What’s the highest risk?
Travel to or visits from individuals in states with Covid 19 positivity rates higher than 10%. This link will show you up to date positivity rates in each state: https://coronavirus.jhu.edu/testing/individual-states

How can I decrease the risk?
Very careful travel, using your own car, and having almost no people contact during travel. And at your destination, having a very small contact group, and only with individuals who have been very careful about their own contacts in the two weeks prior to travel. Use of masks, social distancing and careful hand washing are a necessity.

What’s the best choice? Don’t go.
Our offices assess your risk in the same way, every time you are scheduled to come visit us, in order to keep you and our space as safe as can be. We must consider your family’s degree of increased contact, and if there is significant potential for increased Covid 19 exposure. We may need to reschedule a non-urgent (wellness or non-acute illness) appointment if it occurs within 2 weeks of your family having travelled out of state.

We also want to remind you of the State of Maryland’s Guidance on Travel. On July 29, 2020, Robert R. Neall, Secretary of Health advised that all Marylanders:

• refrain from non-essential travel outside of Maryland.
• get tested for Covid 19 promptly upon return to Maryland and self-quarantine until a negative result is received
• avoid travel to a state with a Covid 19 positivity rate above 10%.

Additionally, those traveling TO Maryland are advised to get themselves tested and have negative results within 72 hours BEFORE travel to Maryland.

We realize this is all inconvenient but it is what each of us must do at this time to protect our communities. We appreciate your understanding of our policies, in advance, as we strive to keep you and our offices safe and healthy. As always, your Main Street Pediatrics physician is happy to help you with your decision-making.

It is tremendously important to get your entire family vaccinated this year, as early as possible. We recommend September and October as best. If your child already has a well visit scheduled, we will offer it to them at that time. You do not need to schedule a separate appointment time.

Influenza ('the flu') on its own causes substantial prolonged illness and hospitalization each year, including 30,000 to 60,000 deaths in the US on average.

This year though, with Covid-19 in our communities, getting infected with the flu will be much more problematic, requiring evaluation for Covid, isolation and quarantine for the child and family contacts, and potentially decreasing one's available immune response to Covid.

Call, or email us through your child's patient portal, to make an appointment as soon as possible. We will be having influenza vaccine 'clinics' in a socially distanced and protected fashion, at designated weekday and weekend times.

We are also happy to offer flu vaccines to parents and siblings six months and older at the same time. We ask that you schedule these additional flu shots in advance of your appointment. This will ensure that we have the appropriate time, space and staff allocated to your family. Please note that since we are not the physician of record for parents, there is a fee for service charge of $35 for each parental flu vaccine. This charge can be submitted for reimbursement to your insurer. We do ask parents to register and pay in advance on-line to manage your family's time and care in the office most efficiently.

Main Street Pediatrics remains happy to protect you as well as help you with all your child's and family's needs.

Unfortunately, insurance carriers are now cutting back on these measures. Dates of change and the specific changes vary widely, but we want you to be aware of the possible impact on you and Main Street Pediatrics.

First and foremost: Main Street Pediatrics will not limit your appropriate access to our pediatricians. We remain available every day of the year, 24 hours per day. We will continue to offer Telehealth services or phone call services whenever they are appropriate, and we can always see you/your child in the office when that is indicated.

However, some insurers (check with your own, and complain if you need to) have decided to reduce their coverage of services, including:

1. discontinuing coverage of Telehealth well visits.

2. discontinuing coverage for telephone call visits.

3. reinstituting copays and deductibles for all services.

Main Street Pediatrics will continue to offer these services and charge appropriately to your insurance company. If your carrier does not honor our charges, it is possible that you will be billed for these services.

Main Street Pediatrics and your doctor are certainly concerned about the impact of fees on families, especially given the monetary strain of many during this pandemic. We do ask for payment within 30 days of receipt of billing (we need to pay our staff and our increased overhead too in this very difficult time). However, if you are unable to pay, please discuss a payment plan with our billing company and let your physician know if you are in financial distress.

We wanted to give families with children who are asthmatics and use nebulizers for inhaled medications an important update before the “wheezing season” begins. Current data shows that nebulizers aerosolize (spread all over the room, enhancing disease transmission) coronavirus particles when used by someone who is infected with COVID 19. Remember that infected individuals do not always exhibit symptoms. As such, we are recommending that nebulizers not be used this Fall & Winter. In the event a nebulized medication is required during an emergency situation, it should be used in an isolated room with doors closed. Afterwards, that room should be empty for at least one hour and then thoroughly cleaned. We recommend that until coronavirus is under control (too early to say when that will be), you substitute a metered dose inhaler and spacer for inhaled medication delivery. Some families already have both devices and need to do nothing other than store the nebulizer away so no one uses it by mistake. If your child currently does not have an MDI/spacer, please call your doctor in the coming few weeks to learn about the specific options and recommendations for your family. Metered dose inhalers require some brief teaching, so a short visit in person or by telehealth, may be needed if you do not already have an appointment coming up.

Similarly, if you do need to come to our offices for a respiratory illness, Main Street Pediatrics will NOT be administering nebulized medication. We ask ALL ASTHMATICS to bring their albuterol inhalers and spacers with them to any respiratory sick visit. (In that way, we can use YOUR inhaler rather than any other for your child.)

And, as always, remember that getting an influenza vaccine (“The Flu Shot”) will also further protect the health of those who need inhaled medications. And, it is a public health bonus that it may prevent you and your child from needing to make a sick visit to a medical facility during the upcoming “respiratory virus season.”

Be well!

Please understand: bringing your forms to the office when you do not have a specific appointment makes it very difficult to maintain orderly social distanced spacing. Please do the following for form processing going forward:

Influenza ('the flu') on its own causes substantial prolonged illness and hospitalization each year, including 30,000 to 60,000 deaths in the US on average.

For Routine Forms:

1. Fill out ALL PORTIONS of the forms that ask for patient/parent identification and information.

2. Go online to www.mainstreetpeds.com, click on the “Pay Invoice” button and pay the applicable fee (see below) in advance in this touchless fashion. When the website requests an Invoice Number, you can enter your child's account number or 0000. (Please note that Medical Assistance, Medicare and MCO members have form fees already 'included' in government payments, and you do not need to pay separately.)

3. Enclose a note indicating the form fee has been prepaid.

4. If you do not have a scheduled well visit, MAIL us the forms via US Postal Service. Be sure to enclose a Self-Addressed Stamped Envelope, so that we can mail the form back immediately upon completion.

5. You can bring forms with you to a well visit and you may be able to leave your appoinmtent with the completed forms, as work flow allows.

We do regret to inform you that we will be increasing the standard form fee from the current $10 (at that rate for nearly 20 years) to $15 effective 8/11/2020. (The complex form fee for FMLA, endocrine and similar forms will remain at $20.)

For Form Emergencies: Call us for a form 'emergency' and we will work with you to deliver the completed form within 48 hours. There is a surcharge of $20 for this special processing.

Please understand: School and Camp forms require a full chart review, recording of health information and vaccine records, and our physicians taking responsibility for school and athletic health and performance during the year.

If the form fee is an excessive burden due to financial stress, please speak with our billing group EHS and your Doctor about options.

Thank you for helping Main Street Pediatrics help you with forms in these stressful times.

All patients who are ill with respiratory symptoms, gastrointestinal symptoms, or who have a fever without an apparent source are seen late in the day in a completely separate and sanitized space via a separate entrance. Upon entering our office, patients are escorted immediately to their exam room.

For all other visits to our office, each patient and accompanying adult(s) are pre-screened by telephone the day before the appointment to ensure there are no respiratory symptoms, gastrointestinal symptoms or fever, and that there has been no recent exposure to anyone with these symptoms.

In addition, all patients and accompanying adult(s) are screened again at the time of the appointment, including having their temperature checked. Any child or parent with respiratory symptoms, gastrointestinal symptoms or a fever will have to re-schedule.

Whenever possible, only one adult should accompany the patient.

For all patients and family members who are two years old and older, you must wear a non-vented mask (note that masks with exhalation vents DO NOT prevent the spread of coronavirus to others and therefore are not allowed in our offices).

Due to the risks to our staff, doctors and patients, we have continued to suspend our walk-in clinic time.

We are offering telehealth visits whenever it is medically appropriate.

We value being able to care for you all in these complicated times.

WELL VISITS: We are only performing in person well visits for our youngest patients and those requiring updates of vaccinations or follow up of significant issues. These are being conducted in the first part of the day, via our main entrance, but in a dedicated wellness space, at a different time of day and with separate doctors and staff from our patients who have respiratory illnesses. We are restricting chaperones to one parent or guardian and requiring both parent and child to cover their nose and mouth with a mask or scarf. We will have curbside check-in to further pre-screen anyone who will be entering the office.

SICKNESS VISITS: We are performing in person respiratory illness visits in the afternoon, via a separate REAR entrance, in a completely sanitized space, with separate doctors and staff from our well patients. All illnesses will need to be screened by our staff by phone before an appointment is given. Only one parent may accompany the sick child to the office and both parent and child need to cover their nose and mouth with a mask or scarf.

TELEHEALTH: Most insurance companies will cover telehealth services for illness visits, medication follow-ups and even well check-ups. Our offices and doctors have been up and running with Telehealth for nearly two years. We use an easy, totally HIPAA compliant, well-trialed platform. There are many advantages you wil discover in talking with your personal physician regarding health and mental health issues. Telehealth visits for any appropriate situation can be conducted in either the morning or afternoon.

WHEN TO SEEK IMMEDIATE CARE If your child has a fever and is developing a significant cough with trouble breathing or shortness of breath, that is when we certainly need to hear from you. Please call and we will discuss whether we need to see your child, whether s/he SHOULD (eliminate: will) be referred to evaluate (eliminate: your) symptoms (eliminate for testing), or whether your child is fine to be cared for at home, quarantined away from others in your family.

SOCIAL DISTANCING: The schools are closed, the malls and theaters are closed, and we all are practicing social distancing. What does this really mean. It means that even though you may feel well, we want you to limit contact with others, including other children. We want you to stay 6 feet away from others outside your intimate family members. When children play outside and go for walks and bike rides, they need to be six feet away from others.

WELL VISITS: We have changed our schedules to only allow well visits in the mornings, and only those that involve updates of vaccinations or follow up of urgent issues. Other routine well visits are being postponed to after this pandemic is over.

KEEPING OUR OFFICE OPEN: We need to keep our staff and doctors safe and healthy. PLEASE let us know before you come to our office if you have been exposed to someone with COVID-19 or someone who is under observation for it. We need everyone having any respiratory symptoms or any exposure to keep their nose and mouth covered. PHONE CALLS: We are experiencing a large number of phone calls. We want to help everyone but we ask to follow the recommendations below to lessen the calls for minor illnesses.

MINOR ILLNESSES AND FEVERS: Children will continue to get upper respiratory illnesses- mainly involving the body above the neck- and may run fevers. Most regular viral illnesses may cause a fever for the first few nights, and minor symptoms may last 7-10 days. We do not need to see you for these minor illnesses. We want you to keep anyone with a fever over 100.4 away from others, encourage rest, fluids, and fever reducers, and watch for any worsening symptoms.

SIGNIFICANT SYMPTOMS: Children will still get ear infections and strep throat. It is appropriate to call for an appointment if you suspect your infant is experiencing an ear infection or a significant sore throat. These respiratory illnesses will be seen in the afternoons and will need to be screened by our staff by phone before an appointment is given. Only one parent should bring just the sick child to the office and anyone with symptoms needs to cover their nose and mouth with a mask or scarf.

CHRONIC ILLNESSES AND ASTHMA: To prevent any worsening symptoms with COVID-19, we encourage asthmatics to be in good control now. We encourage the use of inhalers more than nebulizers. Others with significant illnesses like cystic fibrosis or cancer need to consider self-quarantining themselves during this pandemic.

COVID-19: This virus is expected to infect many of us, and children thankfully have been experiencing less significant symptoms than adults. COVID-19 particularly causes lower respiratory symptoms- in the chest. If your child has a fever and is developing a significant cough with trouble breathing or shortness of breath, that is when we need to hear from you. Please call and we will discuss whether we need to see your child, whether s/he will be referred to evaluate your symptoms for testing, or whether your child is fine to be cared for at home, quarantined away from others in your family. We expect most children with COVID-19 symptoms will be cared for at home, will not need definitive testing, and will recover easily within their 14 day quarantine time. We do not test for COVID-19 in our office.

There are many good websites to answer questions and get advice from. Healthychildren.org gives great advice from the American Academy of Pediatrics and has ideas on keeping children active, emotionally and physically, during this time.

Try to encourage healthy children to get outside and enjoy the beautiful spring weather, while keeping social distancing in mind. Encourage reading and board games. Enjoy this time together to talk with your family members. And remember laughter is great medicine too!

The Doctors of Main Street Pediatrics

We are continuing to see pre-screened, well visits for children who need vaccination in the mornings. We are using telehealth to manage more chronic issues (asthma follow ups, medication checks) and acute issues (cold and allergy symptoms, asthma flares and injuries). And for those who need to come in to be seen (throat cultures and concerns about ear infections), we are seeing them in the afternoons under very strict infection-control precautions.

HAVING SAID THAT, WE NEED YOUR HELP!!

Because we will need to move even more kids through the office for delayed well visits in the summertime to meet everyone’s needs, we are asking you to think ahead with us. Things that CAN be taken care of now, ought to be done separate from well visit time. For example, we know that for convenience, families often come to a well visit with a list of other health items that they have been wanting to discuss with us. Topics like allergies/asthma, mood issues, medication checks, medical complexities, behavioral/developmental questions (toilet training, temper tantrums, sibling issues, meeting milestones, school struggles) and other general concerns would be GREAT to take care of for you now. This way, when well visit time comes, we are able to meet the built up need that is rising as a result of this pandemic.

If you child has chronic issues for discussion or new concerns that you are “saving up”, please call us to schedule a Telehealth visit while we all have this available time.

We cannot create more hours in the day, but we can use our time now and then as wisely as possible. (And, we have LOVED it when the kids want to show us their rooms!)

Thank you for your consideration and be well.

The Doctors & Staff at MSP

The Good News Is….

Infants and children appear to experience coronavirus with very mild symptoms. Typically this includes the familiar symptoms of a cold: runny and stuffy nose, cough and fever. They tend to not have the severe illness course that we are hearing about in the elderly.

How do I know whether my child’s cold symptoms are from coronavirus?

The short answer is: you may not know. And, very importantly, if the symptoms are mild (s/he “perks up” when the fever is down, drinks enough to urinate at least once every 4 hours (infants) or 8 hours (toddlers and older children) and shows no signs of difficulty breathing) we do not really need to know for the sake of caring for that child. Having said that, a sick child needs to be kept isolated from other people to avoid spread. As we start to see more community spread of coronavirus in Baltimore, children will get COVID 19 illness and because it will be mild, there will not be any need to test them. The purpose of having a test is to help doctors determine what is causing a very sick patient to get sicker. In a stable child with cold symptoms, even in a pandemic situation, we will treat them as if they have a contagious viral illness. We will watch them carefully and teach you to watch them carefully for any signs of worsening illness.

But, I want to know if my child is infected!

We understand that sometimes it is reassuring given everything that is going on just to get checked out. We are working on being able to run tests from our office but we only anticipate using them when children are worrisomely sick, without another identified cause, which is not expected to be very often. Once again, if your child’s symptoms are not causing distressing respiratory symptoms, there is no need to test them since it will not lead to any specific medicinal treatment, as none exist at this time.

So what do I do if my child has cold symptoms?

More than ever, it is important to practice good infection control. Cover coughs with tissues and then discard them, wash hands (for 20 seconds!) when coming inside your home, before eating, after touching your face and after caring for a sick child. Keep your child away from others until s/he is fever free for AT LEAST 24 hours.

What if my child has had a cold and then gets worse?

THIS IS EXACTLY WHEN YOU NEED TO CALL US! As you know, sometimes a cold is the breeding ground for an ear infection or pneumonia. To avoid possible coronavirus spread in our office, we are prepared with the ability to increase physician phone triage and the use of Telehealth visits as alternatives to face-to-face visits, when appropriate. PLEASE, PLEASE, PLEASE CALL US BEFORE COMING TO THE OFFICE so that we can make the necessary preparations based on what we know about any local spread at that time.

A word about the psychological effects of social distancing and pandemics on our children (and ourselves!)

Social distancing and disruption of routines puts a strain on everyone’s mental health. We need to remind our kids about, and demonstrate our own, resiliency. Please limit media exposure for all family member. Too much exposure to what seems scary leads to unnecessarily heightened anxiety. Keep your kids in a routine: getting dressed, brushing teeth, regular meals, naptimes, homework even if doing remote learning, outdoor play and regular bedtimes. (Remember how they get at holiday time when there are too many days of no/low structure?!) Remind them what we do have control over to keep ourselves healthy: washing hands and covering coughs AND staying home after illness until we are truly well before returning to the wider community. If you suspect your child is not adapting well (very irritable, acting out, crying, withdrawn), we have resources in our office to help.

We continue to be here to help you navigate this health situation with factual information. When you do read news, be sure it is from a reliable scientific or public health source. Stay calm and focus on what you can do to prepare to keep your children safe both physically and emotionally. Children read our emotional state and you can help them immensely by avoiding unnecessary panic. Teach them by example that the way we deal with uncertainty and potential medical problem is by listening to public health officials and scientists who best advise us on how to keep ourselves healthy. For more information: https://www.cdc.gov/coronaviru... https://phpa.health.maryland.g...

What is Coronavirus?

Coronaviruses are a large family of viruses that can infect humans and animals. They are spread by respiratory droplet (sneezes and coughs). It is possible that there are other modes of transmission that are yet to be determined. Coronaviruses cause respiratory (cold-like) symptoms.

What is COVID-19 and why is it in the news?

Viruses do change themselves all the time. (For example, this is why the flu vaccine changes from year to year!) This novel strain of Coronavirus, named COVID-19 (“the Coronavirus that was identified in 2019”) is special because it is a strain of virus originally found in animals that is now infecting humans…and is being transmitted from human to human.

Who is at risk?

Currently, those at greatest risk are those who have had prolonged contact with a person who has confirmed COVID-19 infection and those with recent travel to China, especially the Hubei Province. Those who are elderly and those with compromised immune systems may have more difficulty recovering from this infection

What symptoms does COVID-19 cause?

COVID-19 has been reported to cause a mild to severe respiratory illness with fever, cough and sometimes difficulty breathing and pneumonia. Sometimes this has progressed to severe respiratory distress and septic shock.

What is the treatment for COVID-19?

The treatment is “supportive”, meaning staying hydrated and treating fever and cough with age appropriate over-the-counter medications. Currently, there is no medicine to cure this viral illness. There is no vaccine currently available and creating one for general distribution will take 12-18 months.

Are children at increased risk?

There is no evidence that children are more susceptible to this virus than adults. Studies thus far have shown that children with confirmed COVID-19 have generally presented with mild symptoms. However as with other respiratory illnesses, children with underlying health conditions (for example, severe asthma, cystic fibrosis, diabetes and sickle cell disease, to name a few) may be at increased risk of more significant infection.

What can I do to protect my children and family?

Practical, routine measures are the best. Since there are no confirmed cases in Maryland right now, we have the opportunity to reinforce these common practical measures

1. Teach your children infection control measures: wash your hands thoroughly (lather with soap for the time it takes to sing “Happy Birthday” TWICE) and frequently (when you come home from work or school, before eating, after being in public spaces, after caring for a sick child or sneezing or coughing into your own hand).

2. Keep kids home when they have symptoms of illness and model the same behavior yourself.

3. Cough or sneeze into your elbow, or a tissue that you throw away and then wash your hands. Teach your kids to do the same.

4. Keep your home well supplied with the regular medications that people need and use.

5. Be sure your children are up to date on the usual and recommended childhood vaccines. This can help prevent other infections that can come after having viral illnesses.

6. Make sure that you have signed up for Main Street Pediatrics health emails so that we can keep you informed.

7. For more information, visit the CDC’s website: https://www.cdc.gov/coronavirus/2019-ncov/index.html 

We are here to help you navigate this health situation with factual information. When you do read news, be sure it is from a reliable scientific or public health source. Focus on what you can do to prepare to keep your children safe both physically and emotionally. Children read our emotional state and you can help them immensely by avoiding unnecessary panic. Teach them by example that the way we deal with uncertainty and potential medical problems is by listening to public health officials and scientists who best advise us on how to keep ourselves healthy.

Situations that may be appropriate for a telehealth visit include:

- Discussion visits about medical, emotional or behavioral concerns when you or the patient are unable to make an office visit (for example, for a college student living away from home or if there are significant transportation issues to the office).

- A dermatology only visit (simple rash with no other concerning symptoms)

- Certain after hour situations which may be better assessed by telehealth than just a phone call.

The following insurers offer telehealth visit coverage through Main Street Pediatrics: All Blue Cross/Blue Shield policies (EXCEPT Federal employees) as well as all LifeBridge Health based insurances. These insurers will cover a telehealth visit as if it were an office visit (same copay or deductibles would apply). We are working with other insurers to expand coverage for these services. In addition, you must be located in Maryland or an adjacent state for insurance to cover a telehealth visit.

Click here if you want to view or fill out this paperwork.

With our Patient Portal, you can take advantage of the following features:

• Review your medical records online in a safe, secure environment
• Communicate privately with physicians via secure messaging
• View test and lab results
• Update your health information (allergies, medications, conditions, etc)
• Request prescription renewals
• Request or change appointments
• Create one proxy account that accesses the medical records for ALL your children or dependent adults

There are numerous benefits of the Patient Portal, including:

• SAVING TIME! No more waiting on hold to speak to staff or schedule appointments
• IT’S CONVENIENT! Anywhere anytime access lets you communicate on your time
• IT’S PRIVATE: Secure messaging ensures privacy between you and your physician
• MORE CHOICE: Gives patients a new way to communicate with their doctor
• SET & TRACK GOALS: Use the portal to track your health conditions/wellness goal and chart progress
• PATIENT-CONTROLLED: You own your portal and all of the data within it and control who sees what
• Create one proxy account that accesses the medical records for ALL your children or dependent adults

There are numerous benefits of the Patient Portal, including:

Just stop by our front desk and we’ll get you started. Or, click to register, and a staff member from our office will contact you by phone to complete the registration process.

Downloading the app is simple, just click here: app.everseat.com , or click the Everseat icon at the bottom of our home page. You can also visit the App Store or Google Play to download the Everseat app to your iPhone or Android. To sign up, you simply need to register your child (or if you have more than one child, then register each child), designate your regular pediatrician as your favorite, and let the app know when you are interested in making an appointment. A message is then sent to our receptionist who will confirm, or if necessary, arrange an alternate appointment. Appointments currently available through Everseat include acute illnesses, last minute available check-ups and some consultation visits. If we get a positive response from our patients about using Everseat, we hope to expand your scheduling capability through Everseat in the future.