experienced pediatrician may tailor contraception to fit a teenager’s specific needs and preferences.  Learning about reproductive health in no way opens proverbial floodgates for sexual promiscuity, but instead empowers adolescents with the knowledge of how to make a responsible transition to adulthood.  Whether that is a 14-year-old looking to better handle her heavy menses or a 18-year-old looking for a hassle-free form of birth control before heading off to college, contraception is an effective way to guarantee an adolescent’s reproductive safety.  There are risks and benefits to each option, which is important to address with your pediatrician.  For a more in-depth discussion and possible same-day intervention, consider the Pediatric Associates Reproductive Health Clinic!  And the best news is: most insurance companies will completely cover both the visit and any contraception prescribed.

Rashes: When to call, and when to relax

by Diana Wagner, MD

Rashes- When to Call

Rashes are very common, from infant to adolescents.  Most of the time, they look worse than they are, in terms of your child’s health.  It is rare that a rash would need to be seen in an emergency room or urgent care.  But some rashes are more worrisome than others.  When the rash is associated with the following symptoms, you should call our office:

  1. A rash associated with a high fever
  2. A rash that is painful, or tender to the touch
  3. A rash that does not blanch (that means will not lighten when you put gentle pressure)
  4. Rashes that start soon after eating a food or after taking a medication
  5. Rashes associated with your child acting sick
  6. Rashes in young infants

The bottom line though, even if the above conditions don’t apply, if you are that worried about your child’s rash then you should have your child seen in our office.

Rashes are often difficult to describe over the phone –one person’s pimple is another person’s blister.  Since these rashes are easy to misidentify without actually seeing the child, a visit to the office is warranted.  There are times, however, that even with the best history and physical exam in the office, the exact cause of your child’s rash may not be found in all cases.  For example, we can tell an infectious rash from a contact rash but cannot tell what the irritant was that caused your child to get the contact rash.  And if a rash has just started, and is only a few patches or “dots,” it may be difficult to make a diagnosis and prescribe treatment until the rash has had time to “blossom” so to speak.  While MOST rashes can be diagnosed by your primary care pediatrician, there may be some that require a referral to a dermatologist.  As you may know, this could be a long process, but we will try to help you through every step of the way.