Harbor Pediatrics

As 2022 comes to a close, we hope you and your family are staying healthy and well. Annual "Ball Drops" hardly seem to capture how fast children grow up. We thank you for letting the physicians and staff at Harbor Pediatrics be a part of your family's journey and look forward towards a 2023 filled with... more well checks / less sick visits. Have a Safe and Happy New Years!!!

Happy Holidays!!! We here at Harbor Pediatrics hope this holiday season finds you healthy and enjoying time with your family. Unfortunately, illness is still fairly prevalent throughout our community. Dr Chen is on call all weekend. Please call the office (949-645-4670) if you have concerns about your child’s medical needs. The office will be closed Sat, Sun, and Mon. We will re-open Tues, Dec 27th. We wish you a safe and Hapoy Holidays!!!

Good evening,

Yesterday, the CDC announced that Abbott was issuing a recall of some of its powdered formulas. We wanted to make sure that all of our parents are aware of this recall. This does not apply to all Similac products, so please refer to the CDC statement for the affected brands and specific lots.

https://www.fda.gov/news-events/press-announcements/fda-warns-consumers-not-use-certain-powdered-infant-formula-produced-abbott-nutritions-facility

FDA Warns Consumers Not to Use Certain Powdered Infant Formula Produced in Abbott Nutrition’s Facility in Sturgis, Michigan The FDA is investigating consumer complaints of Cronobacter sakazakii infections and one consumer complaint of infection of Salmonella Newport potentially linke

With COVID running through the community, many families have been asking what are latest rules for those are COVID positive and/or how those rules differ if you have been exposed to someone with COVID. Based on the CDC and CA Dept of Health guidelines for Fri 1/7/22, we have created these two tables to summarize the current guidelines. We hope you will find this helpful. If you are interested in having you / your child receive the COVID vaccine, please call our office. We hope you all stay safe and healthy through this challenging period.

With COVID running through our community, lots of parents have been asking us what are the current quarantine rules and recommendations. This summary is the current guidelines after EXPOSURE TO COVID. Please refer to the other table if you are POSITIVE FOR COVID . Stay healthy and if you are interested in receiving the COVID vaccine, please contact the office.

Hello, several news outlets are reporting that the CDC has approved the Pfizer vaccine as a booster for children 12+ years old. Technically, Dr Walensky, head of the CDC, needs to approve it, but this is expected to be a mere formality. We have the vaccine in our office so please call to sch'd your child's booster.
To summarize
1- We are currently giving primary series Pfizer COVID vaccines to our patients 5-11 years old.
2- We are now giving booster Pfizer COVID vaccines to all patients (and parents/families) 12+ years old. Boosters can be given to patients who finished their primary series 5 months ago (note this changed, it was previously 6 months).

Happy New Year!!! We are open and seeing patient (both routine and acute), providing rapid COVID testing, and administering vaccines (incld Pfizer’s COVID peds and adult forms), but please bear with us this week as we have multiple staff members that are under quarantine regulations. We will be short staffed, so we thank you for your patience and understanding.

COIVD update…part 2

Vaccines - we currently have Pfizer COVID vaccines, both the pediatric form for 5-11yo and the 12-adult version. We have been giving them out and will continue provide vaccines to our patients and their families. Because of the logistics of the vaccine, WE ARE ONLY GIVING COVID VACCINES BY APPNT. Please call if you would like to schedule a vaccine for your child (or you).

To summarize
1 - we are able to provide the Pfizer COVID vaccine (pediatric dose) to children 5-10yo
2- we are able to provide the Pfizer COVID vaccine (“adult” dose) to children 16+ yo.
CALL FOR AN APPNT

BREAKING NEWS… The FDA (Mon) 1/3/22) has recommended that youth from 11-15yo receive a 3rd booster dose of the Pfizer vaccine. The CDC is sch’d to meet on Wed 1/5/22 to discuss whether to approve this recommendation. If approved, children 11yo and older will be eligible to receive a booster. We will update accordingly.

Under the current CDC guidelines, those who have received a booster or have recently completed the primary series are still eligible to attend school and other functions as long as they wear a mask (see previous post). Assuming schools don’t shut down altogether (neither schools, families, nor physicians want this to happen), it may become the situation that your child’s ability to continue to attend school will be contingent upon booster status. Moreover, in the unfortunate event your child does become ill with COVID, the severity of the disease should be significantly less if they’ve recently completed the series or have recently receivecd a booster. Consider getting vaccinated/“boostered” to keep your kids well and keep our schools open.

As a reminder, HPMG does not provide mask exemptions nor vaccine exemptions unless your child has a chronic medical condition under the management of a verified pediatric subspecialist.

https://www.cdc.gov/media/releases/2021/s1227-isolation-quarantine-guidance.html

CDC Newsroom Press releases, advisories, telebriefings, transcripts and archives.

Happy New Years everyone. We hope you had a safe and merry holidays. As your are aware, COVID cases everywhere are at sky high levels. Omicron is highly contagious, but it doesn’t seem to be as severe as previous varieties (keeping our fingers crossed). With each new variant comes new guidelines and recommendations. We know its mentally exhausting trying to keep up with stuff - believe us, we know!!! So here are the latest facts as we know them…
1- Quarantine/Isolation- based on the most recent CDC guidelines (12/27/21)

A-if you are positive for COVID, isolate for 5 days. At day 5, if you have no fever and are feeling better, you can then stop quarantine but should wear a mask for the next 5 days (10 days total of precautions).

B- if you have been exposed BUT have no symptoms AND completed the primary COVID vaccine series AND received a Pfizer or Moderna booster (all these conditions must be met)…THEN you’re in the clear for now. Wear a mask for the next 10 days and get tested (rapid or PCR) on day 5.

C - If you have been exposed BUT
C1 - never got vaccinated in the first place OR
C2- Never completed the primary series OR
C3- Have not received a booster in the past 6 months. (Any one of these situations)….THEN Quarantine for 5 days at home, test on day 5, and then mask for the following 5 days. If it is absolutely impossible to stay home AND YOU HAVE NO SYMPTOMS, then you’ll have to break quarantine. You must wear a mask for 10 days and get tested on day 5.

D- IF YOU HAVE ANY SYMPTOMS - GET TESTED

We’ve attached the CDC link, please refer to it if you have any questions, esp those that received the single dose J&J series.

More on testing and vaccines to follow…

We are often asked whether COVID19 is improving in Orange County. Looking at trend in hospitalization rates is a better measure of COVID19 incidence than daily incidence. This chart was derived from the California Dept of Health's database and does not bode well for us. Please remember to practice social distancing, wear a mask (if appropriate), wash your hands, and stay safe. https://public.tableau.com/views/COVID-19PublicDashboard/Covid-19Hospitals?%3Aembed=y&%3Adisplay_count=no&%3AshowVizHome=no

Good Afternoon, some of you may have noticed some news about a new COVID19 related complication called Multi-system Inflammatory Syndrome in Children (MIS-C). Here are our initial thoughts on the issue. We will provide any updates as we learn more.

An article we noticed this week. We have been particularly worried that our asthamtics/wheezers would really get sick from COVID19 - maybe not. If your child is asthmatic, we don't think this means your child is less likely to get COVID19, but this hints that they may not be at increased risk. We'll keep seeing if further research supports this observation. In the meantime, stay healthy and safe!

Asthma Is Absent Among Top Covid-19 Risk Factors, Early Data Shows Despite warnings that asthmatics were at higher risk for severe illness from the coronavirus, asthma is showing up in only about five percent of New York State’s fatal Covid cases.

Good Afternoon. We hope this letter finds you and your family well. We wanted to provide an interim update, as best as we understand it here at Harbor Pediatrics.

Office Operations
As a reminder, we have altered the office’s work and patient flow in order to adjust for the COVID19 pandemic. Currently, well visits are first in the morning. After all well visits are concluded for the day, we will begin to see “sick” patients. Additionally, our check-in practice has changed. If you did not receive this previous email from us or would like to review our new procedures, we posted a copy on our page.

Telemedicine
Despite all the precautions you have taken, we understand that children can still become ill (or injured). We are trying to decrease risk for incidental spread by moving much of our acute care onto a video telemedicine platform, but there are still situations that require in-office visits. If you did not receive our telemedicine email or would like to review our implementation, please visit our page.

Testing Update
Many of you have asked about testing. This is constantly changing, but as of today, there are two different tests

1- Nasal Swabs / PCR – This determines if you currently have an infection. This commonly involves swabbing the back of your nostril. There are very narrow criteria to qualify for PCR testing – most of our kids are not candidates. Hopefully, we will be able to start more widespread testing. We will be sure to update you as soon as we hear any change.
2- Serology Testing – In the future, we will want to be able to assess whether we were exposed and recovered from COVID19. Some will have had a sniffle, some will have been severe. Serologic (aka blood) testing will allow us to determine whether we have active immunity to COVID 19 (much like how we can test to see if you’ve had previous exposure to Measles or Chickenpox). There have been many companies/labs that have submitted their tests for approval but as of Apr-10, there is currently only one serologic test that is FDA approved – manufactured by Cellex Inc.

This week, community testing sites began to appear in Orange County, sites that do not require physician assessments/referrals. We don’t know what tests are performed and the validity of these tests. Moreover, some of these “pop ups” require up front payment. Finally, these “self-refer” centers do not report results to Harbor Pediatrics, and we will not be able to track down your results. We cannot speak to whether or not this is right for you and your family, but we want you to be aware of the limitations of pursuing these avenues. We are constantly reviewing the status of community testing and will update you as things change.

What to do If Your Child is Sick
Hoag Hospital is projecting that our area will “peak” next week. Some of you may suspect you/your children have COVID19. Symptoms range widely and may include, fever, cough, shortness of breath, difficulty breathing, muscle pain, achiness, headache, and fatigue (just to name a few). Symptoms are potentially harder to assess in children.

If you think your child has COVID19, here are some things to remember
1- Call us.
2- Isolate and have your child wear a mask as much as is humanly possible. This will obviously vary depending on your child’s age and maturity. Your 3 year old will not behave like your 17 year old. Wipe down surfaces and try to contain the “hot zone” as much as possible. Here are some other suggestions.
3- Quarantine the family – We now know that COVID19 can be transmitted before people are symptomatic. Therefore, plan to hunker down in place while your child remains ill. This is the OC Health Dept statement.
4- Keep them comfortable. Severity can vary, but there is no value in suffering. Suffering more does not bring a quicker resolution to illness.
a. Tylenol or Motrin. There has been debate as to whether or not ibuprofen (Motrin) makes COVID19 more severe, but there is no current data that validates this claim. Try Tylenol first
b. Fluids – Stay Hydrated. Appetite will likely be decreased, smell and taste may briefly disappear, please try to remain hydrated.
5- Monitor for respiratory issues. Contact us or go to the ER if your child is noting significant cough, difficulty breathing, shortness of breath, etc. Trust your parental sixth sense, and call us if you ever get worried.

Emerging from Quarantine
There will come a point where your child is better. Here are some relevant issues
1- Individual Quarantine duration. Your child should remain in quarantine until they are cleared. Since we do not have widespread testing, these are the current guidelines to be “cleared”
a. Minimum of 7 days and
b. Until they have been fever free for 72+ hours, without using any medications such as Tylenol or Ibuprofen.
2- Family Quarantine duration. If your child has had a suspected case of COVID19, the entire household should continue to self-quarantine for 14 days after the your child has been “cleared” - hence 17+ days after their last day of fever (see above)

As always, we are trying to stay informed of new developments and will relay them to you ASAP. Please continue to practice social distancing guidelines, hand washing, and mask wearing. Please stay safe and call us if you have any concerns.

We wanted to further expand on Harbor Pediatric’s telemedicine plans. Please bear with us as this is constantly in flux, as are most things these days. We have traditionally not embraced telemedicine because we believe that sitting with you and your child, listening to their medical problem, observing them, and then performing a directed physical exam is the best way to deliver medical care. We still believe seeing a patient in the office is the best type of medicine. We will not compromise our principle to provide your child with the best quality of care. Once COVID-19 is over, we will resume office visits exclusively. However, this is a period where prudent caution is advisable, we know many of you may be hesitant to come into the office - we understand.

What is Telemedicine?
Telemedicine simply means that we will use a video conferencing platform so that we can still get an accurate history, get some degree of a physical exam, and collectively develop a sound and reasonable plan for your sick child.

What examples can telemedicine be helpful?
There are no definitive examples when we will use telemedicine vs bringing your child in for an exam. No two illnesses look the the same. Some instances where telemedicine may make sense include: a skin rash, vomiting or loose stools, colic, or a fall and now complaints of some joint pain. Again, a telemedicine conversation and limited exam may be sufficient. When it is not, we will have you come into the office.

What instances are not suited for telemedicine?
Some situations really don’t lend themselves to telemedicine. Painful voiding, ear pain, severe abdominal pain, sore throat, significant cough and/or wheezing, are likely to require a physical exam. We may start with telemedicine, but there are some things that are harder with video. Even in those situations, first talking to you will allow us to quickly hone in on areas of interest and also provide us an opportunity to let you know our plans. For instance, if your child is having some “private parts” pain, we can advise you to start giving liquids to drink because we’re going to want a urine sample. Telemedicine may help make visits more efficient.

How is Harbor Pediatrics doing telemedicine?
As we previously announced, we are changing our scheduling. We start the day seeing our “well child” exams, clear the office, and then have “ill” children come in for exams. This is how we currently envision things working:

1- You call our front office because your child has an illness, problem, etc.

2- We will offer you a telemedicine appointment with one of us. If one of the MDs has an open appointment in the AM, having a telemedicine visit may allow you to address the concern earlier. We will send you an email clearly stating which MD you are “seeing” and at what time. Embedded in the email will be a link that you “click” to check in. Signing in is a really simple process at which point you will be in our virtual “waiting room”, our MD will log on, and “off we go” (It goes without saying that we need you to allow both video and microphone on your device for this to work).

2a- Even if you first choose to have a telemedicine appointment, if you or the MD is uncomfortable with your child’s situation, we will arrange for an in-office visit that day.

3- If you want to come into the office, we will give you an appointment. Again, it will be after we have seen all of the well exams for the day.

What about patient privacy?
We will be using a system that maintains HIPAA compliance; your privacy and confidentiality are still paramount. If you would like to have a telemedicine appointment, we will first ask you for a verbal consent “to have a telemedicine appointment”.

I am so tech clumsy!
We will try to minimize the amount of programs, applications, accounts, etc you need to download. The software we have been testing for the past three days does not require you to load an app, seems to be fairly user friendly, and has the flexibility for us to let you know if we are running a few minutes late (rather than having you sit in limbo).

What about cost?
Telemedicine is currently billed just like a regular office visit. We are seeking out guidance on copays and will provide further information as it becomes available. If you start as a telemedicine visit but then come into the office later that day, there is only one day of “in-office service”.

My insurance is advocating a different telemedicine service?
As previously stated, we have not advocated for telemedicine because we have always strived to provide the best medical care possible for your kids. We are offering this now because we have concerns that other providers will not have the tools, experience and personal knowledge of your children. We think your kids deserve better than a random health care provider who doesn’t know your child whatsoever.



We are hoping that this COVID-19 situation and these resultant adjustments are temporary. These first few days may be a bit clumsy, please bear with us. It has always been and continues to be our honor and privilege to care for your children, and we remain committed to your child’s health and well-being.

Dear Parents, we hope everyone is staying healthy during these times. At Harbor Pediatrics, we are undertaking a series of adjustments to try to ensure that we can continue to provide quality care to everyone. These changes are similar to many of our pediatric colleagues and represent what we think are the best ways to keep everyone as healthy as possible.
1. Guests - We are a pediatric practice, and we understand that many families have more than one child. At this time, we are requesting that you limit the number of people accompanying your child to their visit. Respectfully, siblings, relatives, neighbors, friends, and especially grandparents should not be accompanying you and your child. We understand that this poses a challenge for some families, and we sincerely apologize but we do not want to risk guests either transmitting or becoming ill from a visit. Please call us for further details if necessary.
2. Changes to our check-in process. It is impossible to maintain a social distancing perimeter in a waiting room. Therefore, we are closing our waiting rooms - both the “sick waiting room” and the “well waiting room”. Fortunately, our parking is immediately outside our office (vs in an office tower).
- Once you have arrived and parked at our office, please call the office (949) 645-4670. Let the front office know that you have arrived for your designated appointment
- While on the phone with the front office, you will be “signed in”, critical information will be confirmed (e.g. address, email, best phone numbers, Facetime/ Skype), and copays/balances will be collected. Once this has been completed, we are asking that you stay in your car until our staff comes out to es**rt you.
- Our staff will physically come out of the office and show you into our office. As you know, our office has two wings. There are two front doors “well” and “sick” as well as two side doors (one for each wing). Depending on the nature of your visit, we may have you entering and exiting the office through doors you are not accustomed to using. Again, we will es**rt you into the building and also direct you towards your exit.
- We no longer have toy buckets at the end of the visit - they are a significant risk. We have also taken almost all toys and books out of the exam rooms for the same reason.
3. Changes in our appointment structures. We are re-structuring the work flow of the office to make every effort to keep a healthy environment.
- Check ups. We think it is important to continue with interval / annual well exams / check-ups. For newborns and infants, vaccines are still a critical part of your child’s future health and well-being. We strongly advocate continuing to come in for monthly / annual exams. We are now adjusting the schedule such that all “well exams” are first in the morning. When you arrive in the parking lot, please call the office (see procedure above). When our staff comes to es**rt you, they will first check you and your child’s temperature. If either of you are ill or have a

fever, we kindly ask that you reschedule for a make-up once you all are well. We
will not see sick patients until all of our well exams are first seen in the morning. - Sick visits. Once all of the day’s “Well” visits have concluded, we will then begin
to see sick patients. Expect our staff to be masked, gloved, etc. This is for everyone’s protection. This does not imply that we are ill nor that we think your child is a particular hazard - it simply reflects the reality that we must all be safe these days.
4. Telemedicine. We are actively planning how to formally incorporate telemedicine into our practice. Once we finalized the details, we will let you know. Telemedicine will allow us to continue to provide a means to communicate and potentially evaluate your child’s medical issues that may not require coming into the office (e.g. rash, pink eye, reflux). If we determine that an office visit is necessary, telemedicine may help expedite the visit so that it can be completed in a matter of minutes (e.g. hurts to p*e - drop off urine sample). Telemedicine is evolving quickly so things may change. We hope you will use this service rather than talking to complete medial strangers, sit in urgent cares, or the go to ER. Again, we will keep you abreast of our policy once it begins and any changes as we strive to make this work well. We do not foresee this being a permanent feature, but in the meantime, please make sure you provide us with a means of communicating with you via telemedicine.
5. Avoiding COVID-19. We are all undoubtedly a bit stressed about this illness. Keeping everyone safe starts with each of us doing our part and keeping our kids and ourselves safe. This is not the time to be having play dates, group events, etc. There are other illnesses aside from Covid-19 that are still out there such as RSV, strep throat, adenovirus, etc. Don’t take risks that will ultimately require you to interact with us, or other health care workers. We love you guys, but we’d much rather everyone stay home and well. We strongly urge you to practice smart and responsible social distancing procedures.
WORK WITH YOUR KIDS - HAVE THEM WASH THEIR HANDS AND TRY TO NOT TO HAVE THEM TOUCH THEIR FACE.
6. Testing for COVID-19. Currently, California’s ability to test for COVID-19 is severely limited. We are not testing for COVID-19 in the office. This is a very dynamic situation, and we will strive to keep you informed of developments in this area. If you think you or your child may have COVID-19, please call the office. Do not come in to the office. You may potentially shut down the entire practice and our ability to care for everyone in the community. We will work with you to help determine the best way to provide treatment for your child.
There is limited testing through outside labs, but the criteria are fairly stringent:
• Fever and acute respiratory distress AND close contact with a confirmed COVID-19
patient

• Fever and acute respiratory distress AND symptoms developed within 14 days of returning from a high risk travel area as defined by CDC
• Fever and respiratory distress requiring hospitalization
• Fever and respiratory distress AND immunocompromised
If there is any good news so far. China published their pediatric experience in Wuhan (March 21, 2020). Of the 80,000+ people who had COVID-19, only 2143 were confirmed to be children. Of these pediatric cases, over 90% were asymptomatic, mild, or moderate cases. There was only one pediatric death attributed to COVID-19 and that child had other complicating medical issues.

Kids will be kids. If your child happens to get a laceration, the last place you want to go to is the ER. Dr Jonathan Zelkin is a Board Certified Plastic Surgeon who has offered to help provide his office services for lacerations and trauma repair - avoid the ER. If you are in need of his services, please call (949)432-4730 for an appointment.

Late Saturday night saw the first confirmed case of the new Coronavirus in Orange County, the 3rd overall case in the US. At this time, we have no further details about this patient. Since there is still so much unknown about this virus, it is a bit unsettling to have it in our backyard. We will strive to update this link with any information as it becomes available. For now, please review the current US Centers for Disease Control factsheet about this new viral illness. And we can never emphasize enough - hand washing.

Coronavirus | About | Prevention and Treatment | CDC CDC Coronavirus: About prevention and treatment - Describes how to reduce your risk of getting coronavirus infection, and how to relieve symptoms if you get infected.

We have recently been receiving alerts and bulletins from CDC, OC County Health, and this afternoon Hoag sent a memo about Measles. Although we are not aware of any cases in the OC, the flurry of notices clearly hints that there may be trouble on the horizon. To Be Clear- we do not know of any cases. That being said, if your child has somehow missed their MMR vaccine (sick that day, forgot to schedule a physical, etc), we would strongly suggest calling and getting protected now before trouble hits our region. Please remember that getting the vaccine does not confer instantaneous immunity. Plan ahead.

This just came across our emails, especially timely since everyone seems to be ill right now. Again, please note that this is for INFANT ibuprofen - Not Children's ibuprofen.

Infant ibuprofen recall expanded A recall of infant ibuprofen has been expanded to include three more lots that could have high concentrations of the drug.

Many of you were probably aware of this situation, but it’s in our proverbial backyard so it’s worth reposting...

Much of Newport’s Back Bay closes to swimmers after 2 sewage spills dump 15,000 gallons into the water Much of Newport Beach’s Back Bay is closed to swimmers after two sewage spills dumped a total of 15,000 gallons into the water Tuesday, according to the Orange County Health Care Agency.

We hope everyone’s having a great Summer thus far. Please be aware of today’s heat wave. It is supposed to reach 90’s at the beaches, 110+ inland. Make sure you’re kids are sunscreen’ed, hydrated, and frankly, somewhere cool. These high temps can be outright dangerous. If you’re heading for the beach (or Jr Guards) please also be aware of the high surf advisory. Stay cool and have a great weekend.

Happy Holidays from all of us at Harbor Pediatrics. Whether you are close to home or afar on an adventure, we hope the season remains safe and festive.
For Christmas- We will be open tomorrow - Sat AM. However, we will be closed Monday. We will reopen on Tues 12/26 for a regular day.
For New Years- we will be open Friday as usual. We will have Sat AM hours on 12/30. We will be closed on Mon, Jan 1 and reopen on Tuesday, 2018.
If you have any issues, questions, etc over the holidays, please call the office and speak with our answering service. Dr Chen is on call this weekend and Dr Michelis is covering for New Years.
Happy holidays from all of us!!!

AMA approves policies on social media use, screen time

Interesting stats to ponder...although the irony is that we're using Facebook to distribute this information to you.

healio.com Noting the negative impact on health from excessive use of social media and electronic devices, AMA encouraged primary care physicians and schools to be more proactive in educating patients and parents about their potential impact during the interim meeting of the House of Delegates,

Toddler is 1st reported flu-related death in OC, agency says

This is a sad reminder that influenza can be a really serious illness. We continue to give influenza vaccines (flu shots) at the office, on most weekdays and some Saturdays. Call the office to set up a time if you are interested in having your child vaccinated - it is not too late.

abc7.com A toddler was reported to be the first flu-related death in Orange County, health officials said Thursday.