Category: Blog

Masking up for School by Dr. Meghan Garcia

We understand that this is an incredibly difficult time for parents as they prepare to make decisions about sending their children back to school. We have received a great deal of questions about this topic, and we empathize that many of our families are weighing the pros and cons of each scenario. While we cannot make this decision for you, we hope to provide some reliable information on masks for those who plan to return to in-person teaching this year.

The AAP recommends that children 2 years and older wear masks in public places. Due to the nature of our specialty, we have a number of patients with breathing related concerns such as asthma. We will not be providing letters stating that our patients are exempt from any policy requiring masks. We believe that masks help protect our patients and those around them from contracting and spreading illness. Oxygen and carbon dioxide levels are not affected by wearing a mask, even for extended periods of time. If you have concerns about your child or yourself wearing a mask, we encourage you to make an appointment so we can help address these concerns. We would be happy to measure oxygen levels during these appointments.

There are a wide variety of masks available, and many local stores are now carrying them. In general, we recommend trying different types of masks and using one that works best for you/your child. A mask with a good fit to your face that leaves minimal to no “gaping” is ideal. You may consider a trial of different types of straps/ties to help with the fit/comfort. There are also “ear savers” available that help keep pressure off the backs of the ears if you prefer the ear-loop style masks. Some masks are designed to be washed and re-used, and others are disposable. We recommend keeping backups in the car, back pack, purse, etc in case your original mask is soiled, lost, or forgotten.

While we encourage finding masks that fit your individual preferences, we wanted to make our readers aware of two big points. First, valved masks generally do a good job of protecting the person wearing them, but allow respiratory droplets from the wearer to escape the valve, which could put others at risk. If you have a valved mask we recommend covering the valve with tape, a Band-Aid, etc. Second, research has emerged recently on the efficacy of different masks, and bandana style masks and fleece masks were found to be clearly inferior compared to other types of masks. Briefly, in this study participants wore different types of masks and the “relative droplet count” (or respiratory droplets that escaped the mask while they were speaking) was recorded. Bandana masks were minimally effective and only cut the relative droplet count in half on average. Fleece masks appeared to actually increase the relative droplet count, and the authors hypothesize that this is from larger droplets dispersing into smaller droplets as they pass through the fabric.

As we approach fall and winter don’t forget the basics of washing your hands, avoiding touching your face, and staying home if you are showing any symptoms of illness. We plan to continue to offer telemedicine visits to our patients for convenience and safety. If you have additional questions please call to schedule an appointment for the near future.

 

References:

https://advances.sciencemag.org/content/early/2020/08/07/sciadv.abd3083

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ASTHMA and PREGNANCY

Dos and Don’ts of COVID-19 Infection

You have no doubt been following the developments on COVID-19, and you may have some questions about what to do if you are experiencing symptoms of illness. We hope this information helps to clarify some questions you may have.

At this point in time, testing is not easily available to the community. Therefore, we cannot always test every person having respiratory symptoms for COVID-19. If you are experiencing any symptoms of infection, you must assume that the symptoms could be related to COVID-19. Symptoms can start from 2-14 days after exposure to the virus. Symptoms may include:

  • Fever/chills
  • Cough
  • Shortness of breath
  • Fatigue
  • Body aches
  • Headache
  • Nasal congestion
  • Loss of sense of smell/taste
  • Runny nose
  • Sore throat
  • Diarrhea

Some patients experience more mild symptoms that can be treated/monitored at home. If you have an underlying chronic lung disease such as asthma, it is important to take your medications as directed by your doctor. You can contact your doctor to let them know you are sick, and decide if any other treatments are needed. At AACPC we would welcome you to make a telemedicine visit so your symptoms and concerns can be discussed via video chat from the safety of your home. It is best to stay out of the doctor’s office to avoid exposing other people to illness.

There may be instances where a higher level of evaluation and care is needed than what you can do at home. In these cases, we recommend that you go to the ER, or call 911 if you are unable to have somebody drive you (or if it is a more urgent emergency). You should alert the medical team as soon you come into contact with them that you are having respiratory symptoms so they can use the proper precautions. Symptoms for which you should seek medical attention include:

  • Significant trouble breathing/worsening shortness of breath
  • Bluish lips or face
  • Coughing up blood
  • Fainting/dizziness
  • Inability to keep liquids down/dehydration
  • Chest pain or pressure
  • Confusion, weakness, or decreased level of consciousness
  • Vision changes (new blurry vision, losing part of vision, etc.)
  • Any other new and concerning symptoms

There have been some reports of other less common symptoms that may be related to COVID-19 infection. If you or a family member experiences any of these symptoms, please call your primary care doctor to discuss further:

  • New rash
  • Swelling, discoloration, or ulceration of fingers or toes
  • Sudden loss of sense of smell/taste

If you have symptoms of illness, you should only leave the home for emergencies. Let somebody else do the grocery shopping. Isolate yourself as much as possible from other household contacts and pets. Use a separate bathroom if possible. If you have to interact with anybody in your home, wear a mask. Try to get plenty of rest, but please try to change position often and avoid spending a lot of time lying flat on your back. Most patients with respiratory illnesses feel best when they change position often (every 30 min to 2 hours). Try lying on your sides, stomach, and sitting up or at a slight incline. This may help keep the air sacs in your lungs open. Monitor your symptoms (such as taking your temperature). Wash your hands often. Do not share dishes or utensils with other family members, and wash used dishes in the dishwasher, or thoroughly with soap and water. Clean all surfaces regularly. See this handout from the CDC, which outlines several of these points.

https://www.cdc.gov/coronavirus/2019-ncov/downloads/10Things.pdf

In terms of when it is considered safe to discontinue home isolation, the following guidelines are recommended by the CDC:

  • No fever (Fever defined as temp ≥4 degrees Fahrenheit) for at least 72 hours without medication that could reduce fevers (such as Tylenol/acetaminophen or Motrin/ibuprofen)
  • Other symptoms have improved (such as cough and shortness of breath)
  • AND at least 7 days have passed since your symptoms first started.

 

WE CAN’T SEE THEM, BUT THEY’RE OUT THERE…

Here is a video demonstrating how germs are spread. Gross-yes, but important to know about!

https://youtu.be/G9FGrmYUr5c

 

 

How to PROPERLY use a mask

Universal mask use has been recommended in Colorado when in public.

To optimize the efficacy of a mask, it is important to know how to properly put it on and take it off.

TO PUT MASK ON:

  • Start by washing your hands with soap and water (using the WHO technique above!)
  • Hold the mask by the straps/ear loops. Check for any defects and make sure you have it oriented properly (inside/outside/top/bottom).
  • Place the mask on your face, and if there is an adjustable piece that goes over the nose, adjust this to your nasal bridge.
  • If the mask has ear loops, position them around your ears. If it has ties, tie them securely behind your head. Do not leave ties loose.
  • Adjust the mask by the edges to make sure it covers your nose and mouth, and sits under your chin.
  • Wash your hands again.

TO TAKE MASK OFF:

  • Wash your hands.
  • Try to touch the mask by the ear loops/ties only. Remove ear loops or untie ties.
  • If the mask is a disposable 1 time use mask, throw it in the trash.
  • If the mask is a multi-use washable mask, place it in a paper bag/ pillowcase/laundry bag/etc. and if possible wash it immediately. Do not let the mask sit on the counter, dresser, etc. in case it is contaminated with viruses or bacteria.
  • Wash your hands after removing your mask.

PRO TIPS

Once your mask is on, try to avoid touching your face.

Do not pull the mask down below your nose, or up above your chin.

Do not let the mask rest under your chin. When it’s on, leave it on in the proper position until you are ready to take it off.

Do not store your mask in your pocket, purse, or other unprotected place. You want to keep the mask as clean as possible, and want to keep it away from other things in case it is contaminated.

Here is a video illustrating some of these tips:

We understand that this is a lot of information, so please do not hesitate to contact us with questions or concerns.

Remember, we have telemedicine visits available that can be done in the comfort of your own home. Stay safe and healthy!

by Dr. Meghan Garcia

 

Do you know how to WASH YOUR HANDS?

YES, there is a “right way” to wash your hands! And now it is more important than ever that you get this right!  Want to see how your hand washing stacks up to expert recommendations?
This video uses a UV product to simulate germs on the hands and the efficacy of different methods of hand washing:  https://youtu.be/-LKVUarhtvE
This video demonstrates the WHO technique for hand washing: https://youtu.be/IisgnbMfKvI
Please take note, there is no special kind of soap needed (such as antibacterial soap). All soap will work against killing viruses and bacteria.

STAY HEALTHY – WASH OFTEN

by Dr. Meghan Garcia

Chloroquine as treatment for COVID-19: What you should know

It is likely that you have read or heard about chloroquine or hydroxychloroquine for prevention or treatment of COVID-10 infection. As there have been instances of people finding and ingesting non-pharmaceutical grade chloroquine phosphate, we wanted to provide a warning to our patients and the community that this should NOT be done under any circumstances. Unfortunately in one report of a couple who ingested chloroquine phosphate designed to be used in aquariums, both became very ill. One person died before arrival to the hospital and the surviving person was in critical condition for several days with cardiac and gastrointestinal complications. The CDC has reported that online sales of these non-pharmaceutical grade products has been increasing significantly, which raises concern that people may be planning to ingest them.

Unfortunately at this time, there are no medications that have been FDA approved for prevention or treatment of COVID-19. Pharmaceutical grade chloroquine phosphate and hydroxychloroquine sulfate are currently being studied as treatment for COVID-19 infection, however the efficacy of these drugs has not been established. These drugs are used to treat autoimmune diseases like Lupus and Rheumatoid Arthritis, as well as malaria prevention and treatment. They do have well known side effects such as cardiac arrhythmia (specifically prolonged QT interval), retinopathy (damage to the eye), gastrointestinal symptoms such as nausea/vomiting/diarrhea, and blood count abnormalities. More serious neurological symptoms have been noted (usually at higher doses) such as seizure, dystonia (repetitive muscle contractions), tremor, and ataxia (incoordination of movement and speech). Therefore, these medications should only be taken if prescribed by a doctor and should always be taken at the dose prescribed.

We understand that this is a scary time, and that people want to feel like they have something more definitive that can help prevent or treat COVID-19. However, we urge you to follow your common sense. Please do not take medications that were not prescribed to you. Please follow the instructions of medications you are prescribed. Please do not ingest non-pharmaceutical products. Please continue to wash your hands thoroughly and often, try to avoid touching your face, and follow stay-at-home orders/social distancing to protect your family and the people in your community.

-Meghan Garcia, MD

Resources:

https://emergency.cdc.gov/han/2020/han00431.asp

https://reference.medscape.com/drug/aralen-chloroquine-phosphate-chloroquine-342687