As we sit down to finalize this post, we can’t believe how much has changed in the two-weeks since we sent out our first COVID-19 post. The Boulder Valley School District (among other districts across the country) has decided to close for the next 2-weeks and President Trump has now declared a National Emergency due to this Pandemic. This has made each of us at our office check-in with how we feel and what this all means.

On one hand, it’s hard not to feel panicked and start catastrophizing about how this will affect all of us. Are we really on a runaway train with unavoidable devastation as the media will have us believe? Or are we simply overreacting and feeding into the panic frenzy? The honest truth is that it is hard to know. What’s for sure is that we are all getting a strong dose of life’s ultimate uncertainty.

In this post, we will cover the following topics:

• What is the real risk of COVID-19?
• How do you know if you have COVID-19 or a cold or flu?
• If you think someone in your family has COVID-19, where should you go to be seen? Can you come to Mindful Pediatrics?
• Moving from panic to proactive measures
• In-office & phone appointments are available at Mindful Pediatrics
• Is it safe to travel for Spring Break?
• What it means to love thy neighbor
• What our families are personally doing right now
• Our wish for you and your family

What is the real risk of COVID-19?

At this time, we simply don’t have enough accurate information to assess the real risk from COVID-19. On one hand, it seems much more deadly than the flu with the news reporting death rates as high as 4%. (Flu is generally 0.1% annually.) But are we using the right numbers to calculate these statistics?

Using China, for example: there have been approximately 130,000 confirmed cases so far with approximately 5,000 deaths. China has a population of 1.5 billion people! Due to the limitation on test kits, especially early on, it is likely that millions of Chinese people were infected with minor symptoms and did not seek medical attention.  If we add those minor cases to the statistics, the mortality rate would certainly be significantly lower.

For example, in South Korea, as of March 12th, the mortality rate was calculated to be 0.65% and that of Germany 0.2%—much closer to the 0.1% mortality rate we expect from influenza.

Fortunately, at least this far, our children still seem largely to be spared from serious complications—and not a single death has been reported in a child under 9 years old.

How do you know if you have COVID-19 or a cold or flu?

You feel a sniffle coming on, or a slight tightness in your chest…and your mind now goes to the worst! Do you have COVID-19? How do you know?

This is a chart from the World Health Organization that lays out which symptoms are more likely COVID-19 compared to the common symptoms experienced from the cold and flu that we typically see during this time of year.

We want to highlight that the main symptoms of COVID-19 are fever, cough and difficulty breathing.

COVID-19 cases generally do not involve any digestive issues—or even a runny or stuffy nose.  If you have those common symptoms, it would seem that you most likely have a tummy bug or a common cold or flu.  

If you think someone in your family has COVID-19, where should you go to be seen? Can you come to Mindful Pediatrics?

To be sure that we are providing the best and safest care for our community and the families in our practice, we have been in contact with the Colorado Department of Public Health and Environment throughout the last several weeks.

Due to the size of our small practice, we have been advised to NOT evaluate or test any patients in the office with a suspected or known exposure to COVID-19 (Coronavirus) at this time.

If our staff were to have a direct or suspected exposure here at the office, we could be forced to close the office and go into a two-week quarantine. Closing our office would be unfortunate for the majority of our patients, since we are still able to serve most of their current needs. 

Moving from containment to mitigation

As of March 13th, the Colorado Children’s Hospital has moved from a containment phase to a disease mitigation phase. This means that they are no longer looking for people who may have been infected in order to place them in quarantine.

COVID-19 has now spread throughout the community enough that we are placing our hospital and testing efforts upon caring for the people who need hospitalization and more extensive care and support.

This includes children that are immunocompromised or those that have underlying health conditions (heart disease, lung disorders, severe seizures …)  that make them more susceptible to complications.

Children’s Hospital is only testing patients who meet their criteria to be admitted to the hospital.

Although there are currently not enough facilities to test everyone who qualifies based on the CDC recommendations, our Governor Jared Polis, is currently working hard to increase the number of testing sites around the state.

• Please see this link for testing qualifications
• Watch Governor Jared Polis’ March 14th announcement

Moving from panic to proactive measures

Although it may feel scary to not know what virus is making you sick, as always, assessing how severe your symptoms are is far more important than identifying the infectious agent. The main reason to get tested is to know how to better protect those who are more vulnerable to complications.

Remember for at least 80% of people (and an even greater percentage of children and young adults) COVID-19 will just be like a cold. 

If your child is a patient at Mindful Pediatrics, and you feel anxious and are uncertain whether you or your child should be tested for COVID-19, please call us during office hours. It seems that we will likely be trading our expertise for toilet paper in the near future 😉

We recommend the same symptomatic care that we have always promoted and suggest that you and your family stay home until you are more than 72-hours free of fever, cough, congestion, diarrhea or vomiting.

Please see our first COVID-19 post which addresses prevention and support in great detail.

In-office & phone appointments are available at Mindful Pediatrics

As always, we are here for our regular patients to answer any questions or offer advice.

In addition, Children’s Hospital also has a hotline you can call for COVID specific questions: 720-777-2221.

If you are wondering whether to come into the office to be examined, or are in need of a more extensive conversation, we will be scheduling phone appointments in addition to in-office visits. Please call us and we will be advising on a case-by-case basis. 

We also want to remind everyone that our office always uses “universal precautions”. This means that we always clean the rooms, doorknobs, exam tables, toys, chairs and equipment with medical grade disinfectants and cleaners. This assumes that every patient we see might have an infectious communicable disease and is the expected standard for a medical practice. We have followed these procedures since the day we opened our doors. 

We will now be adding additional high-quality air purifiers to our treatment rooms.  

And again, we will be screening patient calls and sending those who we know or strongly suspect have COVID-19 for treatment and testing outside of our office.

Is it safe to travel for Spring Break?

With spring break approaching, we have received dozens of calls from people inquiring if it is safe to travel. Because the nature of this pandemic is unknown and can rapidly change for the worst (as has been seen in Italy) we are recommending that you please avoid all non-essential travel.

Airports and airplanes are very common places to contract infectious diseases and we feel that this is a risk best avoided at this uncertain time.

We know how disappointing, costly and frustrating it is to have to cancel something that you want and have been planning for. We urge all of you to be aware that this is not the time to be prioritizing convenience and our personal desires but a time to use our common sense.  And, in our opinions, this is a time when being cautious is most necessary. You want to be a part of the solution, not the problem.

Please see the following helpful links:

• Current CDC travel recommendations in the United States: https://www.cdc.gov/coronavirus/2019-ncov/travelers/travel-in-the-us.html

• What to do if your travel plans are impacted by the Coronavirus

What it means to love thy neighbor

You may be thinking to yourself that your children are young and healthy and that this won’t severely affect your family—and we are grateful for you that this is probably the case. But aren’t we all part of a much larger community?

There are people who we cross paths with daily who are immune compromised, going through cancer treatment, elderly, or those who may be at higher risk for death due to heart or lung disorders. Aren’t these people our responsibility too? How would you feel if you were indirectly responsible for their sickness, suffering, or even death?

Yes, we will have some casualties regardless of what choices we make, but you can do your part. Sometimes the right thing to do is also the hard thing to do.

Please, if it is under your control, minimize unnecessary travel and exposure to large groups of individuals.

These precautions may seem extreme to some, but we only have one chance to prevent COVID-19 from spreading in our community, state, and country. Once we hit a critical mass it will be too late for that. 

What our families are personally doing right now

Many of you have asked what our families are doing right now. Because we are generally healthy, we are not practicing complete social distancing and isolation. We are, however, trying to minimize every unnecessary risk.

We are not traveling, even within the state. We are only having people to our house who we know very well. We are distancing ourselves from those who have recently traveled and those we know generally take less precautions than our family regularly does. We are getting into nature as much as possible. We are taking our supplements, eating very well, and doing things to mitigate our stress and help us cultivate love and joy.

These decisions are different for each of us. For example, I (Dr. Roy) have been regularly exposed to infectious disease for more than half my life. I think taking a yoga class with 10 people (in a studio with sterilized mats 6’ away from each other!) is probably safer than what I do 5 days a week! With that said, one of our closest friends is “socially distancing” from that same studio because she personally falls into a higher risk category and distancing is what feels safest for her.

Our wish for you and your family

We write to you now, not only as your healthcare providers, but as members of this community. At this uncertain and scary time, we must remember we are all on this tiny rock floating in space together. We must love and protect each other as best as we possibly can.   

When life throws us for a loop and things get disrupted, we will come face-to-face with both our strengths and weaknesses—as individuals and as a community.

We want to urge you to take this opportunity to look inside and evaluate not only where you currently stand, but where you would like to be in your own personal evolution.

This is an opportunity for us as parents and role models in the lives of our children to model the behavior we wish for them to emulate when they are faced with fear and adversity themselves.

It is our hope at Mindful Family Medicine that you will take this time with your children at home to demonstrate how we can find peace when the world around us is feeling anything but that.

Whether this is through a religious or spiritual practice, breathing, mindfulness, spending time in nature….or simply turning off the TV and incessant news reporting.

We encourage you to talk to your kids, in an age appropriate manner, as this event continues to unfold. (This video may help you get started by addressing some of the basic questions your kids may have.)

We welcome your comments below and you may feel free to share this post with anyone who may benefit. 

We are here for you and our community.

With love,
Dr Roy Steinbock, MD
Ara Haupt, PA
Debbie Steinbock, HHC