FAQs About Coronavirus (COVID-19) and CNPA Primary Care Practices

• Section 1: General Questions About COVID-19 Illness
  
• Section 2: Questions About Scheduling In-office and Telehealth Visits
• Section 3: Family, School and Daycare Tips

Section 1: General Questions About COVID-19 Illness

What is coronavirus and is it different from COVID-19?

Coronaviruses are a large family of viruses that are common in people and many different species of animals, including camels, cattle, cats and bats. Several coronaviruses routinely infect humans and are a cause of the common cold. The CDC is currently responding to an outbreak of a respiratory disease caused by a novel (new) coronavirus that was first detected in China and has now been detected in many locations internationally, including the United States. The virus has been named “SARS-CoV-2” and the disease it causes is named “coronavirus disease 2019” (abbreviated “COVID-19”).

What is the risk of my child becoming sick with COVID-19?

Based on available evidence, children do not appear to be at higher risk for COVID-19 than adults. While some children and infants have been sick with COVID-19, adults make up most of the known cases to date. You can learn more about who is most at risk for health problems if they have COVID-19 infection on CDC’s current Risk Assessment page.

Where can I get information about how COVID-19 affects children and how to talk to my children about it?

Children’s National Hospital has some wonderful resources for families and children via Rise and Shine Coronavirus Resources for Families. Find tips for talking to your children about the pandemic, for home activities and more. And, Kelly Register-Brown, M.D., child psychiatrist at Children’s National, created this wonderful factsheet for kids: A Kid's Guide to Coronavirus (PDF). Another useful website is this one from the American Academy of Pediatrics: Coronavirus Information for Families from the AAP.

Should I bring my child in for an appointment if I suspect they have been in contact with someone with COVID-19, but has no symptoms?

No. We are following the advice of experts and advise you to keep your child at home and self-quarantine. If they start to show signs or symptoms of COVID-19 infection, please see the next question. We are not currently able to test for coronavirus in our office however we can refer your child for testing if needed. Please call to schedule a video visit so we can determine next steps together.

What if my child may have been in contact with someone who has COVID-19 infection and is now showing signs of illness?

If you are concerned that your child may have been exposed to COVID-19, you should immediately contact us. If symptoms are mild (a bad cold), we will like advise you to monitor your child at home and self-quarantine. Please call us if your child has fever, trouble breathing, bad cough or any other symptoms that concern you. We will most likely schedule a telehealth visit for you with one of our providers. If, after the telehealth visit, we agree that your child needs to be seen in person, we will arrange for a visit in the office or we may advise going to an urgent care or emergency room if the situation warrants. We will call the emergency room in advance to be sure they are prepared.

Should I go to the emergency room if I’m worried my child has COVID-19?

If you suspect that your child may have contracted COVID-19, you should immediately contact us. We will then work with your local and state health departments to determine the appropriate next steps for your child’s care. Please visit the Emergency Department only if you are experiencing an emergency. This will help limit the potential spread of the virus in our community, and will help ensure that our Emergency Department is able to care for patients with the most critical needs first.

Should I call the office if my child is sick?

If your child has a mild illness and is coping well, please keep your child at home and monitor for any worsening symptoms. See the American Academy of Pediatrics Healthy Children site for recommendations on how to care for a variety of illnesses at home. If you have questions or if your child has signs such as shortness of breath or dehydration, please call us for advice. We will most likely schedule a telehealth visit for you with one of our providers and decide together if you need to be seen in the office.

Can I bring my child into the office to get tested for COVID-19?

No. We are currently not able to test for coronavirus in our office. If your child is ill and has been or may have been in contact with a person with coronavirus, please call us. If we decide with you that they need testing, we will call ahead to arrange for them to be seen at a center that is currently able to do the testing.

Section 2: Questions About Scheduling In-office and Telehealth Visits (Video Visits)

What should I do about my child’s regular check up?

We continue to see babies and children who are due for shots or who may have other conditions that are better served with an in-office visit. This includes 4 and 11 year olds, and some teens. We are able to provide all other patients their regular check-ups by video-visits (or telehealth). We encourage you to take advantage of this opportunity so that your child doesn’t fall behind in getting the care they need. Most insurance companies have agreed to cover these visits as they would in-office visits: with no co-pays or shared expense. During a video visit check-up we are able to review nutrition, development, behavior, chronic medical problems, refill prescriptions, and make referrals. But, if you prefer, we can arrange for any of your well child checks to be in person, and we will do our best to fit you in in a safe manner.

What if I have concerns I was planning to discuss with my provider at the appointment?

If you have concerns you would like to discuss with your provider, please ask for your appointment to be converted to a telehealth visit. You and your provider will still be able to talk to each other. You will be advised to schedule a visit in the office if you decide together that your child still needs an evaluation in person.

I think my child may be due for immunizations. Should I call to schedule an appointment?

Yes! Now, more than ever, we want to be sure that all of our children have the full protection that immunizations provide. When travel restrictions are lifted, and people are moving about again, we want to be sure we’re ready!

To see if your child needs an immunization, you can check here: 2020 Childhood Immunization Schedule.

Is it safe to bring my child to the office for check-ups and immunizations?

Yes! We have changed our office set up to bring well children in at a time when no sick children are in the office. Our waiting rooms are pretty empty! We have altered schedules to either minimize or entirely avoid your time in the waiting room and in the office in general. All of our staff wear protective equipment and each room is cleaned after every visit.

How you can help:

• If you receive our “well child handout” prior to the visit, please read it before coming. It is designed to address many of the issues that come up at your child’s age such as safety, nutrition, and development. When possible, we will arrange to address your questions or concerns via telephone before or after the visit. We appreciate your understanding!
• We ask that only one caretaker arrive with each patient. Please wear a mask to your visit and have a mask on all children over 2 years old.
• To maintain office safety for everyone: please notify us by phone beforehand if you, any family member or your child has known or suspected COVID-19 infection so our office staff can safely prepare for your visit. This includes any family member or patient with sore throat, headache, cough, fever, diarrhea or vomiting, loss of sense of smell and taste.

Is it ok to bring siblings to the office for the appointment?

For the safety of our community, we would like to limit the number of people in the office. If possible, we ask that only one caregiver and only children who have an appointment come to the office.

What should I do if my child has signs of illness on the day of their scheduled well-child visit?

Please call the office to arrange a telehealth visit or telephone consultation if your child has signs of illness on the day of the visit. If, after that, we decide together that your child needs to be seen, we will schedule an office visit.

If I have questions about my child, will I be able to schedule a telehealth visit instead of coming into the office?

Yes! We have been working hard to increase our telehealth capacity. In fact, we will likely offer you a telehealth visit before scheduling an in-office visit. View our infographic, Tips for Your Telehealth Visit (PDF). Our staff will help schedule an in-office visit if you and your provider decide together that your child needs an evaluation in person.

Will I be charged co-pays for both the telehealth visit and the in-office visit if both are needed on the same day?

No, if the telehealth visit and the in-office visit occur on the same day, you will only be charged your usual co-pay for the in-office visit. Most insurance companies are now waiving extra fees for telehealth visits.

Can I schedule a telehealth visit for reasons other than an acute illness?

Yes – telehealth is a convenient way to discuss a variety of concerns such as behavior concerns, developmental school concerns, asthma management and constipation follow-up.

How will I get my daycare, school or camp form?

We will give your child any needed forms at the rescheduled appointment. If your daycare, school or camp needs a form before the rescheduled appointment, please call the office for a letter explaining that your appointment was cancelled due to the COVID-19 pandemic.

How can I get the well-child handout I usually get at the check-ups?

If you are on our portal, we will send the handout to you that way.

How do I sign up for the Patient Portal?

Please call our office to ask for a PIN and instructions on how to set up your account. See the Patient Portal for more information.

Should I keep my child’s appointment for 2-month, 4-month, 6-month or 12-month check-ups even if I don’t plan to do the routine recommended vaccines?

Children who are under-immunized are at even greater risk to themselves and others during a time like this. If you are not planning on getting the routine recommended vaccines, please call us to change your visit to a telehealth visit.

Section 3: Family, School and Daycare Tips

Should I send my child back to daycare?

There is no one right answer to this question. It is important to take into account what needs your individual family has, how much risk your family is willing to take on and what infection control measures your daycare is taking. Group childcare tends to be more risky in terms of exposure to any illness than one on one, but having a babysitter or nanny is not a feasible choice for many and socialization is also important for child development.

It is critically important that your child is up to date on all immunizations before returning back to daycare or school. Make sure your daycare is adhering to strict immunization requirements for all children.

Take into account what your work and life demands are when considering childcare. Many parents are essential workers or reliant on full time work to provide for their family. In these cases, sending your child to a daycare or caregiver is necessary. Consider framing the return-to-daycare question in blocks of time - should we send our child(ren) now or do we have flexibility in our jobs and work-life balance to re-evaluate in several weeks?

It is also important to ask the daycare questions about their response to the pandemic.

• What are their cleaning plans?
• How many children will be assigned to each provider?
• Will there be room for some social distancing?
• Will adults/parents be kept out of the facility as much as possible to limit exposure?
• What is the plan if a child, provider or family member tests positive for COVID-19?
• Will there be contact tracing?

The DC Department of Health recently published reopening guidance for daycares and is great reference. Do also think through contingency plans for intermittent daycare closures, which many people predict may happen if clusters of infections arise locally.

As with many difficult decisions during this pandemic, the daycare question is about risk tolerance. We not only have to consider “What is the risk of serious illness to my child in sending him or her to daycare?” (answer: probably fairly low as most children do very well if they get the COVID-19 infection). But, we also have to consider these questions: What is the risk of serious illness to a member of our household if my child or I were to be exposed to COVID-19 infection through daycare? Are there children or family members with high risk medical conditions such as diabetes, lung disease or heart problems? Do any older family members live with you? If so, think about limiting your contacts through a nanny or nanny share where all members practice similar social distancing measures. This may be a safer option for your family. Or, consider choosing one or two other families whose adults share childcare responsibilities who all agree on social distancing practices.

Keep in mind that we continue to learn about COVID-19 on a daily basis. As more information becomes available about this virus, our recommendations may change accordingly. We welcome your questions as we all navigate this challenging and rapidly changing new landscape.

When is it ok to see grandparents?

We understand that these have been really challenging times for families and that it has been very hard for people to remain physically distanced from their loved ones. Many people are starting to question when it may be okay to have grandparents visit their grandchildren or to travel themselves to visit family members. While social distancing and isolation are crucial to controlling the spread of the novel coronavirus, we recognize that mental health and family relationships are also critical during this strange “new normal”.

There is no single answer, but here are some things to consider when evaluating your family’s risk factors and risk tolerance. Do the grandparents have high risk medical conditions? In general, the risk of getting very sick due to COVID-19 is higher in older people, but medical conditions such as lung disease, heart problems and diabetes can place people at higher risk for a more serious infection. Consider how well each family member has been socially distancing—have any family members still been working outside the home on a regular basis? Some jobs may be riskier than others (for example, healthcare and grocery store workers) due to how much contact they have with other (potentially sick) people.

If you decide to visit with grandparents, some options for reducing risk of the visit could be:

• Spend the visit outdoors (studies show that transmission of COVID-19 is significantly decreased outdoors compared to a closed indoor space).
• Do not share utensils or a family style meal together.
• Consider driving instead of flying and minimizing public rest-stops.
• Consider traveling to the grandparents instead of grandparents traveling to you if air travel is required for the visit.
• If possible, both the grandparents and the visiting family should be diligent about socially distancing for two weeks prior to the visit to reduce the risk of any member of the group acquiring and even unknowingly spreading COVID-19 infection.
• Consider meeting somewhere geographically neutral if family members live in a high COVID-19 prevalence area.
• Consider pre-visit testing if this is available in your area. The nasal PCR test can accurately identify active COVID-19 infection; but, so far, none of the antibody tests can reliably determine immunity or confirm past infection.

I'm having a baby - when can people come visit?

From what we understand thus far about COVID-19 infections, those most at risk of more serious illness are the very old and the very young (infants). We’ve developed some guidance around visitors in the newborn period based on mom’s COVID testing results at delivery, if applicable:

If mom and/or baby test COVID positive, visitors should only be considered once at least 10 days have passed since mom/baby developed symptoms AND at least 72 hours have passed during which there has been no fever (ON NO ANTI-FEVER MEDICATIONS), and any respiratory symptoms are improving. If there are other members in the household, then there should be a full two weeks of quarantine for all household contacts after symptom improvement of the infected individual to ensure that no other members of the household develop any symptoms.

If mom tests COVID negative, visitors should still be quite limited. Those who you might consider allowing to visit are those who are in good health and who have adhered to strict social distancing for at least 14 days before coming to visit. They would ideally minimize potential exposures during travel (private vehicle with minimal rest stops versus shared bus/train/air). In case of potential COVID exposure during hospitalization, visitors would ideally wait until your family has been at home for at least 14 days since being discharged from the hospital. However, families may also choose/need family or friends to come prior to delivery to help care for other children in your home. If visitors require air travel to visit, consider an arrival two weeks before they are needed and have them quarantine in a hotel or nearby rental, especially if traveling internationally or from a high COVID prevalence area.

If you have additional questions unique to your family’s needs, we’d be happy to talk through them with you. We can also schedule consultation visits for existing patients (call appointment line for telehealth consult). We offer prenatal visits via telehealth for new patients.

As we continue to learn more about this new virus, please note that the above guidance may change. Lastly, remember that frequent hand washing, wearing a mask while in public, avoiding touching your face, social distancing and sanitizing high-touch surfaces remain critical to controlling viral spread.