Lorton Location: 9010 Lorton Station Boulevard Suite 100 Lorton, Virginia 22079 (703) 436-1200 Open SATURDAY, SUNDAY, and EVENINGS by appointment only. Lakeridge Location: 1990 Old Bridge Road Suite 101 Woodbridge, Virginia 22192 (703) 491-4131
Dr. Farber's Coronavirus update:
There has been much talk lately about the danger of a second wave coming this fall. I will discuss one reason why I am concerned, and several reasons why I am less worried.
My biggest fear is not a second wave, but the current wave not going away any time soon. There are some people who believe that the virus is a hoax, and a larger number who feel it is not a significant problem. Lastly, we come to the largest group, those who are perhaps too ignorant or selfish or lazy to take steps to mitigate the virus; unfortunately, many of these are elected officials. The members of this group are recognizable by their unwillingness to wear masks or socially distance; it is not a difficult prediction they will keep the virus around in this country much longer than otherwise. Fortunately, informal observation when I am out and about suggests that the majority of individuals in Northern Virginia are taking appropriate steps to protect themselves and others.
And now, four reasons why I am hopeful a second wave will not be as bad as the first:
1. It may not happen. Many people are predicting this because it happened with the Spanish flu back in 1918. However, that was a flu virus, a different entity. There was a second wave of the first SARS (coronavirus) in Toronto during the 2002-2004 epidemic; however, in that case the virus first appeared in February 2003 in the city, was declared eradicated in mid-May, and then reappeared later that month. That was not exactly the timing of a second wave (and it was brought under control in weeks). China later had a ‘second wave’ infecting less than 20 people, thanks to rapid diagnosis and quarantines. That was about it for second waves. The first SARS epidemic should be a better predictor of the course of the current pandemic, so although there could certainly be a second wave, I do not feel it is ‘inevitable’ as some have stated.
2. It looks like we will have a useful treatment which could greatly reduce, but not eliminate, severe morbidity and death from the virus. I am of course not talking about hydroxychloroquine, which was hailed by many media personalities and others as a ’gamechanger’ but instead appears to do more harm than good. I am instead referring to remdesivir, where actual scientific studies, and not just wishful thinking, suggest it will be valuable. This will not be for general use (unlike Tamiflu/oseltamivir for the flu), as we will not have sufficient amounts to treat everyone in the world (we cannot hog it all to ourselves), plus it needs to be given intravenously, but by reducing serious cases it will ease the severe strain hospitals have been under.
3. We will be ready. Even if the federal government again dismisses it as unimportant early on, the states are prepared. We have plenty of tests, and can ramp up even more if needed quickly; they should also be more accurate, and I expect us to have useful antibody tests by then, which will be quite valuable. We have enough personal protective equipment around, and can go back to masks and such early; if so, we should be able to keep the numbers down to where we do not have to have the shut-down the current pandemic required. Along these lines, even if we do have an oral treatment readily available by that time, handwashing, masks, and social distancing is where preventing spread occurs, not by treating after a disease has shown up (the same way that flu vaccine, not Tamiflu, is primarily responsible for keeping the nation healthier than otherwise during flu season).
4. The example set by South Korea (and other countries such as New Zealand and Germany). South Korea is next to China, with many people going from one country to another. It is very densely populated (1339 people per square mile versus 87 in the United States), and its largest urban area has more people than New York City. All of this should make it a hot-spot for COVID-19. Based on the number of cases in the United States, one would predict South Korea to have around 200,000 cases and 12,000 deaths, but the actual numbers are around 11,000 and 260 (this is not a typo). Why?
South Korea took the disease very seriously early on. They did extensive testing with subsequent contact tracking and social isolation/quarantine. Frequent hand washing and temperature taking were practiced. Masks were used and accepted as normal to minimize spread. With such measures, the disease never developed the foothold it did in this country, they did not have to lock down the country totally, and now South Korea has even started their professional baseball season (without spectators) back up again. (The system is not perfect; this week Seoul had to shut down bars and nightclubs when 40 new cases were reported, but the disruption is still nothing like what our country continues to go through).
If you think that there is something different about the South Korean culture that allowed them to do this, that is a valid point. However, Germany, much closer to us culturally, has been able to have half the expected cases and deaths that we do, and New Zealand (where schools were only closed for five weeks) has done better than us by an order of magnitude.
As always, continue to fight the good fight. The situation is improving in Northern Virginia, but there is still a ways to go. Next week, my thoughts on easing restrictions in Virginia.
Motherhood was challenging enough before the pandemic. Please know that you are not alone--if you need help or you have concerns, please reach out to us!
Happy Mother's Day to our Supermoms!
The beautiful part about motherhood is that if they consistently feel your love and protection, no mistake will be too great. And you can always start over tomorrow.
From One Mom To Another: A Pediatrician's Mother's Day Message:
"Normally, this is the time of year where I would write a heartfelt letter to moms for Mother’s Day. But given our unique, uh, pandemic situation … nothing is normal. So, instead, let me tell you what my heart feels.
Since mid-March, I have never felt so much like a doctor. And I have never felt so much like a mother. I have never felt – I mean really FELT, like deep in my core – those roles as much as I have these past 7 weeks.
Let’s evaluate my performance as both, shall we?
As a pediatrician, I encourage a thorough and varied education for kids and encourage parents to consistently uphold expectations.
(Yesterday, we literally couldn’t handle any homeschooling because my 6-year-old was having a tiny mental breakdown about his broken Lego set, my daughter threw her letter cards in the trash, and my qualifications as a home teacher are basically a solid nil. I propose giant pay hikes for all teachers ASAP.)
As a pediatrician, I stress the importance of a full night’s sleep. It’s so necessary to keep bedtime consistent to ensure children are getting enough!
(Says the lady who literally can’t understand how her 6-year-old can stay awake until 10 p.m. with enough energy to spare to run a small country - and I swear, child, if you get up out of bed one more time to tell me how your “eyes feel weird, not bad, just weird and I probably should watch some TV or eat something to help it oh and mommy did you know that a scorpion could probably beat a tarantula in an epic battle?” I will lose it.)
As a pediatrician, I ask you to consider socialization of your children, whether that be enrolling them in school, going on playdates, or simply a walk to the local library or park.
(OK well, yeah that’s a no right now.)
As a pediatrician, I ask you to get your children as much fresh air and exercise as possible. Minimum one hour a day!
(When it rains, when it’s too hot, when it’s too cold, or the wind isn’t right, or there is a breeze in the next state, or when just life happens - we are literal lumps. Couch lumps. Sometimes I can’t tell my daughter from a pillow. I literally lost her for 25 minutes the other day because she became a part of the couch.)
As a pediatrician, I tell you to offer your children three well-rounded meals daily. Offer 4-5 fruit or vegetable servings each day. A treat here and there is fine, of course!
(Last night, my kids ate frozen cheese pizza for the third night in a row. No fruit. No vegetable. Just pizza. And if they don’t get to pick out a piece of candy afterwards, God help us, it’s World War 3 in my household and if I hear any more screaming I may literally start bawling in the front yard so yeah, Twix bar? Sure, kid.)
As a pediatrician, I ask parents to set an example for their kids – your strength during these hard times is their strength!
(I have cried alone in my bathroom more times than I can count.)
As a pediatrician, I ask that you limit screen time for your children to less than two hours each day.
(Ask me to recite Olaf’s entire monologue from Frozen 2. Ask me. And prepare to be stunned as I have watched that movie now 54 times and now have it fully memorized. And if I desperately have to get work done? Let me tell you about my friends “Shark Boy and Lava Girl”.)
As a pediatrician, I want you to approach discipline wisely and effectively. Use positive reinforcement for the behaviors you want, and try varying methods to dissuade the behaviors you don’t want.
(Some days in my house, I yell more than I talk in a normal tone. Some days are really hard. Some days are really, really hard. I reach out to others for a break or for help on those really bad days. Click here to find resources to help you during this stressful time: https://bit.ly/2YJao5i)
I’m not divulging my shortcomings to you as a mother to prove anything to you other than… it’s OK, Mom. You’re human. Guess what? I am too. Just because I’m a pediatrician doesn’t mean I follow my own advice 24/7. And I certainly can’t do that during something as unprecedented as a silly little global pandemic.
Mothers, give yourself a little grace. We’ve never done this before – and no matter what that scientist or leader on television says – none of us know how long this will last. We can’t excel at all things on all days. We can only do our best as parents.
I’m here with you, and I see you trying really hard.
So if your family needs that second (or third) movie…do it. If you need time alone, it’s OK – you’re not a bad parent. If you need to just throw a frozen pizza on the table…I feel you, sister.
Use the extra time you’ve been given to soak in those children. Soak them in! Soak in their funny laugh at this age, and save all those drawings. Get in some giggles during that goofy TV show together. Watch their legs and hair curls grow longer on those walks.
Because things will get back to “normal” eventually, whatever that is for you – and those moments won’t be as visible or obvious. So soak it in! And fail sometimes with me. The beautiful part about motherhood is that if they consistently feel your love and protection, no mistake will be too great. And you can always start over tomorrow.
- Dr. Diane Arnaout, pediatrician at Cook Children's Pediatrics Forest Park.
Weekend hours will be held at the Lakeridge location.
allpeds.com We will be moving weekend hours to our Lakeridge location on 5/9 and 5/10... View Article
Dr. Farber answers COVID sports questions:
To follow up my last post, I’ve been asked to comment further on some specific sports. Just as a reminder, I do not have any say in any school’s decision. I expect the state to be rather conservative here, so if they say to go ahead, I expect that I will agree. I am not as sanguine about decisions at the college level, where sports are a billion-dollar industry and the temptation will be greater to start them up.
Swimming: chlorinated water should be safe, indoor or outdoor. I am not that concerned about social distancing for the brief period of time when swimmers are on their marks, heads facing forward. The bigger risk would be after a swim, if people all gather around to congratulate the swimmer.
Hockey: this does involve people slamming into each other, but not as a major goal (at least, not at the amateur level), and contact is rather brief and incidental. As such I would place it as similar to something like soccer. If the virus is around but not rampant, hockey should be safe with surgical masks on (note that a hockey face mask is not sufficient). Arrangements should be made so players can distance themselves on the bench.
Volleyball: this is similar to soccer in my mind; wear a mask. I realize that true social distancing is not possible in the sport. The six-foot rule for social distancing first arose before masks were in general use. Masks greatly reduce the risk, and make the six-foot rule less absolute, in my mind (although I will still be encouraging this whenever practical, if the virus is still around in numbers)
Wrestling: a sport which involves prolonged direct physical contact, where masks are unlikely to stay on, and two faces may be close enough to make breathing each other’s air around the mask likely. Sorry, but no.
Lastly, summer camps. I understand the urge to have children be with other children, and support it. Camps will be much trickier to run than individual sports, given the numbers of children and less structure to the daily routine. Masks will be important. Some activities will probably have to be curtailed for practical reasons. For example, large groups of children will not want to spread out in a swimming pool and just do laps, or isolate on the pool deck, so it will probably be necessary to limit this. There will need to be enough spacing in dining facilities so that children are not clambering all over each other. Sleep-over camps will be harder than day camps. However, the major determinant here, for me, will be the overall rate of new cases. Early June is a long-shot for camp openings at this time, but if we continue to practice good pandemic behaviour, late June/early July may be realistic (if camps have not already made a decision to shutter for the summer before then).
Our nurses are truly superheroes in scrubs! We appreciate their dedication, compassion and bravery during this difficult time!
Happy Nurses Day ❤️😷❤️
Parenting During A Pandemic, Random Thoughts From Dr. Caplan
A Little Parenting Can Go a Long Way .... (Episode 1)
We are an interesting people when you consider these two juxtaposed parental concerns I hear day after day:
"I feel so guilty working these long hours, I never have enough time with my family"
"We have so much downtime together as a family I feel as though I am not meeting my children's needs"
My advice: Take it easy on yourself.
Our culture was speeding at a rate (social media, unlimited choices, phones, instant gratification with same day shipping, etc.) that it was not sustainable for the family unit. We have forgotten what is the most important element in the development of family ....
“Home is the nicest word there is.”
― Laura Ingalls Wilder
Despite the challenges the world is facing right now we have been given a gift--the opportunity to reset our lives and focus on home and family.
Do not stress, as said above, a little parenting can go a long way....
Better grades, decreased substance use, improved self esteem, improved vocabulary, lower BMI. How?
No duck taping your child to the chair so that he will read, no promising ice cream if he/she will just take a walk with you. Just dinner (actually any meal will do). Sitting at the table interacting as a family.
Quality, not quantity is the basis of good parenting (in my opinion) and there are very few investments that pay off as well a family meal. Hey, you have to eat! Even the pickiest eater must ingest a minimum number of calories.
Rules: No media for anyone. Make the table a no media zone.
Bonus Points: choose a menu together, prepare the meal together, assign chores for clean up, serve only one meal (I know all of you short order cooks out there are smiling at this one), include a vegetable, have a tradition (example everyone says something they liked, disliked from the day or review the Kids Post section of the paper).
No matter how your day has gone (and there will be some tough ones), you have nothing to feel guilty about because you provided your child with a family meal!!
"Believing in one’s own abilities makes parenting during a crisis easier, which bolsters a sense of self-worth and strength—suddenly, your other problems feel lighter."
theatlantic.com When something outside your control changes your life, it’s what you do with what you can control that really shapes your children.
Dr. Farber's Sunday COVID update:
I intend to discuss school sports and coronavirus, but there are two topics I want to touch on first. One is masks, and the other is relaxing stay-at-home guidelines.
Masks are our number one defense against the virus. They reduce the risk of breathing the germ in and out, and also prevent you from putting your fingers in your mouth and nose, a major mode of transmission. I would have thought this obvious, but after seeing many citizens on television, I must remind everyone: the mask must cover both the mouth and nose. I’ll also remind you that infants should not be wearing masks, which are potentially dangerous; instead, just keep the infant away from people who do not live with you, or who are ill.
I understand the push for relaxing stay-at-home guidelines, although the rates of new cases continue to rise. The number of people currently affected would be very much worse had we not done stay-at-home, but it is not a perfect measure by any means. We are lacking data here on re-opening for many situations. For example, we do not know if going to a restaurant where the staff wear masks, hand sanitizers are available, and seating is limited will be a major risk, so it is not unreasonable to suggest this, although I personally am not going back until rates are well down.
What we do have data on is what happens with mass gatherings. This was already done at Mardi Gras, and spring break in Florida, when coronavirus was not as prevalent as now, and we all saw what happened. I think allowing mass gatherings is a terrible decision, and will increase rates markedly. As much as I value masks, there is no way I would attend such an event now, even with a mask. Remember, when you expose yourself to the virus, you are not just putting yourself in harm’s way, but everyone with whom you come in contact.
On to school sports. Now that school sports are gearing up for the fall (e.g. physical examination done now will be good for the 2020-2021 year), I’ll look at how I see this possibly playing out. We cannot have a no-risk life, but if there are only a handful of cases in the country daily, then regular sports should be fine. This would also be true if we had an almost totally reliable, readily available, on-the-spot COVID test which would allow anyone testing negative to play that day. In contrast, if we still have high numbers of cases, for example, from a second wave (I’ll discuss this next week), there should be no sports. What should we do if the situation is between these extremes when the season starts?
One of the more important questions which is still to be answered, and may not be resolved by then, has to do with transmission modes. Although there is lots of talk about constantly sanitizing surfaces and things you touch, the reality is that this is not a major source of spread, which is why one can handle mail, take-out cartons, door knobs, etc. without having to wipe everything down (and waiting for the sanitization to take effect, which is not immediate) and not be at huge risk. The question is: if someone with COVID touches a ball, and throws it to someone else, how dangerous is it for the person who catches it?
Now, looking at various sports, not all of them, and not all contingencies in them:
Golf: easy; that’s a socially distant sport to begin with, and you use your own equipment.
Tennis: should not be a problem, but masks would be needed if the ball could transmit the virus.
Track and field: should be doable, but clean off equipment (e.g. a discus) properly between athletes, don’t pack runners in adjacent lanes, and have lots of hand sanitizer available.
Baseball: much of this is socially isolated. Batters, catchers, home play umpires, base runners and fielders holding them on base would need masks, as would everyone else if baseballs themselves can pass the germ along. Communal bats should be sanitized between batters.
Soccer and lacrosse: Players do bump into each other, but it is transient, and I suspect masks, if they stay on, would suffice.
Football and basketball: these, the two most popular sports, are however high-risk ones, with close body contact a major component, and masks likely to be readily dislodged. These are ones I am less sanguine about being ready this fall.
Lastly, the biggest risk for many of these team sports is not the game itself, but the locker room/school bus. It will be important not to pack these locations, and for the former to limit the number of players who can shower and change at one time, and to get them in and out quickly.
Looking for a compassionate, family–centered pediatrician in Alexandria? You've come to the right place.
Our goal is to provide accessible, one-stop primary health care to families and individuals of all ages. We care for both acute and long term health conditions, and we stress prevention to keep you healthy and active.
Associates in Otolaryngology is here to treat everything from ear, nose and throat, sinus, allergies hearing and dizziness symptoms.
The Kidz Docs is a group of dedicated medical professionals who offer high quality, on time, pediatric care in a warm, friendly, professional atmosphere. Twitter: @docs_kidz Instagram: thekidzdocs
At Van Dorn Pediatrics we are committed to providing state of the art medical care in a friendly, compassionate atmosphere.
PAA: Passionate, Accessible, Adaptable