Sarabenet Sequeira, MD, FAAP

COVID-19 Vaccination

Hi All,
COVID boosters have gotten so confusing that the CDC has made a interactive quiz to determine if you are eligible. Bottom line is for 12 and up if it's been 2 months since you've gotten a booster or 3 months since you've had COVID, they are recommending an updated booster. I don't yet have availability of these in the office, due to short supply generally, but will let you know if I get any. Private vendors such as Safeway or Rite Aid Pharmacies may have their own supply and more availability.

COVID-19 Vaccination COVID-19 vaccines protect against COVID-19. Get safety info and more.

Back to school updates:
Illness season started the minute kids went back to school, in spite of the hot weather. Until our immune systems catch up from the two pandemic years of minimal exposures, we can expect a busy illness season. Toddlers and college age students seem to be getting hit especially hard. Make sure your family is attending to things like good sleep routines and hand hygiene as kids adjust to the new school year. Let the weekends be about rest for these first couple of weeks of school. I'm also recommending masks in crowded public spaces, but not in school.
I am also anticipating an early Influenza season, since we saw Influenza in the community as late as July. I recommend taking preventative measures now. We are already administering our preservative-free 4 strain Flu Shots in the office.

Things are also shifting in COVID land and we are trying to catch up. We've updated our machines and protocols for the winter season ahead.
You may have heard the news that the new Omicron plus the original strain COVID booster is coming (It's called the "bivalent" version, meaning 2 strains).
CDPH just informed us that we should no longer give the original booster but instead wait until the new bivalent booster is available for those 12 and up.
The source for these boosters will likely be Marin County Public Health sites, given the limited supply, so watch this space or check their website for updates. If we get a vial or two I will prioritize teens and parents in my practice but I'm not sure yet when and if we'll receive any.
COVID vaccines for kids are also changing as Pfizer is not going to be making any more doses for the kids 5-11 years. Today Marin County Public Health was able to give us two of their last remaining Pfizer pediatric vials so we will do our final primary and booster dose clinics for 5-11 year olds on 9/16 and 9/30. Let us know if you want one of these final doses before winter. I think the primary 2 dose series is the most important but we should have enough doses for boosters as well.
Bivalent shots for kids are still a ways off.
As always, text the office if you have any questions.

This has been a big priority for our state leaders, including Governor Newsom and Dr Mark Ghaly (my former resident!), and California’s head of Health and Human Services. It’s been in the works for quite some time. The goal is to create a safety network of school counselors and community mental health workers to intervene early in young people’s lives. Couldn’t have come at a better time. The stresses of the last 2.5 years have added significantly to the mental health needs in the Pediatric population. Fully 1/3 of my day is still mental health support. I’m so grateful I live in a state in which our priorities are directed towards prevention and compassion for our most vulnerable.

Unvaccinated man in Rockland County, N.Y., diagnosed with polio

Polio is a sneaky disease, easily transmitted from water sources. While the number of cases worldwide have dropped dramatically due to vaccination and interventions like water treatment, Polio still tends to crop up anytime there is unrest- be it geopolitical or weather. For example, after the Tsunami in Indonesia, Polio cropped up again for the first time in many years.
Polio vaccination is required in California for day care or school entry, so most here are up to date, but it’s worth knowing your child’s polio immunization status before you travel this summer.

Unvaccinated man in Rockland County, N.Y., diagnosed with polio First U.S. case of polio in nearly a decade confirmed in unvaccinated 20-year-old in New York state, who traveled abroad this year.

Marin COVID-19 Update: BA.5 & Masks (July 19, 2022)

Marin COVID-19 Update: BA.5 & Masks (July 19, 2022)

Beginning today, July 16, if you are experiencing mental distress and need help, you can call or text 988 to quickly connect to the National Su***de Prevention Lifeline. Trained counselors are available 24/7 to assist with mental health and substance use treatment. You don’t have to fight alone. ***dePrevention

During checkups for 3rd and 4th graders I love to ask my patients what they are reading, and introducing them to the wonders of our local library system. This is why.

Timeline photos

Families should remember to choose an adult to be the designated water watcher while you’re cooking dinner or doing other activities. More tips from here: http://ow.ly/EAH250JRQXK

Novel Coronavirus (COVID-19) | Marin County Coronavirus Information

The proof is in the p**p, people!
I know it's been a long time since I've updated, combination of being busy in the office, trying to take some much needed vacation, and not a ton that was new or interesting enough that I felt it worth posting. Well, there are a few new things worth noting in our local COVID scene.
1. I am seeing the highest number of cases I have ever seen in the entire pandemic. Even in the original Omicron surge last winter I did not see this many cases. Back of the envelope math tells me about 1% of my total patient numbers have a new infection each day. Thats a lot if you consider in 2 weeks it's 15% of my entire practice! The Marin COVID wastewater surveillance data tells us why- the amount of COVID-19 virus in our wastewater is nearly as high as the Omicron surge last Dec/Jan (Check out the data page I linked to below). I predict we'll see even more after the superspreader event that was the entire 4th of July weekend.
2. I've been seeing a trend that I didn't quite understand- the infections themselves seemed to be getting worse. Omicron 1 was thankfully quite manageable. The BA2 version seemed a little worse, "like Delta and Omicron had a baby" I'd say on calls with my COVID+ folks: little more fever, more loss of taste or smell, more respiratory disease. Well recently I've been seeing... more. More symptoms, more severe symptoms, and worsening symptoms, including A LOT more big fevers to 102-103 degrees for several days. This puzzled me until I heard from public health last week that as of 6/28, already 40% of our cases in Marin were the BA4 and BA5 strains. I can't say for sure if this accounts for the changes I'm seeing clinically, but that's my guess. Each COVID variant has it's own clinical characteristics, and I'm clearly seeing something new that just started, spread fast, and seems a little bit worse. Consider that in your socialization decisions this next week! I'd certainly mask again for indoor activities like the grocery store, and try to keep social events outside in our lovely summer weather.
3. And finally, vaccination is clearly making a difference in terms of disease severity. In unvaccinated individuals of all ages I am seeing higher fevers, and worse symptoms overall. I'm seeing over and over that even in the same family, those that are unvaccinated are having much more significant symptoms than those who are not. Parents are experiencing much more stress about sicker kids, and I'm doing more video calls to assess for respiratory status, hydration, etc. It's also my unvaccinated patients who are getting long covid and for me that's one of the most compelling reasons to consider vaccination now, or a booster now, if you've been on the fence.

So, in summary, there's a ton of COVID out there, it's a little less friendly, very easy to catch, and you have multiple means to protect your family.
I am always happy to discuss with my families the pros and cons of vaccinating or getting a booster for an individual child, and what makes the most sense for them right now.

Novel Coronavirus (COVID-19) | Marin County Coronavirus Information Marin County COVID-19 Status Update for July 5, 2022 includes; pediatric vaccine update; 2nd boosters for older adults, and updated local COVID-19 data.

Timeline photos

To help ease the national shortage of baby formula, the U.S. government is importing several brands that weren't previously sold here. Healthy Children shares helpful facts, tips and more about imported formula for families: https://www.healthychildren.org/English/tips-tools/ask-the-pediatrician/Pages/why-are-we-seeing-baby-formula-brands-on-the-shelves-from-companies-i-havent-heard-about-before.aspx

My Toddlers Already Had COVID-19. I'm Still Getting Them Vaccinated

We had our first COVID vaccine clinic today for the under 5’s. I’m glad I am finally able to offer protection for these youngest patients. I got many questions today, but they all boiled down to “Do they really need it?”. My answer is yes. We won’t prevent your kiddos ever getting COVID, but we will reduce the risk of the worst outcomes, and that is what matters. A cold illness? Fine. Hospitalization for severe respiratory or cardiac issues? No.
The goal isn’t to eradicate COVID, it’s to prevent the worst case scenario.

Katelyn Jetelina, author of Your Local Epidemiologist, does a great job of explaining why here.

My Toddlers Already Had COVID-19. I'm Still Getting Them Vaccinated Why this epidemiologist and mom of two believes the benefits clearly outweigh the risks

Highly recommend this course for anyone who has ever birthed a baby. Mothers I’ve recommended it to still thank me years later for sending them!

Pediatric COVID vaccines for kids

Marin County law enforcement agencies are sponsoring a gun buy back event to remove unwanted guns from our community.
Marin County Gun Buy Back event – June 4, 2022


The event will be held on June 4, 2022, 9:00 a.m. – 1:00 p.m. outside the Marin County Sheriff's office located at 1600 Los Gamos Dr #200, San Rafael.
The event will be outside and cars will drive through the Sheriff's parking lot, staying in their car.
Fi****ms will be removed by Police/Sheriff from the trunk of the car.
Questions? Call 415 485-3070 or email City of San Rafael Mayor Kate Colin at [email protected]

We will be doing 12 and up boosters on Monday or Tuesday of next week and have a few extra doses if anyone needs.

A local therapy center is offering some camps for the summer that look great- options for girls entering 6th grade to help with the transition to middle school, and getting gamers outside and connecting with peers IRL.
https://wellspringpsychotherapycenter.com/services/groups-workshops-consultation/summer-2022-groups-camps/

MARIN IJ READERS' CHOICE

Thank you! Marin Independent Journal contacted me to let me know I'd received a "Best Pediatrician" award. There's a list of the four largest practices in the county, and then little old me. Thanks for your confidence and support. I'm happy to say the new practice is thriving. Once I have my patients settled in I'll be back taking requests for more updates.

MARIN IJ READERS' CHOICE

Photos from Marin County Government's post

TOO. MUCH. COVID. TO. WRITE.
Minor updates for today:
1. Keep a few rapid antigen tests at home (some iHealth are still shipping from Amazon) so that if your family gets COVID you can use them on day 5 to test out of isolation.
2. By special request, I am doing one afternoon of Moderna boosters next week, so let me know if you need one. I actually recommend Moderna boosters for most, as you may get a little better antibody response if you cross booster. These are only available for those 18 and up.
3. If it looks like a duck, and quacks like a duck, it's Omicron. In other words, if you've been exposed and are symptomatic, ASSUME it's COVID. If you have a positive home test, ASSUME it's COVID, and do not waste resources on a confirmatory PCR right now. This is straight from public health.

COVID-19 Status Update for 01/03/2022 | Marin County Coronavirus Information

Please note CDPH is asking for a negative rapid antigen test to get out of quarantine early at 5 days. I’m relieved to see this requirement.

COVID-19 Status Update for 01/03/2022 | Marin County Coronavirus Information Marin County COVID-19 Status Update for January 3, 2022 includes Updated Guidance: Isolation & Quarantine; FDA Greenlights Boosters for 12- to 15-Year-Olds; and updated local COVID… Read More

Happy New Year everyone!
Just a quick note regarding testing as the kids head back to school next week.
I suggest that every student be tested 1-2 days before returning to school. All the positives I have seen on home tests in the last two weeks have been true positives. Unfortunately, I am also seeing many false negatives on home testing- people who repeatedly test negative at home but on a DNA amplification molecular test in the office immediately test positive, as do their family members. So, if you have a positive on a home test or have symptoms, please try to get a rapid DNA test or PCR. Unlike other times in the pandemic, the vast majority of the families I am seeing with symptoms have COVID, so act accordingly.
Thankfully, Omicron seems to be causing much milder illness than Delta. Families are uncomfortable, but getting through and severity of illness definitely seems to correlate with vaccination status. Kids that were just recently vaccinated and parents that were recently boosted seem to be faring the best.
For my patient families, if you have symptoms or a positive home test please text the office to arrange for rapid DNA testing, accuracy is almost as good as PCR and the immediacy of results is really helping guide management.

COVID-19 Status Update for 12/22/2021 | Marin County Coronavirus Information

Omicron has arrived, sigh. The highly contagious variant has been confirmed in cases in Marin, and interestingly, detected in all wastewater cachements in Marin, so we know it's now widespread in the county. It appears to be much more contagious than even the Delta variant so this may be a time to reconsider holiday gatherings for unvaccinated or especially vulnerable individuals. My suggestion is to rethink indoor unmasked activities (Is everyone protected?). I would prioritize the most important activities and consider not attending large indoor events. Also consider testing before any gathering, although this is not foolproof, as the superspreader event in Marin in mid-December taught us.

The good news is that the cases I am hearing about in vaccinated and boosted individuals are mostly mild, so the vaccines we have are continuing to do their job. I have yet to see a recent case in a 5-11 year old with both doses as well, so hopefully the recent pediatric vaccines will help them get through safely. I am less concerned about severe illness in the families I care for and that is one blessing in this.

County officials told me yesterday that vaccine and booster appointments are being taken up as quickly as they can post them. They provided me with extra supplies of Pfizer vaccine for my office and we are doing what we can. I will have adult and pediatric vaccine days next week so let us know if you can't find a spot and need one. We are also doing a lot of in-office DNA testing (like PCR) via curbside swabs, for those exposed.

I hope you all can find some joy in the holiday weekend, even if it doesn't look quite as anticipated.

COVID-19 Status Update for 12/22/2021 | Marin County Coronavirus Information Marin County COVID-19 Status Update for December 23, 2021 includes an omicron update from Dr. Willis; Marin a Focus in National Conversation on Hospitalization Rates; California First State to Require Boosters for Healthcare… Read More

In the interests of getting our pediatric patients fully protected before returning to school in January, we have added an additional pediatric COVID vaccine clinic.
Pedi clinics: 12/28, 1/7, 1/21
12 and up (including adult boosters): 12/22, more dates TBD

The WISDOM Study - Join The Movement

I’m a participant in the WISDOM study- a landmark research trial working to find better ways to screen for breast cancer. We all know women affected by breast cancer and this study might help us learn how to detect it better. I hope you’ll consider joining the study- check it out online at www.thewisdomstudy.org!



Any woman in the U.S. between 40 and 74 years old without a history of breast cancer can join. It’s easy to participate, just go to the website to sign up and complete all study steps online.

I have a family history of breast cancer. So I was interested when I had the opportunity to participate in the WISDOM study, which is a multi center study looking at questions like- How and when do we need mammograms? As part of the study I got a free genetic screening to see if I was at risk for genetic types of breast cancer. For a few minutes of your time, participating is worthwhile.

To learn more about how WISDOM is impacting women’s lives in real time, check out a 4-part series in TIME magazine online featuring participants and the study founder, and follow WISDOM on Facebook. Please share this study with all the women in your life and consider joining today!

The WISDOM Study - Join The Movement The WISDOM Study is working to find the safest and most effective way to detect breast cancer for every woman. Join the movement today.

Boosters are now approved for down to 16 years of age.
We will be doing another COVID vaccine clinic 12/17, and one more the week of the 20th, possibly on 12/20.
https://www.cdph.ca.gov/Programs/OPA/Pages/NR21-350.aspx

So many families wanted COVID vaccines today that we are opening up additional spots. Please text the office if you need a pediatric or adult COVID booster today. 415-634-1004.

We are happy to announce we have been approved by the state and county as a COVID-19 vaccine site. We will be offering Pfizer only vaccines Friday afternoons from 11-7 for 5 and up primary vaccines or adult boosters. We will offer teen boosters once approved as well. Please call or text the office at 415-634-1004 to schedule an appointment for a vaccine.

Novato High is taking walk ins today from 9-5 for pediatric COVID vaccines. I’ve been thinking a lot about holiday gatherings and how to reduce risk. I chose to vaccinate my own 6 and 10 year olds and recommended boosters for their grandparents. Rapid antigen tests are also a decent day-of screen for gatherings. We have multiple vulnerable family members and this makes me feel safer about all of us getting together. Each family can take steps to reduce risk for their own loved ones.

We’re off to a great start in our rollout of pediatric COVID-19 vaccines in Marin County. Demand has continued to increase so we are adding new locations this week for families to get their children vaccinated.

Here is the latest schedule of available pediatric vaccination clinics offered by Marin County Public Health.

Note: Reservations are required. Space is limited. Recipients of a vaccine must be accompanied by a parent or guardian.
Our clinic schedule is subject to change as spaces fill up or new sites becomes available.

For updates on our COVID-19 pediatric vaccination clinics and to make an appointment, visit: http://GetVaccinatedMarin.org

Thanks for keeping our community strong!

Good morning everyone!
I am incredibly excited to announce today that I am opening my own Pediatric wellness- based medical practice. After 17 wonderful years at Pediatric Alternatives I am setting off on a new adventure.
My lovely new office in Mill Valley at 141 Camino Alto #4 will be staffed with the most kind, caring, thorough staff. Our website and electronic medical record will be fully integrated so you can book appointments online, view your records and my recommendations to you at any time, and you can email me directly with questions. You can even text us!

It has been a privilege to care for so many of you through this pandemic, and I hope you will come find me in my new practice. I will continue to take PPO insurance plans so that I remain accessible to my long term patients. Practice size will be limited so that everyone can get “special treatment” and have access to me when their family needs me. Prior patients will get priority for entry into the practice for the first 3 months.
Please check out my website at:
www.wellnesspedsmarin.com

Exciting news to share later this week. Stay tuned!

I spent my day yesterday volunteering with the Marin County Medical Reserve Corps to help with pediatric vaccines. I had the opportunity to support fearful kids, and monitor hundreds of kids for adverse reactions after their vaccination. I'm happy to report all the kids did beautifully.
This article explains why I am in favor of pediatric COVID vaccinations, and it doesn't even go into the mental health benefits of our kids being protected.
I just got my Moderna booster and my own children are vaccinated, and while we are still masking, being thoughtful, and following county guidelines, we are opening up. I love live music so I went to a concert last night (My first in nearly 2 years!) and the kids will be socializing more freely with vaccinated friends. I am hopeful that if we are careful over the holidays and children are vaccinated we may be able to loosen up on guidelines for pediatric masking next year.
Please consider the vaccine for your children. After some family feedback, I've cancelled the zoom for 11/16, and will be doing individual short consults so families can ask more personal questions about the vaccine for their kids.
https://www.sfchronicle.com/opinion/openforum/article/Yes-kids-5-to-11-need-a-COVID-shot-say-doctors-16583436.php?fbclid=IwAR3cnaPc8NAc8ga2_mCXFQ5ZlEHdWFYXEpqIGQuFOvXf4BEyHgcbo9aGaXw

Strawberry Point School and Northgate Mall sites are accepting walk ins and not busy right now if you are looking for a Pediatric COVID-19 vaccination appointment. I’m volunteering at Strawberry today and have already seen some of my patients.

COVID-19 Vaccine for Pediatrics | Marin County Coronavirus Information

https://coronavirus.marinhhs.org/vaccine/pediatrics

Pediatric COVID vaccination slots are now available and live for the large Marin County pod sites. FYI, it asks for last 4 of social, so ideally have that handy, but you can still register without it. I'll be volunteering at the Strawberry Point School Pod next weekend.

COVID-19 Vaccine for Pediatrics | Marin County Coronavirus Information Marin County COVID-19 Status Update for November 3, 2021 includes Marin Ready for Pediatric Vaccine Roll-out; Pediatrics… Read More

Marin Ready for Pediatric Vaccine Roll-out

https://www.marincounty.org/main/county-press-releases/press-releases/2021/hhs-covid-joint-pediatricvax-110321

Walgreens is already booking pediatric appointments in Marin and San Francisco. Kaiser opens up their scheduling links tomorrow.

There will be plenty of supply so no need for the mad rush this weekend.

Marin Ready for Pediatric Vaccine Roll-out Marin parents can anticipate expanded appointment access as COVID-19 vaccine supply arrives for the kids.

Join our Cloud HD Video Meeting

For those of you that have questions about the pediatric COVID-19 vaccine, here are some good options.

Zoom link: https://www.google.com/url?q=https%3A%2F%2Fus02web.zoom.us%2Fj%2F81025450050%3Fpwd%3DdmtBNGxlZkMvK0hwU2VvTE5rOVFyQT09&sa=D&sntz=1&usg=AFQjCNHyiYHYuhhwkY8QgxkcWJ90Q7ZOcg

Wed 11/3 the County of Marin and the School Board, in conjunction with UCSF, are hosting a talk. Guest of honor is my friend Ted Ruel, who was a chief with me at UCSF, and now is the head of the department of Pediatric Infectious Disease at UCSF. Ted has experience with the more severe side of COVID in pediatrics. Dr Nelson Branco, local pediatrician, will also be there with public health officials, to answer your pediatric questions.

The most common side effects reported with the dose being looked at for kids were low grade fever and muscle pain.

The link for the talk will be up on the Marin County Public Health Covid website tonight.

I will also be hosting a private zoom for my own patients on 11/16, which will be recorded and can be sent to patients by request. Please DM me here for the link.

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Been inundated with questions. I will update daily as I learn more and get live links to schedule.

UPDATE ON VACCINES for 5-11 year olds:
Approval from the CDC is expected tomorrow 11/3. After that, the vaccine safety and efficacy data will be reviewed independently by the Western States Consortium, and then the vaccine will likely be approved for pediatric use and available this weekend.

Marin County is planning a large pediatric vaccine pod at Miller Creek school this weekend 11/6 and 11/7, but these will be available by appointment only.
There will be additional clinics at Strawberry point school 11/13 and 11/14, and Novato High School 11/19 and 11/20. There will also be appointments available at certain pharmacies, the Kerner Ave clinic site, and the Northgate mall. Again, you'll need to make appointments for all of these.

As soon as I have information about how to schedule I will post it here. Watch the Marin County, or your local public health website, for more info.

The Real Scandal About Ivermectin

I get a lot of Ivermectin questions. It's worth understanding that not all science is created equally. Experts are having to evaluate study quality in real time. Much more work remains to be done to determine which outpatient drugs are effective COVID treatment options and which are not.

The Real Scandal About Ivermectin Claims about the drug are based on shoddy science—but that science is entirely unremarkable in its shoddiness.