We have been sharing the good news about how the Bay Area “flattened the curve” by following national and local health guidelines [shelter at home, social distancing, hand washing and wearing a mask when we have to go out].  However, recent reports have discussed a new concern for our children – Pediatric Multi-system Inflammatory Syndrome or PIMS.

PIMS is a very rare syndrome similar to Kawasaki Disease and Toxic Shock syndrome, which most of you have never heard about.  While extremely rare, about 100 children have been affected as of this writing. The syndrome is thought to be a post-viral process, most likely related to COVID 19.  The majority of patients with PIMS are COVID-antigen negative, but antibody positive or have a history of close contact with a COVID-positive patient.

Children with PIMS look sick.  They have had a few days of fever greater than 101, and may have symptoms that include abdominal pain, vomiting, diarrhea, headache, rash, red eyes, swollen hands or red cracked lips.   Younger children may not want to drink.  Few patients actually have the respiratory symptoms we see in adults.

Our concern is the syndrome may affect heart function requiring hospitalization and ICU care. The  majority of children do well with this syndrome but they need special attention and supportive care.  Pediatric Multi-system Inflammatory Syndrome is new. We are watching this very carefully and scientists around the world are working hard to understand this syndrome and how best to treat it. The AAP website Healthy Children has written an excellent summary for parents and you can find that here. We will continue to update you as we get more information.

Until then, we want to reassure parents that most children are not affected by the coronavirus, and reports of children who become seriously ill remain rare and unusual cases. Many children have red eyes, or rash or diarrhea without fever or looking ill.  These children do not have PIMS.  What should parents do?  If you are concerned, please contact our office. We can set up a telehealth visit with your pediatrician who can evaluate your child and answer all your questions.

The best advice in a nutshell…

Big news for those of us in San Mateo County from our county health officer Dr. Scott Morrow: he will release a new order this week that allows for the return of retail and manufacturing with new physical-distancing measures.  A big thank you to all of you for doing the hard work to follow shelter in place guidelines these past few weeks, you have saved lives!

Team PWG is here for you and will continue to be here for you every step of the way. We’ve worked hard to keep our office a safe place for all our families, we’ve put new workflow protocols in place that allow us to see patients safely while following social distancing guidelines.  There have been reports in the news this week about an unusual inflammatory illness in pediatric patients that may be triggered by COVID. We do not have the full picture yet, but we are monitoring developments closely. Please feel free to discuss any concerns you may have with your doctor at PWG.

We have been getting a lot of questions from families about local COVID-19 serology testing options that are currently available for people and wanted to give you all an update. Please note that information about COVID serology testing is changing rapidly and may already be out of date by the time many of us get tested. Before you decide to proceed there are some important considerations:

• many local options are NOT FDA approved or only approved under emergency use guidelines. Getting FDA approval takes time and because of the pressing need to expand testing options many companies/health systems are working on getting FDA approval while allowing public access to these tests.
• If you do have COVID antibodies it is not clear if this means you are immune to future infections. We recommend continuing with all social distancing protocols and following local county health department guidelines until we learn more.
• We recommend you check with your insurance company about whether testing will be covered.
• Serology testing that we discuss is for people with no symptoms. If you are sick and would like to discuss COVID testing please call our office to set up a video visit to discuss further.

Local COVID antibody testing options for asymptomatic people:

• For Quest:
  • They are testing for one type of COVID antibody, IgG type
  • The price for this test is $119 plus an additional $10.30 service fee, you can find more information on Quest’s website
  • If you have any further questions you can set up a telemedicine appointment with your doctor at PWG to discuss the test, we can then order the test for you and follow up with you when we get the results.
  • We are being told it can take up to 7 to 10 days for results, it might be sooner in some cases.
• For Stanford:
  • They are testing for 2 types of COVID antibodies, IgM and IgG
  • Please check with Stanford directly about the cost of the test.
  • If you have any further questions you can set up a telemedicine appointment with your doctor to discuss the test, we can then order the test for you and follow up with you when we get the results.
  • We are being told it can take up to 7 to 10 days for results, it might be sooner in some cases.
  • If your child is under 18 years of age, please call their customer service line at 1-877-717-3733 to confirm which draw station is open and accepting pediatric patients. As of this writing either 725 Welch Road or 730 Welch Road labs are open for pediatric patients.
  • You can find additional information on their website

Thanks to your efforts in following the shelter in place guidelines the Bay Area has flattened the COVID-19 curve and saved many lives. Team PWG has been working hard to make sure our office remains a safe place for our staff and our families, and we thank all of you for being patient and understanding as we navigate this “new normal”. The AAP has emphasized the importance of maintaining routine health visits during the pandemic. We are currently prioritizing well visits for infants 0-24 months, children 4-6 years, and adolescents 11-13 years of age to make sure they remain up to date with crucial vaccinations.

Team PWG is dedicated to your health and well-being, we wanted to share some of the things we’re doing to keep our staff and our families healthy:

• Walk in appointments are not allowed
• Temperatures are taken on anyone entering our office, including our staff
• Our staff is wearing gowns and masks when interacting with patients
• We have designated rooms for well visits and sick visits
• All exam rooms are disinfected after each visit, and the entire office is deep cleaned at the end of the day.
• Our front office is cleaned regularly throughout the day
• We have stopped offering refreshments, prizes, and stickers
• All sick visits start as a telemedicine appointment to limit potential exposure and to make sure you are given the right treatment at the right place at the right time
• we are asking anyone with a fever, cough, or other symptoms to wait in their car
• Visits are limited to the child/adolescent/young adult being seen and 1 parent/guardian
• We practice social distancing as much as possible, including between our staff members
• We have also implemented several behind-the-scenes protocols designed to protect all of us from spreading illnesses.

We are ready to respond quickly as our local health climate changes. Stay safe, be well, and know that Team PWG is here for you!

We are entering a crucial time in our efforts to slow down the spread of COVID-19; the Bay Area appears to have a “flatter curve” than other parts of the country but experts caution that our peak is expected to arrive next week. We remain open to serve our patients and our community; we are prioritizing well visits for certain age groups (0 to 24 months, 4-6 years, 11-13 years) to keep our patients on track with important vaccines, we are making telemedicine appointments for all sick visits, and we are following state and local guidelines to keep our patients and staff safe. Please see earlier updates for more details.

Cleo, our kitty correspondent based at Dr. Eileen’s house, has been diligently keeping up with the latest data and she wants to share some good news with you:

• on Monday the CDC released a report analyzing US data of laboratory confirmed COVID-19 cases between 2/12/20 and 4/2/20. The bottom line: COVID-19 tends to be less severe in children.
• for those of you who want numbers:
  • there were 149,760 cases in that time frame; 2,572 cases (1.7%) were in children < 18 years.
  • in pediatric patients with confirmed cases 73% had symptoms of fever, cough or shortness of breath (93% of adults with COVID-19 had these symptoms)
  • the hospitalization rate for all pediatric patients was 5.7% (adults had a 10% rate) and 3 pediatric deaths have been reported nationally.
• some key takeaways from the data are 1) relatively few kids with COVID-19 are sick enough to be hospitalized 2) fewer kids with COVID-19 experience the symptoms of fever, cough or shortness of breath 3) social distancing and preventative measures such as washing hands and avoiding touching your face are very important in reducing the transmission of COVID-19
• Testing is still limited in our area, and we still do not have access to unlimited testing at this time.

Team PWG is here to support our families and our community with important information; we are strong, and we will get through this!

It is official, the Bay Area has done something different and our curve appears to be flatter. We want to thank all of you for following the shelter-in-place guidelines, it has helped to keep both your family and your community safe.  School is going to be on-line for the rest of the academic year in many parts of the state, and we are headed into one of the most crucial weeks of this pandemic. The Chief Barking Officers at PWG, Moxie on the left and Benji on the right, want to give you some important updates:

• your 3 best tools for staying healthy: wash your hands, follow social distancing, and don’t touch your face.
• both the CDC and local health officials also recommend that “Residents cover their nose and mouth when leaving home for essential activities, such as grocery shopping, doctor appointments, and going to the bank”.
• there continues to be a shortage of PPE so remember “Face coverings should not be medical masks or other similar products but include any type of breathable material that will cover nose and mouth.” There are several great sources for free patterns,  consider making some for your friends and family.
• PWG is taking extra steps to keep our office safe for everyone:
  • screening everyone [staff, patients, families] who comes into the office in accordance with national and local guidelines.
  • all our staff will be wearing masks
  • our office is deep cleaned nightly, in addition to regular cleaning throughout the day
  • we are limiting the number of people at visits to the child/person being seen and one parent/guardian
  • we are making telemedicine appointments for all sick visits, based on that visit you and your doctor may decide to treat at home, bring your child to the office, or be referred to the right place for the right care.
• local officials are working to expand testing capacity but at this time it is still limited.

We are not out of the woods yet, but we have reason to hope.  This calendar can help us get through a tough time together. Team PWG is here for you, we are strong and we will get through this!

Week 2 of Shelter-in place begins with Doctor’s Day, and we wanted to take this moment to recognize the tremendous team we have at PWG.  We are part of the front lines of health care in this country, and we are proud to serve our patients and our community. This is a tough time for all of us, the news is full of scary facts, and no one really knows when things will go back to “normal”.  We want you to know we are here for you, we are strong, and we will get through this! Here are some photos to remind us of the time “before”, and here are some updates we want you to know:

• we will be wearing masks at all visits
• local experts tell us they are not seeing the same degree of patient surge that other areas are seeing, and we are cautiously optimistic that the curve may be a little flatter for us in the Bay Area. Please continue to follow current shelter in place guidelines, they are even more crucial right now.
• local experts are confirming that COVID-19 is less severe in pediatrics than in adults.  We are not aware of any local pediatric fatalities.
• we are continuing to see well visits in our office to make sure kids stay current with important vaccines. We are prioritizing well visits for infants 0 to 24 months, kids 4 to 6 years, and adolescents 11 to 13 years.
• we have made changes to our office protocols to keep our staff and our patients as safe as we can, please see our 3/23/20 update for details.
• we will be closing our office at 6p Monday through Thursday while shelter in place is in effect.
• testing is still very limited in our area, we still do not have access to unlimited testing.
• we still lack enough PPE so if you, or anyone you know, has any extra PPE that is not being used please consider donating some of that to us. We would be very grateful!

Happy Doctor’s Day to all our colleagues!

Day 9 of SIP [shelter in place] is coming to a close, and there is much to share with all of you:

• Los Angeles Public Health Department has retracted yesterday’s report of a pediatric fatality from COVID-19, and we are not aware of any local pediatric fatalities from COVID-19
• There is evidence that California is seeing a much slower rate of rise of COVID-19 infections which is very good news! Local experts are still expecting numbers to rise, local hospitals are still planning for a surge in patients, and following CDC and local county guidelines about social distancing/shelter-in-place is even more important now.
• We are getting lots of questions about whether it is safe to use ibuprofen right now, and there are a lot of internet warnings based on the 3/14/20 statement from the French Minister of Health. As of 3/18/20 the World Health Organization stated “based on currently available information, WHO does not recommend against the use of ibuprofen.” Experts in the USA continue to review the research but have NOT issued warnings about using ibuprofen as of today. If you have further concerns or questions we encourage you to reach out to your doctor at PWG.
• Testing remains very limited in our area, we do not have access to unlimited tests for COVID-19 and are referring to local test centers. They are telling us they also have very limited access to testing and are following CDC guidelines to decide who gets tested. These include: if you or your child have a fever AND a cough AND trouble breathing AND/OR travel to a hotspot AND/OR known exposure to COVID-19 than testing may be indicated.
• keeping our staff safe while staying open to serve our patients and families is our priority; we have made changes to PWG protocols so please see our 3/23/20 update for details
• we encourage you to use the patient portal which allows you to communicate with us via email. We are actively working on a way to have families sign up for the portal without having to come into the office and will announce those details on our website, Facebook and Instagram pages
• We want to thank all of our families for doing their part in keeping our kids and our community healthy by following health department directives and NOT walking in to our office without calling us first.

We wanted to take a moment to acknowledge the hard work and dedication of our staff.  Mary Kate, our intrepid medical assistant, sewed masks for all of us this week! Team PWG is here for our families and our community, we are strong and we will get through this!

 As day 8 of SIP [shelter in place] comes to a close we are hearing more news of rising COVID-19 cases both nationally and locally.  As of today there were 1023 confirmed cases in the Bay Area while Los Angeles reported the first possible pediatric death from COVID-19. Many of our area hospitals are ramping up planning for surge patient volumes, but we still have very limited testing capacity. Items we want to share:

• keeping our staff safe while staying open to serve our patients and families is our priority; we have made changes to PWG protocols so please see our 3/23/20 update for details.
• we encourage you to use the portal which allows you to communicate with us via email. We are working on a way to have families sign up for the portal without having to come into the office and will announce those details on our website, Facebook and Instagram pages.
• we do not have access to unlimited tests for COVID-19 and are referring to local test centers. They are telling us they also have very limited access to testing and are following CDC guidelines to decide who gets tested. These include: if you or your child have a fever AND a cough AND trouble breathing AND/OR travel to a hotspot AND/OR known exposure to COVID-19 than testing may be indicated.
• We want to thank all of our families for doing their part in keeping our kids and our community healthy by following health department directives and NOT walking in to our office without calling us first.
• here are 2 online tools to help you determine if you need to be seen and/or tested for COVID-19:
  • the CDC and Microsoft have collaborated to create a coronoavirus self-checker
  • Vital, a digital platform for emergency care, launched a Coronavirus checker on 3/20/20

We wanted to share this picture of Krystal, one of our fantastic MAs, who has been doing a very deep clean of our entire office.  Team PWG is committed to the health and well being of our staff, patients, families and community. We are strong and we will get through this!

Week 2 of SIP begins…and we are making some changes to our office protocols to keep our staff and our patients as safe as we can during this outbreak. We are monitoring both the national and local situation closely and will continue to adjust our workflows as needed.

Effective immediately:

• • we will be limiting the number of people present at an appointment to the child being seen and 1 parent/guardian.
  • we will be taking everyone’s temperature as they enter our office.
  • we will be making telemedicine appointments for all sick visits, based on that visit you and your doctor may decide to treat at home, bring your child to the office, or be referred to the right place for the right care.
  • we will continue to see well visits for infants and toddlers 18 months and younger to keep them on track with their vaccines as per the AAP guidelines.
  • we are not making any well visit appointments for kids 2 years and up right now.

Like everyone in health care we face shortages of PPE [personal protective equipment], Team PWG is being creative at making what we have work for us right now. We are grateful to all of you for your patience and understanding, we are a strong community and we will get through this!

COVID19_flowchart_03.18.20

Day 4 of SIP [shelter-in-place], TGIF!

Today the Governor announced the legal order requiring all Californians to stay at home in order to try and slow down the spread of COVID-19. We want to thank all of our families for doing their part in keeping our kids and our community healthy by following those directives and NOT walking in to our office without calling us first. News we wanted to share:

• As of 3/19/20 there were 18 cases of COVID-19 in pediatric patients 0-17 years in the entire state of California
• We are not aware of any local pediatric fatalities, all of our local experts are telling us that COVID-19 is less severe in kids than adults.
• There is still very limited pediatric testing in our area, we do not have access to unlimited tests. We have included an infographic published by the California Health Department which follows current CDC guidelines. We are seeing patients via video visits and if someone meets the criteria for testing we are working to arrange testing, we want you to get the right care at the right place.
• Current CDC criteria for testing are: if you or your child have a fever AND a cough AND trouble breathing AND/OR travel to a hotspot AND/OR known exposure to COVID-19 than testing may be indicated. Local hospitals have limited COVID-19 testing capacity and are following CDC criteria to make final decisions about who gets COVID-19 testing.
• There are several fantastic resources to help families find healthy ways to stay connected with “the outside world”, we are sharing some of our favorites:

• • Audible has free stories available for all kids to enjoy
  • The AAP’s Healthy Children website has some great tips on working and learning from home
  • you can tour some of the best museums in the world without leaving your living room
  • you can take free art classes at home
  • public television has great At-Home learning resources

We are working hard to make sure we can keep our staff safe while continuing to serve our patients, and will post updates regularly, we appreciate your patience and understanding! We are a strong community, we will get through this, and Team PWG is here for you!