LINKS:

Click here to find a test.

Click here to see the latest Delaware data.

Click here to read about COVID-19 vaccination.

Click here to see the latest recommendations about Isolation and Quarantine.

 

(As of: December 10, 2021)

In this emergency situation, my staff and I are working hard to keep you, and us, safe and cared for.

Should I get myself, and my kids, vaccinated?

Absolutely, yes!  All the vaccines available are amazingly safe and effective; the new technologies are a major public health advance.  (After the COVID-19 epidemic is over, the same technologies might be used to develop more new vaccines against diseases that we’ve never had effective vaccines for in the past.)

Side effects generally are mild and temporary, usually involving achiness and sleepiness for a day or so.  More serious side effects, despite some news reports, are much more rare than most other vaccines.  Certainly, getting sick with COVID-19 (and being contagious to those you love) is far worse than getting the shots!

Remember that COVID-19 is a very bad disease.  800,000 Americans have died of COVID-19 since March 2020 – more than the total number of HIV deaths since the 1980’s.

Please click here to see my handout about COVID-19 vaccination for children.

Must we still wear masks?

The CDC says that vaccinated people can stop wearing masks and social-distancing outdoors and indoors, unless it’s crowded (such as a concert) and you don’t know that others are also vaccinated.  Unvaccinated people generally can also stop wearing masks and social-distancing outdoors, unless it’s crowded. 

Masking is no longer mandated indoors by the State of Delaware except in crowded situations, but it’s still recommended indoors; and a store or business may certainly still require it for entry.  Delaware still mandates masks (regardless of vaccination status) in schools, on public transit, in health care facilities (including medical offices like ours), and in State offices (like the courts or DMV).

For children under 12, even if immunized against Coronavirus, masking is still required in school buildings.  Essentially, the rules are the same as for unvaccinated adults.

If in doubt, wear the mask.  Personally, I still wear a mask in shops, even though I’ve been fully vaccinated.

Can kids go to camp safely?

I think so, if vaccinated!  Each camp will have its own rules to follow.  But in general, older, vaccinated kids can participate in camp activities, without masks, indoors and outdoors, unless they’re singing together indoors.  Unvaccinated kids can also go without masks outdoors (unless singing), but should still wear them indoors.  Obviously, don’t wear them during water activities!

Outdoor sports appear to be an unlikely way to transmit COVID-19.  In my opinion, kids don’t need masks for informal outdoor play; and they should be allowed to participate in outdoor sports as usual.  But kids should follow the rules of the school or sports organization.

Recommendations for masking are more stringent, of course, for those with a chronic illness involving an immune deficiency.

How much has Coronavirus spread?

In Delaware, case numbers are increasing again.  The percentage of positive tests is, as of mid-December, about 9%, close to a 2-year high.  More than 1 in 6 people in Delaware have tested positive in the past 2 years.  (Many more probably didn’t know they had it.)  Here's the latest data:

https://myhealthycommunity.dhss.delaware.gov/locations/state/days_to_show/90/primary_trend_type/bar#trends_dashboard

Several more contagious “variants” have appeared.  Current vaccines appear fairly effective against the Delta variant.  There is concern that the new Omicron variant seems somewhat less susceptible against antibodies, but it is hoped that “booster” vaccines might overcome this problem.

It is possible that T-cell-mediated immunity, generated by vaccines (and by COVID infection to a lesser extent), may still be effective against Omicron, but it’s not known for sure because T-cell studies are more difficult to do than simple antibody levels.

Fortunately, as of December, 85% of Delawareans over 18 have already received at least one vaccine dose.

However, we’re seeing kids with ordinary illnesses every day!  Even though everyone is trying to isolate, kids are still getting ordinary respiratory and intestinal viruses (though less frequently than usual).  Most of our patients with fever still have an illness other than Coronavirus.  (So please continue to get your flu shots!)

How is it transmitted?

Most people contract COVID-19 from a direct, indoor, person-to-person exposure with a sick contact.  There probably is also some spread from asymptomatic (or “pre-symptomatic”) people, but even then, the exposure is generally an in-person, close personal contact from relatively heavy “respiratory droplets” that rarely travel more than 6 feet.  This is why mandating masks and social distancing, even among friends and family, has been effective in controlling the spread of disease.

There has been much scientific debate about “aerosol” transmission of COVID-19 by smaller, lighter particles, farther than 6 feet.  The CDC is now acknowledging that it is possible, but mostly in closed spaces with poor ventilation.  The evidence for this continues to be mostly theoretical, tracking RNA “signatures” rather than documented illness; there are very few reported cases of transmission of actual illness from small droplets, hanging in the air long after a contagious person has left the room.  Wearing masks greatly reduces infection rates.

Almost no one gets COVID-19 from “fomites:” objects in public places such as door handles, that contagious people might have left their handprints on.  It’s easy and reasonable to use hand sanitizer or wash your hands, but there’s no need to quarantine your mail!

 

What testing is available?

PCR testing is available, if symptoms warrant.  These are now always nasal tests; oral tests are no longer considered sufficiently sensitive.  With an appointment, we can perform PCR testing and send samples to LabCorp or QuestLab.

Also, without a doctor’s order, anyone can get a free test.  Medical Aid Units also perform testing, usually with an exam that they charge for.  Click here to find a test:
http://www.dmpkids.com/index.cfm?fuseaction=content.pageDetails&id=212821&typeID=63

Rapid antigen tests, which give results in less than an hour, are unfortunately no longer available in my office.

False-negative tests do occur, with all testing types.

Antibody tests on a blood sample can be drawn at a commercial lab such as Quest or Labcorp, but generally they are not helpful.  False negative tests are common.  I have not generally been ordering COVID-19 antibody tests for patients.

 

When must we quarantine or isolate?

The distinction is a bit soft, but generally “quarantine” means that if you are exposed, you must stay home (or outdoors well away from others).  “Isolate” means that if you are sick, you must also try to stay away from uninfected household members as well.

Click here to see the latest recommendations about isolation and quarantine.

 

Questions about masks?

Who?  Everybody should wear a mask if they can.  Wearing a mask is not dangerous, does not cause breathing problems, and does not make Coronavirus somehow worse.  (Though nobody enjoys wearing them!)

The CDC and AAP still advise against masks for children under 2, “due to the risk of suffocation.”  I find this advice puzzling; I’m not aware of any such cases or research indicating danger from masks at any age,  (Obviously, any child wearing a mask must be supervised, but I expect any child under 2 to be continuously supervised while awake.)

What kind?  Anything that fits tightly, and keeps air from escaping out the sides.  The mask must cover the nose, as well as the mouth.  Beards make masks less effective (sorry, fellows) because the mask can’t fit tightly.

What material?  Cloth masks are fine for general public use, if the material is a tight weave; double or even triple layers work much better, especially with two different materials (such as a paper mask under a cloth mask).

Masks with gaskets or pop-off valves are NOT suitable and should not be used in public.  They protect the wearer, but because exhaled air is not filtered through the valve, they do not protect the people around you.  Please wear masks without a gasket, unless it has a separate filter.

Remember that masks are not just to protect you from contagion, but also to protect others from catching something from you!  Wearing a mask is a public courtesy, even if you don’t feel sick yourself (and even if you are vaccinated).

 

What should I tell my child?

Kids pick up on everybody’s anxiety.  In my office, I am seeing an unfortunate increase in the anxiety shown by children.

Emphasize that your family has control over your risk, and that hygiene (including universal masks) and social distancing is effective.  Promise to get the COVID-19 vaccine for them as soon as it’s available – and get vaccinated yourself!

It can be helpful to review as a family the positive actions you’re taking, to give everybody a sense of control.  Be a role model:  “Here are the actions we’re all taking to stay safe!”

Reassure kids that children are unlikely to suffer major complications.  But also point out that kids have a responsibility to protect the people they love around them, just as the adults do, by avoiding unnecessary contact and practicing good hygiene. 

Kids under 12 seem somewhat less likely to catch COVID-19, but certainly they can get it, and they can become quite sick (and contagious); they have a responsibility to take precautions.  Teens are just as likely as adults to catch and be contagious for COVID-19; it’s dismaying to see teens in public not wearing masks or social-distancing.  I’m delighted that so many teens are eager to get vaccinated.

 

What is Delaware Modern Pediatrics doing?

We are continuing to provide all routine sick and well care.  We have not restricted our hours, since the beginning of the Pandemic.

Our office has dedicated Sick and Well waiting rooms; please make use of them!  Chairs are placed a “socially distanced” 6 feet apart. All patients are taken back to an isolated exam room as soon as they are checked in.  (We are no longer requiring temperature checks of all visitors, since temperature checks have not been shown to reduce the spread of disease.)

We are diligently disinfecting exam rooms and surfaces between patients.

Our staff is wearing protective equipment for all patient encounters.  Symptomatic staff members are sent home immediately (with sick pay).  Almost all our staff is fully vaccinated.

If there is a reasonable (even if low) suspicion that your child might have a mild case of COVID-19, we may arrange to bring you in at the end of the day.

In certain circumstances, we may make use of Telemedicine encounters.

 

How can parents help us?

If your child is sick, please call our office first – NOT Urgent Care or the Emergency Room.  Usually we can schedule an appointment the same day, if you call us in the morning.  Go to the ER only if you think your child is so sick that they may require hospitalization, or if you know that your sick child has a known COVID-19 exposure.

If you have an appointment with us but you can’t make it, PLEASE call to reschedule as soon as you know!  No-shows make it harder for us to care for everybody.

If you’re coming for a routine checkup, but the child has any fever or upper respiratory symptoms, please come to the Sick waiting room, not the Well side – and call us first to let us know.

Please do NOT avoid coming to our office for regular care!  We are taking all precautions to keep your family (and ourselves) safe.  You are much safer in our office than, say, in the grocery store!   But deferring infant vaccines simply puts them at risk for epidemics of measles, meningitis and pneumonia.

 

What if I have more questions?

Call us!  We’re working hard, and we’re ready to help you.  Thanks for your confidence in us.

     --  Dr. Epstein