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COVID-19 UPDATE

COVID-19 UPDATE

New Sick Visit Protocol

We are now scheduling patients with symptoms that could be attributed to COVID-19 (cough, congestion, fever, sore throat, headache, nausea, vomiting, diarrhea, body aches, impaired sense of smell or taste) during afternoon hours only. To ensure the safety of our patients, families, and staff, the following sick visit protocol has been implemented:

  • When scheduling your child’s sick visit appointment, you will be asked a series of symptom and exposure related questions. After you pass the screening process, an afternoon appointment will be scheduled with your nurse practitioner and you will receive a text with your unique patient number.
  • Your credit card information will be collected if necessary in order to allow for contact-less check out.
  • Prior to your visit a member of our staff will call you to collect more information about your child’s illness. Please be prepared to provide a recent temperature and weight.
  • Upon arrival to our clinic, please text us to notify us that you have arrived. When your chart and room are ready, we will ask you to meet us at the door. An Angelina Pediatrics staff member will greet you at the front entrance and shepherd you and your child directly into an exam room.
  • All patients age two and above and those accompanying them are required to wear a mask during the visit.
  • If any payment is necessary your credit card will be charged the appropriate amount and a receipt will be emailed to you.


Well checks and patients with non-covid symptoms will be seen separately during the morning clinic hours. We also will continue to offer our telemedicine service for those who prefer it.


COVID Update April 20, 2020

As there is much to report this update is rather lengthy. Our goal with these updates is to arm you with the best information from multiple credible sources to keep you as current as we are.

Local Impact

Local officials are uncertain as to whether or not we have peaked in our case numbers. (See below for more details).

Angelina County is bound to follow the directives related to business openings and restrictions as prescribed by the Texas State Governor, Greg Abbott. Too, our civic leaders, Mayor Bob Brown, city manager Keith Wright and our City Council are in communication with local healthcare leaders to develop plans that maximize safety while attempting to restore and/or maintain local economies and businesses. Their decisions impact the very lives of thousands of people. We ask for your understanding and support as they formulate plans based on available information to thread a small needle.

As of today, Angelina County has reported 23 cases of COVID-19. No deaths have been recorded yet.

Concerns Regarding Local Testing

For Angelina County, we recommend significant expansion of testing as a critical element in determining the timing of the relaxation of current restrictions.

Of note, several of our patients have reported having specimens obtained inconsistent with recommended guidelines. Below is a brief summary of proper specimen collection from the CDC for COVID-19.

Nasopharyngeal (NP) Swab

nasal-swab.jpg#asset:5320:half

A long flexible swab is introduced clear into the nose as shown by the illustration above. The swab should be rotated during the entire time it is in the nose to maximize absorption of secretions (15 to 20 seconds in each nostril).

Arguably, the greatest question immediately before us is when to begin to consider returning to “normal”. The answer will lie in the data from dramatically expanded testing in all of our population segments, from the very young to the very old. Only by so doing will we be able to piece together the true weighted range of disease expression from little or no symptoms to severe illness and death. The questions like - should we re-open schools, daycare facilities, restaurants, theaters, all businesses - will be better answered with more powerful data. As of today, it remains guesswork.

What To Do Now

  • Remaining at least 6 feet away from people around you while in public must be more widely practiced. As this is our best protection against infection, we recommend strict observance of this singular measure as our greatest weapon against infection.
  • Face masks remain recommended for children five years and older for travel outside of your residence.
  • Routinely clean touched surfaces (for example: tables, doorknobs, light switches, handles, desks, toilets, faucets, sinks, and electronics) with household cleaners that contain at least 60% - 90% alcohol.
  • Wash hands frequently with soap and water. When using waterless hand wash, make sure it contains at least 60% - 90% alcohol.
  • Sneeze or cough into your elbow fold, the back of your forearm or some kind of protective cloth.
  • Shelter in place if you are at high risk (if you have moderate to severe lung disease, kidney disease, diabetes, immunocompromising conditions or are 65 years old and older.)

Reduce Your Risk of Getting Sick with COVID-19

  • Continue your medications and do not change your treatment plan without talking to your doctor.
  • Have at least a 2-week supply of prescription and non-prescription medications. Talk to your healthcare provider, insurer, and pharmacist about getting an extra supply (i.e., more than two weeks) of prescription medications, if possible, to reduce trips to the pharmacy.
  • Talk to your healthcare provider about whether your vaccinations are up-to-date. People older than 65 years and those with many underlying conditions, such as those who are immunocompromised, have significant heart disease, diabetes, kidney disease or significant liver disease are recommended to receive vaccinations against influenza and pneumococcal disease.
  • Do not delay getting emergency care for your underlying condition because of COVID-19. Emergency departments have contingency infection prevention plans to protect you from getting COVID-19 if you need care for your underlying condition.
  • Call your healthcare provider if you have any concerns about your underlying medical conditions or if you get sick and think that you may have COVID-19. If you need emergency help, call 911.

If you have moderate-to-severe asthma,

  1. Follow your Asthma Action Plan
  2. Keep your asthma under control.
  3. Continue your current medications, including any inhalers with steroids in them.
  4. Know how to use your inhaler.
  5. Avoid your asthma triggers.

If you have type 1, type 2 or gestational diabetes,

  1. Continue taking your diabetes pills and insulin as usual.
  2. Test your blood sugar every four hours and keep track of the results.
  3. Make sure that you have at least two-week supply of your diabetes pills and insulin.
  4. Follow the sick day guidelines.

New Challenges

The American public has feasted on a continuous news cycle for more almost 40 years (CNN began broadcasting June 1, 1980). We have grown accustomed to having questions posed on Mondays and answered by Fridays with all manner of inflammatory, often polarizing, opinions in between. The questions being currently posed regarding every facet of this pandemic will require months, at best, to answer. Unaccustomed to this new cadence we are programmed to look for alternatives that promise answers immediately. To wit point of care testing for antibodies has a market that is preying on a worried American public. While American and international companies have been unleashed to develop cures and prevent or minimize infection you, our patients, families, employees and indeed the citizens of our county and service areas must understand the more protracted time frame required for reliable solutions to the questions before us.

We are still in the early phase of data collection that then must be analyzed. The analysis will lead to the questions that must be asked. Developing trials and following those to conclusion will be the final step in conquering the challenges that this new infection presents.

As stated in the last update, we will prevail. We are 100% confident of that eventuality. Until then, we invite you, your friends and colleagues to remain informed by visiting our updates which are a synthesis of multiple sources including the CDC, Johns Hopkins University, the National Institute of Health, Harvard School of Public Health, Kaiser Permanente Healthcare System and many others.

Challenges Ahead

The most recent research indicates that we have underestimated the transmissibility of the virus as well as its ability to cause infection. While the question of whether the virus will spread as rapidly in warm, humid conditions remains, (most studies indicate a slowing in progression during warm humid conditions and resurgence when cooler, drier temperatures and conditions return in the fall) Dr. Anthony Fauci reports that his team of scientists believe that this new virus may be here to stay for a few years until effective vaccination protects us. As such, they anticipate a resurgence of infections once colder weather returns in the fall.

Testing for COVID-19

Many point of care tests are being released to the market prior to adequate scientific evaluation. Currently, there are no known reliable point of care tests that provide meaningful information.

Blood tests for COVID-19 are becoming increasingly available. Most are from China and have not undergone any significant reliability evaluations. Testing for antibodies suggest acute infection (IgM) or past exposure (IgG). A positive test may in fact be reacting with one of several common, harmless viruses within or related to the coronavirus family. (High likelihood of false positive). Hence, the reliability of the results are completely unknown. We simply do not know what level of antibody is protective and, if so, for how long. The tests are quite meaningless at this time and may give a dangerous sense of false security. “If you are getting an antibody test and it’s being conducted in your physician’s office, it’s a red flag,” said Kelly Wroblewski, director of the infectious disease programs for the Association of Public Health Laboratories. We agree.

Good News in the Fight Against COVID-19

Time from contracting the virus to developing symptoms has now been somewhat established. Research has now determined that the median incubation period for COVID-19 is just over 5 days and that 97.5% of people who develop symptoms will do so within 11.5 days of infection.

It usually takes about 10 to 15 years to develop a vaccine. The good news: leaps in technology, such as the ability to rapidly sequence virus genomes and to create vaccines out of messenger RNA, are speeding up the process of development. Developing new drug treatments can also take time—about a decade from discovery to getting on the market. But here technology also provides an advantage. New types of antiviral drugs and immunotherapy treatments can treat a wide range of other diseases which means that drugs already in the development pipeline or already treating diseases in patients could be useful to fight COVID-19, shortening the time it will take to make an effective medicine.

Many other drug combinations, 300 in all, are being tested at this time across the globe. It’s just a matter of time before we find the silver bullet.

Treatments

  • Remdesivir is gaining momentum as a leading therapy within the hospital setting. Multiple studies are currently underway and early results are promising.
  • Several monoclonal antibodies are being developed using related technologies and strategies against other known viruses including Ebola virus. Again, early results are bearing fruit.
  • Data regarding hydroxychloroquine/chloroquine and Zithromax are inconclusive at this time. Studies remain ongoing and are having some mixed results although most seem to have some benefit.
  • Ivermectin has been shown to inhibit viral replication in the laboratory setting and has had some success anecdotally. Formal studies are also underway investigating its potential therapeutic benefit.
  • Immunoglobulin therapy: Antibodies from recovered COVID-19 patients could help with free virus and infected cell immune clearance. Further studies are warranted. On March 24, the FDA released guidance for screening donors for COVID-19 convalescent plasma and on emergency investigational new drug applications based on this modality.

Vaccines

Clearly, vaccines represent the “most effective long-term strategy” to prevent future COVID-19 outbreaks, though at least 12-18 months would be required until vaccines can be widely deployed. The company Moderna continues its early testing of the COVID-19 vaccine with the second dose of the immunization administered April 15. Subjects will have blood work performed in approximately 2 to 3 weeks and periodically thereafter to determine immune response. Stay tuned.


COVID-19 Update April 5, 2020

Angelina County issued a stay-home, stay-safe order effective 11:59 PM April 3 for all county residents. This order will remain in effect until it is rescinded, suspended, or amended or until it expires on May 1. This is not shelter in place.

The order requires any business open to the public to enforce certain safety requirements and to have a written plan in place to enforce those rules, including procedures for maintaining a 6-foot distance between people and for regular cleaning. The number of customers in each store at one time will be limited. The new orders also state that travel in Angelina County is prohibited except for essential activities or going to work in an essential business. Essential activities are defined as performing tasks essential to your health and safety or the health and safety of family and household members, obtaining necessary services and supplies for an individual, family, or household or delivering those supplies to a person in need, outdoor activities provided social distancing requirements are followed, caring for another family member or pet in another household, school-related activities, and engaging in the work of an essential business.

The order can be found here: https://www.angelinacounty.net/files/pdf/order0402.pdf

Please be reassured that the Children’s Clinic and Angelina Pediatrics are following these guidelines, with screening of all employees, patients, and parents at the door, maintenance of social distancing, and constant cleaning. Consistent with the recommendations of the American Academy of Pediatrics we continue to provide well checks and vaccines. We are prioritizing well checks to the morning hours and sick visits to the afternoons, and are not allowing anyone who fails COVID-19 screening into the buildings. We are personally caring for all patients with fever, cough, congestion, or other such symptoms via telemedicine. See our website for more information.

On April 3 City of Lufkin officials recommended that residents over the age of five wear facemasks when in public. The mask should provide coverage of nose and mouth. Examples of masks include allergy masks, homemade masks, scarves, bandannas, or handkerchiefs. They are to be used when engaged in social settings. It is critical that citizens understand that this measure is additive to the social distancing 6 feet or more and not a substitute for social distancing.

LOCAL IMPACT

Officially the ACCHD lists ten cases of COVID-19 in our county as of this update. Due to limited testing the number is likely much higher. Perhaps the most important message of this update for our patients, families and employees is that COVID-19 is here. There is community spread now. We are reminding everyone that this virus cannot come and find you; you must go find it. Restated, travel only when necessary and maintain social distancing.

Keep in mind that SARS-Co V-2 (Severe Acute Respiratory Syndrome CoronaVirus 2), the official name of the virus causing COVID-19, is a novel, or new, virus first appearing in December in China. Thus, to our knowledge 100% of all humans are susceptible to infection. Our strongest and most effective tool against this novel infection is social distancing of six feet or more. Washing your hands with alcohol-based sanitizer or soap and water frequently, avoiding touching your face, mouth, eyes, or nose, and wearing a mask in public are our additional protections against infection.

Pre-symptomatic transmission has now been documented. This means that people who are infected with the virus have been documented to shed the virus before symptoms develop. This is a significant finding in that it means that people with virus in their system can spread it before they themselves know they are ill. Thus again, social distancing and the measures mentioned above are to be strictly observed.

The number of cases in Angelina County is going to climb, perhaps dramatically. The public must know that our county may experience higher numbers of patients with severe disease or death. The reason for this likelihood lies in the general health of our population. According to the 2020 Texas Department of State Health Services website Angelina County ranks number 207 out of 254 Counties in regard to health behaviors. That means we smoke more, drink more, and in general engage in more unhealthy behaviors, many of which increase our risk of severe disease or death if infected with the COVID-19 virus. Specifically, people with chronic lung disease, diabetes, heart disease, kidney disease, immune compromising conditions, along with people older than 75 are at highest risk of poor outcome. We strongly recommend that those with these risk factors shelter in place.

NEW DEVELOPMENTS

New Challenges

As discussed above, pre-symptomatic transmission has now been documented. People without symptoms may unknowingly transmit the virus. Our best weapon remains social distancing.

Age and Gender Matter

The overall risk of serious illness or death in children remains extremely small. However, there have now been reports of children becoming seriously ill and dying due to COVID-19. Fortunately children, with rare exception, seem to be spared severe disease. This observation has been documented in all countries. Research is underway as to why.

For reasons that are not understood men may be at increased risk of severe disease or death. This trend has been observed consistently across all countries.

Older people are developing more severe symptoms than younger people despite neither having immunity to COVID-19. There is no rational answer at this observation. People over age 60, particularly those with secondary medical conditions, are at greater risk of severe disease. People older than 75 with or without underlying conditions seem to be at risk of severe disease as well. These findings are also consistent across all countries.

Hopeful News

A few medication regimens seem to be gaining traction as treatment options for patients with COVID-19.

1) Remdesivir- The leading candidate to treat this highly infectious disease. The Chinese government in fact has undertaken mass production to synthesize the active pharmaceutical ingredients of Remdesivir.

2)Leronlimab- A medication typically used for patients with HIV and/or metastatic triple negative breast cancer. Its primary benefit is to reduce respiratory symptoms and complications in patients that have impending respiratory failure or are on ventilators by mitigating cytokine storm, an abnormal hyper-inflammatory response some people experience with infection, which if left untreated can cause multi-organ-system failure.

3)Ivermectin – this drug may block the virus’s attachment to our cells.

4)Chloroquine and Zithromax. Multiple studies are currently underway evaluating the efficacy of this combination.

5)Dr. Jacob Glanville reports that he has engineered an antibody that blocks the ability of the virus to attach to human cells. He developed a similar antibody against Ebola virus and reduced its mortality rate from between 50%- 70% to approximately 6%. More to come.

6)The second dose of the experimental vaccine (first dose given March 16) is due to be given April 16. Approximately two weeks afterward serum will be drawn from subjects to determine immune response. If effective, the vaccine should be available for healthcare workers in 4-6 months. The general public would have access to the new vaccine approximately 10 to 12 months later.

Keep in mind there is a global effort, a race, to find a cure as well as a means of preventing infection. The best and the brightest minds in the world are at work night and day. We will win the day.

Know too that the vast majority of all people with COVID-19 experience mild disease (82%). With widespread testing it is almost certainly going to come to light that many people did not even know they were infected. It is our belief that the 82% figure will rise significantly.

A Note on Transmissibility

It has been widely reported and repeated that the virus remains viable on plastic for up to 72 hours. A close look at the data that resulted in this report reveals that only 0.1% of the virus was viable at the 72nd hour. That viral mass is considered too small to lead to infection.

It has also been widely reported and repeated that the virus can linger in air for up to three hours. The aerosol used for that test was far smaller than 5 µm. Unless we are in conditions of extremely low temperatures and low humidity the droplet size in our speech is typically larger than 5 µm. Also, moisture in the air will attach to the virus-containing droplet making it larger and heavier. It will typically fall to the ground within 30 to 45 minutes or sooner. This explains why maintaining a safe distance of six or more feet from each other remains our best defense against infection.

COVID-19 Update March 27, 2020

NEW INFORMATION

Yesterday evening the CDC published its first report on COVID-19 infections in the United States. The data is reported from a total of 4226 positive cases, 2449 of which included the age. Thus, the number of patients who have been studied is still extremely small even though as of this update the United States now leads the world in cases with 82,400. The next CDC report will likely provide significantly better data.

Here is what we know from the 2249 infected patients on whom we have age data:

  1. 6% of patients were 85 years old or greater
  2. 25% were aged 65 to 84 years
  3. 18% were aged 55 to 64 years
  4. 18% were aged 45 to 54 years
  5. 29% were aged 20 to 44 years
  6. Less than 5% of cases occurred in people 0 to 19 years of age.

Among 508 patients known to have been hospitalized:

  1. 9% of patients were 85 years old or greater
  2. 36% were aged 65 to 84 years
  3. 17% were aged 55 to 64 years
  4. 18% were aged 45 to 54 years
  5. 20% were aged 20 to 44 years
  6. Less than 1% of hospitalizations were among persons 0 to 19 years of age.

Infected patients who were less than or equal to 19 years of age were only hospitalized 2% to 3% of time, whereas those equal to or greater than 85 years of age required hospitalization 31% of the time.

The case fatality rate (the number of deaths per 100 cases) increases significantly with age. Particularly at risk are those 85 years of age and older. There were no deaths in people less than or equal to 19 years. However younger healthy people are at risk of severe disease and death as well. Persons aged 20-54 have a case fatality rate of 0.1% - 0.8% (1/1000 - 8/1000).

Based on this very limited and early data those at highest risk must avoid potential exposure to COVID-19. Measures to do so include social distancing, minimize gatherings when at all possible, practicing excellent hygiene such as washing your hands with 60 to 95% alcohol or soap and water, coughing into your elbow, the back of your forearm or a cloth, avoiding touching your face particularly after contact with another person, and disinfecting frequently touched surfaces such as sinks, counter tops, and toilets.

Caregivers of those in the high-risk categories must ensure that they have at least a 30 day supply of all necessary medications and that they continue to take those medications as prescribed. To the extent possible, they should shelter in place. Asthmatics and persons with known lung disease must make sure that they take their medications as prescribed, particularly if they are on daily medication.

The imperatives in the report are to protect the healthcare system and to protect vulnerable older adults. Avoid travel. Avoid crowds and stay home as much as possible to reduce the risk of being exposed. The entire community must work together to slow the spread of COVID-19.

LOCAL IMPACT

The second COVID-19 case in the area has been confirmed. We fully anticipate many more cases as the weeks go by. Local health authorities in partnership with hospital administrations and medical personnel are managing contacts of all cases.

At this moment in the pandemic we are learning who our enemy is. Our knowledge is growing daily. We will get on top of this infection in time. Until then we all must be smart, aware, engaged and caring. The best information is typically not on the inflammatory 24-hour news cycle of the television. The CDC, NIH and WHO are the organizations collecting and interpreting the data with greatest accuracy. Our team of practitioners will continue to post updates as information becomes available.

Our clinics remain open for well checks, pre-participation evaluations, behavioral health care, and all sick patients with non-COVID symptoms. Please share any comments or thoughts on The Children’s Clinic of Lufkin Facebook page.

HOPE IN THE FIGHT

The first doses of the COVID-19 vaccine were administered March 16 to small group of individuals. The study is designed to test three dosage strengths. A second dose will be administered one month after the first. Two weeks afterward blood will be drawn from the subjects and analyzed for results. The manufactures of the vaccine are hopeful to have a commercial product available for healthcare professionals in the fall of this year. A vaccine for the general public may be available mid next year.

The World Health Organization announced the launch of SOLIDARITY, an unprecedented coordinated push to study thousands of patience in dozens of countries with at least four different regimens of medications. The study design is open label which means everybody knows which drug combination they’re getting. The study is extremely simple in design and should yield answers quickly.

Chloroquine and Zithromax remain a medication combination under evaluation. While some results are preliminary encouraging, particularly one study in France, there are no formal controlled studies to date. Thus, all data is anecdotal.

Testing availability is increasing daily as manufacturers produce thousands of tests.

COVID-19 UPDATE MARCH 22, 2020

The physicians and nurse practitioners within the Children’s Clinic System are committed to the health of your child and our community. During this difficult time of the COVID-19 Pandemic, we want to assure you that we are here to help you understand the virus and the impact it may have on the health of your child and family. To ensure the continued well-being of our patients, the Children’s Clinics will remain open to see patients for well appointments and illnesses that do not include flu-like or COVID-19 symptoms. If your child has symptoms of runny nose, cough, congestion, sore throat, fever, or chest discomfort, we are offering tele-visits seven days a week.

WHAT YOU SHOULD BE DOING NOW

  • Continue to follow federal, state and local health official recommendations and mandates as issued particularly as it relates to quarantine.
  • Avoid contact with persons with known or suspected COVID-19 infection.
  • Practice safe hygiene by washing with alcohol-based hand wash, preferably 60% to 90% alcohol.
  • If you’re coughing, do so into the fold of your elbow, the back of your forearm, or a cloth to prevent spread of droplets to those around you.
  • Practice social distancing as currently recommended.
  • If you have any symptoms of COVID-19, contact your healthcare provider or the Angelina County and Cities Health District at 630-8500, and stay at home unless otherwise instructed by a healthcare professional.

UPDATED STATUS OF COVID-19

LOCAL IMPACT

As of this update, there has been one confirmed COVID-19 positive adult from out of state who had returned home to Lufkin briefly to visit family. Shortly after leaving Lufkin he became ill with flu-like symptoms and was tested and found to be positive for COVID-19. He was well after approximately three days of mild illness. Appropriate precautions including quarantining were instituted immediately. The ACCHD is managing the local contacts.

GENERAL CLINICAL UPDATE

As new information becomes available, our understanding of COVID-19 and its clinical impact is certainly going to change. Thus, we recognize that the information that we are providing will likely be modified perhaps significantly as our understanding of the virus expands. Below is a summary of the latest data available from multiple reliable sources.

With expanding testing updated information is revealing the following:

1) The most prepared country investigating the pandemic remains South Korea, a country of 50 million people. As of March 20, they had tested more than 310,000 people. In contrast, the United States, a nation with six times the population of South Korea, had tested only 103,000 people.

2) Those at greatest risk of suffering serious or critical illness or death remain persons with immunocompromising conditions, diabetes, heart, liver or kidney disease, hypertension, and the elderly particularly those over 80 years of age.

3) The World Health Organization in conjunction with the Chinese Center for Disease Control have published their death rate data stratified by age and underlying illness. The Chinese data reveals that healthy individuals under the age of 40 have an overall risk of mortality from infection with COVID-19 of 0.2% or less. Patients over the age of 80 years particularly those with pre-existing underlying conditions listed above have a death rate of 14.8%-21.9%.

The data from South Korea continues to mature as they expand testing, a critical component to assessing the true variance of the clinical impact of COVID-19 infections. Most of the infected individuals had either no or mild cold symptoms, particularly among the young. Currently, they are estimating that the risk of serious illness or death in individuals less than 40 years with no underlying serious medical conditions will be less than 2 out of every 1000 infected.

The importance of widespread testing for COVID-19 cannot be overstated. For reference, in 2009 the pandemic H1N1 Influenza with limited testing was initially reported to have a mortality rate of 1%. With expanded testing the mortality rate fell 50-fold to .02%. Indeed, Dr. Anthony Fauci of the NIH stated a few weeks ago that the coronavirus may have a death rate 10 times greater than seasonal influenza. One week later, on February 28, after reviewing available data across the globe he re-estimated the death rate to be akin to that of severe seasonal flu, approximately 1%.

Put into context with this year’s flu, to date an estimated 22,000-50,000 Americans have died from influenza. Moreover, in a typical season, approximately 27 million Americans will contract influenza and 55,000 will die. (Interestingly, only 55% of eligible recipients will receive a flu vaccine.) Of the four modern flu pandemics the Spanish flu pandemic of 1918 had the highest death rate, 2.5%, and was particularly severe in healthy young adults. Thus, the earliest COVID-19 data available, again based on extremely limited testing, is revealing that the risk of serious illness or death is likely to be far less than originally broadcast (4% - 14%).

Clinical symptoms of infection include:

1) fever

2) cough, particularly dry cough

3) runny nose

4) sore throat

5) headache and achiness

6) occasionally vomiting and diarrhea

7) difficulty breathing

8) chest pain and tightness

HOPE ON THE HORIZON

1) A vaccine for COVID-19 was given to 45 healthy adults aged 18 – 55 in the Seattle area. A second dose will be administered in approximately a month. The limited trial will last six weeks. A vaccine in the Middle East is also being deployed. More to come.

2) Chloroquine, an old antimalarial medication, has shown efficacy in blunting disease severity. The government has now restricted the prescribing of this medication in the event it is proven to be truly effective against COVID-19.

3) A few antivirals medications are being investigated. Data is pending.

Nobel prize winning author Daniel Kahneman in his book, “Thinking, Fast and Slow,” notes the tendency of humans to overweight fear particularly of the unknown compared to everyday events that often have a greater negative impact. While extremely preliminary, the data regarding severe disease and risk of death is trending toward that of severe flu. We encourage our patients and their parents in the community to seek information from reliable sources including the Center for Disease Control, the National Institute of Health and to some extent the World Health Organization. We will continue to update our website as we commit to keeping you up-to-date and all on the same page.

Preventing further spread of the virus

1) Using an alcohol-based hand wash or washing your hands with soap and water after every encounter with people with the above symptoms or anyone who has proven or suspected contact with an infected person is currently believed to be the most important intervention that reduces the likelihood of spread of the virus to you.

2) When coughing or sneezing do so into your elbow area, the back of your forearm or into a tissue or cloth to prevent spread of droplets to those close by you.

3) If you are at risk of having disease or have been told that you are indeed infected with this virus Self Quarantine is mandatory. Currently, recommendation is for 14 days if asymptomatic. The incubation period, that is, the time between virus exposure and when you become ill is between 2 and 14 days. Your local health department will be managing your care if you are proven to have the virus.

The Children’s Clinic System is working with the ACCHD, local hospitals, schools, pharmacies, and other healthcare providers to ensure the safety of everyone in our 4 county service areas. Our team of board-certified physicians and nurse practitioners will be reviewing medical information from dozens of professional organizations on a continual basis and reporting to you any significant changes based on the new information available. Our commitment to you, our patients and our parents, is to fulfill our mission, “Healthy Children, Healthy Communities”.

Telemedicine Instructions

If your child has fever, cough, runny nose, sore throat and/or body aches, please schedule a telemedicine appointment with our doctors. In order to protect our patients and staff, we will NOT be seeing patients with these symptoms in the office.

Telemedicine visits can be performed on your computer, tablet, or phone.

Availability:

Full Service care for symptoms that cannot be seen in the office is available weekdays 8:00 am - 4:00 pm. Our staff will schedule your appointment, verify your insurance, and call you to learn more about your concern prior to your ViP (Virtual Pediatrics) visit.

On Demand care for any type of illness is available after hours until 9:00 pm and weekends 8:00 am - 9:00 pm. Request a ViP visit with the provider of your choice and they will message you through the app to schedule an appointment. Insurance verification and payment arrangements will be performed the next business day.

To make a telemedicine appointment:

  1. Please go to www.medisprout.com or download the V2MD app. Please allow notifications and enable your microphone and camera. Use your child's name to register as a patient, or if that is not possible please make sure your child's name and DOB are in the message.
  2. After creating an account, click the "Request a New Video Visit" button. You will then be asked to select a provider. If you are a patient of Angelina Pediatrics or the Children's Clinic of Jasper, Woodville, or Rusk, please select the appropriate clinic as your provider. If your pediatrician is at the Children's Clinic of Lufkin, you may select your specific doctor; there is not a general Children's Clinic of Lufkin icon.
  3. Follow the instructions as given. You can also upload pictures if needed.
  4. After clicking the "Submit Information" button, your request will be sent. On weekdays you will be messaged and appointed for a specific time, and one of our staff members will call you to get background information. After hours and on weekends the doctor will contact you for availability. Please stay close to your phone. Upon receiving the notification or email follow the instructions to join the appointment and the doctor or nurse practitioner will connect with you. If you are having trouble seeing messages, click the "details" tab and scroll down.

If your telemedicine visit results in a diagnosis and treatment plan, your insurance will be billed as usual and you will be responsible for your portion. If the visit results in an appointment being scheduled in person you will not be charged.

Preparing for your telemedicine visit:

1. Please check your child's temperature, check or estimate their weight, and prepare a list of medications that your child has taken over the last few weeks, as this information with be very helpful to the doctors. If you have a preferred pharmacy please have their phone number available to share.

2. Ensure you are in a location that is well lit and quiet, and that you have an additional light source to assist the doctor in examining your child. Having good wifi service will enhance the quality of the visit.

3. Stay near your phone or computer so that when you receive a notice that the doctor is ready you will be able to log on quickly. And don't forget to have your child nearby so we can examine them!

4. When the visit starts share your biggest concern first, convey all important information, and ensure all of your questions are answered before the end of the visit. If a prescription is required make sure the doctor knows your preferred pharmacy and their phone number.

If your telemedicine visit results in a diagnosis and treatment plan, your insurance will be billed as usual and you will be responsible for your portion. If the visit results in an appointment being scheduled in person you will not be charged.

Schedule Your Appointment

Call (936) 634-9233

Appointments for well and sick visits can be made Monday – Friday, 8 am – 5 pm.

Learn about Appointments
Kelli Morris, RN, MSN, CPNP

Meet Our Medical Providers

Kelli Morris, RN, MSN, CPNP

Call for your Appointment Today
(936) 634-9233