Sunday, March 22nd, 2020

Dear CMG families,

We hope you are all staying safe.  We know this is a scary time for everyone.  We assume you are all practicing good hand washing and social distancing.  Our knowledge about COVID-19 is changing daily, especially as we have seen it spread across Travis County.  We are continuing to make changes here at CMG to keep all our patients and staff healthy.  

The purpose of this post is to update you on our latest office policies and pass along information that may be helpful, based on what we currently know.  

CMG Operating Hours

CMG is currently operating under normal office hours (8:00am-5:00pm, Mon-Fri).  In the event of a “shelter-in-place” order, we plan to remain open. Health care facilities are generally considered an “essential” business and in other communities under these orders, residents have been permitted to leave their homes to seek health care. 

Telemedicine Appointments Are Available

We are offering telemedicine to all patients. For patients with fever and/or coughing, we require an initial telemedicine visit before you may visit our office.  All major insurance companies are fully covering these visits.  Please call our office at 512-451-5161 to arrange a telemedicine visit.

There are limitations to our telemedicine exams, but we can still prescribe medications and do a general overview of your child.  We can evaluate rashes, tummy bugs, feeding issues, sleeping concerns, and many others easily this way. Hopefully, this can save you a visit to our office.  

All patients with a fever and cough will START with a telemedicine visit.  If additional testing or evaluation needs to be done, we will schedule a time for you to come to the parking lot and obtain what we need from your child while in the car.  This may be to look in your child’s ears, listen to their lungs, or obtain strep or flu swabs. We are working on getting a tent set up in the corner of the parking lot. There will be a marked spot in the parking lot reserved next to the tent.

Office policy updates

Well checks

• All of our well child exams will be moved to the morning. If your child already has an appointment for later in the day (after 1pm), you will receive a call from our office to move your appointment to the morning.
• We need to continue to give routine immunizations and make sure your child continues with healthy growth and development.
• However, if it is not time for your child to receive routine immunizations at their well check, we will call you to reschedule your appointment for a later date.
• Each child should be accompanied by only one healthy parent or caregiver to limit exposures in our office.  
• We do not want anyone lingering in the waiting room.  You will be escorted to a room or asked to wait in your car until a room is available.

Acute/ sick visits

• Please NO walk in appointments.
• All acute and sick visits that will need to come to the clinic will be moved to after lunch. 
• If you have a scheduled visit in the office, you will be escorted directly to a room or asked to wait in your car until a room is available.

Other office changes

• All staff will wear a mask at all times – with both sick and well visits.
• We would like to keep our waiting room clear.  
• You will be put directly in a room or asked to wait in your car until a room is available.  
• All books and toys have been removed from the office.  Please plan accordingly. Feel free to bring your own toys, puzzles, and books from home to entertain your child while here.

COVID-19 information

Symptoms of COVID-19

The symptoms in children continue to be reported as more mild than those seen in adults.  Most have been reported as being typical cold symptoms – cough, congestion, and fever. Vomiting and diarrhea have also been reported.  Most of these cases in children can be managed at home with supportive measures, as discussed in our previous email. As of today, Dell Children’s Hospital has no reported cases of COVID-19, which includes all children currently hospitalized.   

Testing options for COVID-19

• Magnolia is a Texas company that will perform a test. There are no criteria for receiving the test and these kits can be ordered from Magnolia by emailing coronavirus@magnoliadiagnostics.com to request an at home kit and payment information. Magnolia will coordinate with you to deliver kits to your home for self-collection and instruction for how to collect the nasopharyngeal swab. If you do not have a doctor’s order, you will be charged $299 for the test and payment must be received prior to testing. You will not be able to be reimbursed through health insurance or government entity without a Doctor’s order. 
• Everlywell will have an at home testing kit available on Monday 3/23 for $135. You can swab yourself or your child at home and return in the mail.  Results will be available within 48 hours. 
• Texas Health and Human Services is still limiting tests to high risk patients.  Please call our office at (512) 451-5161 to review the latest testing criteria, which are constantly changing.
• CPL also has a test available.  They are following most of the high risk criteria that the health department is, although this may change over the following week.   We can perform this test in our parking lot, but they will not run it if your child does not meet high risk criteria. 
• You can call Austin Regional Clinic.  If your child meets enough risk factors, they will have you do a drive-by test for COVID-19. There is an additional consult fee; please contact ARC for further information. 
• Baylor Scott & White has suspended their testing for now.  

Treatment for COVID-19

There is still no known treatment for COVID-19.  A few drugs are currently under investigation and being given in the United States to adults in the ICU setting.  None of these are available or currently recommended for outpatient use. There is also a current trial for evaluating a vaccination against COVID-19, but this also remains investigational.  

There is also discussion about ibuprofen or motrin being dangerous when given to patients with COVID-19.  Some observational studies done in the ICU setting have shown this, but all nonsteroidal drugs (like ibuprofen and motrin) can be hard on your renal vasculature and are typically avoided in patients in critical condition for this reason.  If your child has fever or is uncomfortable, it is fine to give them tylenol. You can also give ibuprofen to your child as long as they continue to be well hydrated. If more accurate literature comes out to suggest that nonsteroidal drugs are truly not safe, we will let you know.

Talking to your child about COVD-19

This is an incredibly confusing time for everyone.  Understandably, many children are worried and scared about the future.  They do not understand why they cannot play with their friends, go back to school, or hug their neighbors.  Many are not capable of expressing their anxiety. The American Academy of Pediatrics has produced some great resources broaching this topic.  We encourage talking to your children about the pandemic. Reassure them that doctors and researchers are doing everything they can to learn more about the virus and stop its spread.  Remind them that they can help by washing their hands, covering their mouths when they cough, etc. Do your best to stick to a routine (or in most of our cases a “new routine”). Watch their media use on the topic and be careful about some of the scary images being shown on TV and computer screens.  Many of us have our televisions on in the background, but remember that your children are listening and absorbing as well.  

Please take care of yourselves and your families. Try to enjoy this time together.  If you have questions, please let us know. We hope you will find us a resource during this challenging time.  

Best,

Children’s Medical Group

Dr. Bell, Dr. Dodson, Dr McConnell