Coronavirus

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During these unprecedented times, we are changing a lot:  Hours, Office arrangements, Check-in Procedures, Masks.

Office Hours

Well Child visits/ Newborn checks                 Mon - Fri: 8 am- 5 pm
Sick Child evaluations                                      Mon - Fri: 8 am - 5 pm; Sat/Sun 9-1 (scheduled by RN)

We have the office physically divided into a subsection for potentially contagious patients, and the remaining 60% of the building is for well child visits and non-contagious visits (headaches, injuries, developmental concerns etc.).

For Sick Visits: After checking in by phone (call the number printed on the building wall: 919-828-4747 during regular business hours, and 919-828-7563 during after-hours), your nurse will phone you to meet her at the Patient Entrance door (by American flag).   She will check the parent's temperature before entering the building, and if the parent has a fever then a different adult will need to return with the patient.  ONE adult may accompany the child.

For Well Child visits: Don't call-- Enter the Patient entrance (by the American flag) and check in at reception.     
Effective June 1st 2021 - All Well Child Visits may be accompanied by 2 parents/guardians if:  
               1. Child is 2 years or under in age   -OR-
                2. Both adults are post 2 weeks from COVID Vaccination

 

All of our staff is masked and vaccinated.   We require that you wear a mask from home and that children > age 2 wear a mask.

Illness frequency and presentation concerns

1. What do the ORP physicians advise about sending my child to school or daycare?
This is a question we are getting from a lot of concerned ORP parents, so the doctors met and developed a consensus statement to share with you.  We agree with the American Academy of Pediatrics advice that children learn best when they are in school.  With vaccination and boosting of all available family members, this can usually be done safely. 

2. How is omicron affecting children?

Luckily, in all of the COVID variants that we’ve seen, kids usually fare better than adults, but serious illness does occur.   Since the Omicron variant is so contagious, leading to widespread outbreaks, then of course the number of kids that need hospitalization and the number of kids with post-COVID issues will go up.   Answer—vaccinate everyone that is of age.

3. What are the primary symptoms?
Symptoms can be quite mild, and hard to distinguish from other viral causes of “a cold.”  Common symptoms are a sore throat, aches or chills, some cough, and stuffy nose.   We have seen some toddlers with croup or new wheezing as the presenting symptom.   

Vaccine questions

1. Is the vaccine working?  
Yes—if your goals are to reduce deaths, hospitalizations, and the collapse of our health care system. Good goals. Virtually all people, child or adult, that needs hospitalization for COVID is unvaccinated.  We share your frustration that we no longer feel invincible with our vaccine.  But we also don’t feel worried that COVID will kill us or our vaccinated family members.  

2  Do I or my kids need a booster?—For everyone >12 years of age, if it has been more than 5 months (as of 3/5/22—this would be Oct. 5) then your protection has waned and you need a booster. If you had the J&J shot, shorten that duration to 2 months.  

3. I worry about safety because of info I’ve heard.  What do we know about long-term effects?

Myocarditis:  It is being carefully followed, with data from >10 million vaccine recipients from the US, Canada and Israel.   The facts are clear: this is an extremely rare side effect, and only an exceedingly small number of people will experience it after vaccination.  Importantly, for the young people who do, most cases are mild, and individuals recover often on their own or with minimal treatment.  In addition, we know that myocarditis and pericarditis are much more common if you get COVID-19, and the risk to the heart from COVID-19 can be more severe> You are 37 times more likely to get myocarditis from a COVID infection than from vaccine, and the vaccine-related cases were mild with no deaths.   In comparison, kids with post-COVID MISC have myocarditis 75% of the time.
March update:  For teens 12+, extending the time to 8 weeks between dose #1 and #2 improves the immunogenicity and reduces myocarditis risks even more. 

Fertility concerns:   This is a straight up False News construction.   And it the myth machine was effective!   COVID Vaccines And Infertility? How Misinformation Spreads In 6 Steps : Shots - Health News : NPR

All new vaccines are meticulously followed for repercussions, and COVID vaccine 100x so.  If you hear word of mouth of a concern, ask yourself "does that make sense?" and feel free to ask us about us.   

5. When will preschoolers/babies get vaccinated?  PLEEEEEASE. We don’t know.   We also hope that it is soon.    We feel you.

6.  I/my child just had COVID.  How does that change recommendations for vaccination?
Right now, not much at all.   Although the person probably has some lasting immunity, now we are not sure if that immunity gives full protection against other variants.   Infection in the last 90 days does NOT change quarantine rules now, and schools are not giving “quarantine wavers” for those with recent infections. If a person is due for either COVID vaccine or booster, just wait until they are out of the 10 day isolation.   You don’t need to wait longer than that.  

7.  My child is bridging the 11 to 12 year old gap.   What should I do?
Everyone should get the vaccine dose that is appropriate for your age right then.  

Testing

1.  What symptoms merit a test?
At this point, really any cold symptoms could be COVID.  We have also seen positive cases that present as croup, or bronchiolitis, or just vomiting, or stuffy nose and scratchy throat. 

2.  Testing options—We care about every single patient, AND we need to make every single in-office appointment essential.   We are all going to rely on outside testing options and Urgent care places more than we normally do this winter.

What do I mean? Here are the resources for COVID testing/exams in the area (probably not exclusive):

a. Say you have a pre-verbal child with a fever, fussy behavior, coughing, poor sleep and you need COVID clearance.   If you also need a good exam of ears and lungs, call us for a visit.  We can do either Rapid COVID or PCR, depending on the scenario, and make sure little Jimmy doesn't have an ear infection.  But if you are comfortable with tylenol and TLC at home, then get an Out-of-clinic test and see how baby Jimmy does over the next days.

b. Your child has been exposed to COVID, and you need testing. Whether your child is asymptomatic or sick, you could probably use Out-of-clinic labs to get your answer, and you will get PCR results faster than our office provides. (see below for resources).

c. Your child is mildly ill, and in normal times you would feel comfortable caring for them at home. Out-of-clinic labs will again quickly answer your question if this is COVID or not. Even if you can’t get a same-day appointment at a Wake County site, you will STILL get a faster PCR response then next day than we can usually provide from our office.

d. You need asymptomatic testing for something-- out-of-clinic lab.

Andor Labs in Morrisville is the lab that processes our clinic's PCR swabs. They do drive-up PCR and rapid antigen with more hours than we offer at ORP. (Like at ORP, they collect swabs on Sundays but neither their nor our swabs are processed until Monday morning). Results via email.

The Wake County testing sites are open M-Sat 7AM-7PM and run PCRs with fast results. 

Order FREE at-home rapid tests (4 per family) through COVIDtests.gov

Quarantine, Isolation and Rules, OH MY

ISOLATION-- Keeping your contagious germs to yourself.

Drat, my child has COVID.   Now what?
Treatment—this is what we call “supportive care”, ie. Rest and lots of fluids, and Tylenol or ibuprofen for fever/chills/achy/pain.  
No cough/cold medicines are miraculous, and none are used in kids <6.   If anyone has respiratory distress, shortness of breath, pale/blue lips, seek emergent medical care.  Monoclonal antibodies are an option for people at risk for serious COVID infection.   

Isolation rules for everyone COVID + or sick, regardless of vaccination status:
(This also works for sick kids without testing done, and therefore presumed to be COVID)

  • Stay home for 5 days (testing or symptom start is day 0). If you have no symptoms or your symptoms are resolving after 5 days, you can leave the house, masked.
  • Continue to wear a mask (*unless masking exemption applies).around others for 5 additional days. If you have a fever, continue to stay home until your fever resolves.
  • Duration of contagion-- 20-40% of people are still contagious during days 6-10 of COVID.   Be smart.  If you are returning to school/work on days 6-10, wear the kind of mask that you would want an actively contagious person sitting beside you all day to wear.   

    Example:  Patient starts with cold symptoms on Wednesday (day 0).  With either a positive COVID test OR no testing and symptoms are improved, per DHHS the child can return to school after day 6 (Tuesday), masked well (*unless masking exemption applies).


QUARANTINE
-- Waiting for the shoe to drop after exposure.

Rules per updated NC DHHS guidelines, last update 3/7/22 for school-aged and daycare-aged kids:

If you have had a direct COVID exposure:

    • Wear a mask around others for 10 days. (aka "quarantine behind the mask"), *unless masking exemption applies.   Masking is not needed while eating, drinking or sleeping.
    • Test on day 5 if possible, sooner for any symptoms
    • If you develop symptoms, get a test (preferably PCR) and stay home until you have the results. 

FOR AN EXPOSURE INSIDE THE HOME:

The above guidelines apply from date of LAST exposure. When COVID is trickling through the house, the guidance is tricky.
If the positive individual is in the house/car, then that sick person is continually spreading COVID through the house the 10 days that they are contagious. So, all family members follow the above quarantine guidance while the family member is sick and THEN they start their own "watch for symptoms" countdown for an additional 10 days.
IF the positive individual can isolate completely, then start counting the 10-day "quarantine behind the mask" the day after the last exposure.
Recommend PCR testing on day 5 after last exposure= day 15 from the first family member's illness start date.

*   Exemptions to mask use:

• children under age 2
• children between 2 and 5 who cannot wear a mask safely due to an inability to:
      wear a mask correctly;
      avoid frequent touching of the mask and their face; 
      limit sucking, drooling, or having excess saliva on the mask;
      remove the mask without assistance
• children who are sleeping or anyone actively eating or drinking
• persons who cannot wear a mask, or cannot safely wear a mask, for reasons related to a disability
• adults for whom wearing a mask would create a risk to workplace health, safety, or job duty

Medical questions about COVID-19:

This remains an evolving situation and the Centers for Disease Control and Prevention (CDC) will provide updated information as it becomes available.

WCPSS rules: Please refer to Return to School for the most recent updates and other clarifications.
Childcare rules:  Please refer to the Childcare Strong NC Toolkit for the most recent updates (updated 1/13/22)

Last updated 3/7/2022