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Individualized Care in a Warm
and Supportive Environment



Larry David ( Curb Your Warning)
It's not always  easy to avoid touching
our mouth nose and eyes)



Dear Parents,
In these trying times, it is important to stay in control of our needs, goals and actions, for ourselves and for our families; and most of all, not to panic.

As we are bombarded with a lot of facts, much of it conflicting, I have attempted to summarize some best practices given the present situation.

1.  I have copied and pasted NYC Dept. of Health recommendations for testing as follows:
Persons with COVID-like illness not requiring hospitalization are instructed to stay home. 
It is safer for the patients and health care workers and testing does not currently change clinical management or recommendations about staying home. 
There is no reason to test asymptomatic persons or mild-to-moderately ill persons who are not hospitalized, including HCW or first responders. Testing may play a more significant role after the pandemic has peaked.
IMMEDIATELY STOP TESTING NON-HOSPITALIZED PATIENTS FOR COVID-19 unless test results will impact the clinical management of the patient.
To summarize: If you have some fever due to a flu-like illness please stay at home. Mild to moderately ill persons are not presently being tested in office or at any responsible  local Urgent Care setting.

2. We are asking our patients to defer  well care visits for those children above the age of 6. Infants and toddlers should still be seen in office for well care and vaccinations when appropriate. Try to stay at home if you or your child has a simple  flu like illness,  unless they otherwise appears ill.

Many ill children in reality do still need to be seen in office, as it is difficult frequently to discern CORONA VIRUS from bacterial infections such as STREP THROAT,and  BACTERIAL PNEUMONAIE. And YES INFLUENZA A and B are still very much around.
When medically appropriate we will handle cases by telephone such as some rashes, cuts and scrapes, diarrhea, tummy aches, and medication refills.

3.  Should children play outside or go to the park?
Playing outside is important to keep both children and their parents sane in these trying times. Please remember that although frequently children do not get as sick as older adults with infection, they may still be assymptomatic carriers. Have your children play in their own yard. If you go for a walk at the  park, keep a safe 6 foot distance between yourself, your children and others. Keep in mind that playground equipment may be contaminated with this virus. The virus has been shown to be stable on hard surfaces for somewhere between 2 and 9 days.
Make sure they are not going over to play with the neighbors.
PLAYDATES ARE NOT OKAY. Instead of physically visiting with their friends,  have them connect via social media, text, and video chats instead. By infecting their playdates, they may be placing older adults living with them in grave danger.

4. Should my children visit their grandparents?
The answer should be an obvious NO. Older person's health can be buoyed by hearing and seeing  their grandchildren, but this should only be through electronic means; not in person.
I can not stress how important it is for families to continue to check on grandparents and stay in touch with them through telephone and social media, in the process keeping them safe from infection.

5. Should our children be taking vitamins?
Let's start with the AAP position that most children with healthy diets do not need any vitamin supplements. These are trying times and many of our children do not have healthy diets, nor are they in the sunlight enough for them to have sufficient stores of  vitamin D.
A daily multivitamin, therefore, is not a bad idea.
Additionally it was recently shown ( BJM) that persons who are vitamin D deficient, who took  vitamin D once to twice a month could decrease their incidence of viral and bacterial respiratory  infections by 30%. Those who took vitamin D daily could decrease viral and bacterial respiratory infections by up to 70%.
How much vitamin D is safe?
The US Food and Drug Administration (FDA) recommends for all of us 400 International Units ( I.U.) a day which is what we will find in most multivitamin preperations. For most older children and adults 1000 or 2000 I.U. per day has been shown to be safe and free of significant side effects..

6. Did President Trump say that I should take azithromycin (Zithromax)?
President Trump mentioned that anecdotally  persons who were very sick with COVID-19 have shown improvement with a combination of Zithromax ( an antibiotic) and Chloroquine ( an antimalarial medication). This has not yet been proven in any study, but has been used by expert physicians in special circumstances. Please do not take any of these medications on your own. In most circumstances antibiotics do not fight viral infections, and the side effects will likely outweigh any possible benefit.

7. Should I use Zinc throat lozenges?
Truthfully, I am not sure.  Coldeeze and similar products were shown in one study to speed recovery from viral respiratory infections. This study has been replicated a number of times since then with the results showing no benefit at all with their use.

8. If I have an essential business and need to go to work should I change my clothes when I get home?
No explanation is necessary. You may want to wash up and bathe as well.

9. Does Ibuprofen ( Motrin, Advil) worsen a COVID-19 infection?
I do not know. 

We will again quote the NYC  Health department in their latest memorandum:

At this time, there are no reliable data to support claims that the use of non-steroidal antiinflammatories (NSAIDs) may contribute to poorer outcomes in persons with COVID-19.
Until very recently, the World Health Organization (WHO) was citing theoretical evidence to advice against the use of non steroidal antiinflammatories, stating not to use ibuprofen to treat pain and fever due to COVID-19. The WHO now say they do not advise against it.

10. Will the virus go away once it gets warm?
I don't know. No one knows.

Some experts have espoused the theory that this will be the case, B H.
These experts also feel that the virus may be with us for the long term, perhaps seasonally, albeit in a form where it causes less disease, and most of us will be somewhat immune to it naturally or via vaccination.

11. Why do children and young adults frequently suffer less severe infection than older adults ?
COVID-19 affects persons of all ages. The city of  Los Angeles today reported the first death of a person under the age of 18 due to a Novel Corona Virus Infection. Those who are overweight, have high blood pressure  or diabetes are especially at risk, as well as those with underlying health issues or immune deficiency. Most commonly, and unlike the flu and other infections, children and young adults frequently have less severe infections. No one really knows why. One possible theory is that children may have some built-up immunity by exposure to other corona viruses in school or day care.

12. Where can I learn more about the present COVID-19 pandemic?
The best sources for information is the
Center for Disease Control and Prevention ( CDC).
as well as the 
New York State Health Department
New York City Department of Health
as well as the
World Health Organization.
For those with more time on their hands, who want information just a bit 
"out of the box," I strongly recommend Dr John Campbell's Youtube Channel. Dr. Campbell is a British retired Registered Nurse, also a PhD., who has some very special insights into this  situation, albeit  from an International perspective.

13. In summary:

Be safe.


Avoid touching eyes, nose and mouth

Why? Hands touch many surfaces and can pick up viruses. Once contaminated, hands can transfer the virus to your eyes, nose or mouth. From there, the virus can enter your body and can make you sick.

Practice respiratory hygiene

Make sure you, and the people around you, follow good respiratory hygiene. This means covering your mouth and nose with your bent elbow or tissue when you cough or sneeze. Then dispose of the used tissue immediately.

Why? Droplets spread virus. By following good respiratory hygiene you protect the people around you from viruses such as cold, flu and COVID-19.

If you have fever, cough and difficulty breathing, seek medical care early.

With G-d's help  we should all be and stay healthy, and we should all be able to tell our children and grandchildren years from now. 







Doctor Nass and his staff remain committed to providing the highest level of pediatric care, combining expert training, the latest medical technologies and 30 years of experience serving the community.

You can reach our office at (718)520-1070 for all of your pediatric needs.
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Howard Nass MD FAAP and staff

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