COVID-19: Social Distancing and Flattening the Curve – PediaCast 456

Show Notes 

Description 

  • Our COVID-19 coverage continues with an update on the pandemic and the important concepts of social distancing and flattening the curve. We also begin a series of check-ins with pediatricians across America and discover how coronavirus is impacting their families, medical practices and communities. First up: Dr Jaime Friedman from San Diego. We hope you can join us!

Topics 

  • COVID-19 
  • Coronavirus Pandemic
  • Social Distancing
  • Flattening the Curve
  • Update from San Diego 

Guest

Links 

Transcription

Announcer 1: This is PediaCast.

[Music]

Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.

Dr. Mike Patrick: Hello, everyone. And welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike, and I'm usually coming to you from the campus of Nationwide Children's Hospital. But today, I'm coming to you from my home and I'll explain why. You probably already know, but I'll explain why in just a moment. 

But first though, it is Episode 456 for March 18th, 2020. We're calling this one "COVID-19, Social Distancing and Flattening the Curve". I want to welcome everyone to the program. 

0:01:07

So things are going to be a little bit different this week and moving forward on PediaCast, just like everything else in life right now. I mentioned last week that we're going to start calling this a pandemic and boy, I really didn't want to be right about that. But just, you know, saw the writing on the wall, I knew it was coming, and here we are. 

My clinical job is that I'm a general pediatrician. As long-time listeners know, I work in a pediatric practice for ten years seeing kids. I now work with Emergency Medicine at Nationwide Children's and work in our emergency department and offsite urgent care centers. And from a pediatric perspective, that means that I am literally on the frontline of the pandemic, as kids get sick with it and families come seeking help. Because of that, from a professional standpoint, my number one priority is taking care of children. That has to come first before podcasting. 

0:02:10

So I've been blessed to be supported in this job and, in particular, by Nationwide Children's Hospital. And I will continue producing podcast as often as I can, but I'm also going to have to flex up on clinical time to take care of these kids. So, there may be some weeks that we do not have a podcast, but I will certainly try to get them out as often as I can because these two and you guys as my audience are all very important to me as well. 

So where exactly do we go from here? I wish I could tell you. I wish that I knew, but that's part of I think why there's so much anxiety, collectively, as a nation right now. Because it's not only the pandemic, it's also our kids at school, this whole idea of social distancing, and the fact that we really need to flatten the curve, which we are going to talk about as we move on in today's program.

0:03:07

But there's also the uncertainty of the economy and our jobs and just so many different things right now, and that creates a lot of anxiety. And I just want to say right up front that we truly are all in this together. 

And it's really time to reach out even if you can't do it face to face through social media to reach out and be there for people, and find out what their needs are and to come together as families and as communities, while keeping our distance by coming together virtually online and figuring out what each other's needs are and really being there for one another.

The time for partisan politics is over, unless until we get through this. We really do have to get through this national crisis together. 

And because we are in crisis mode, my plan for podcast moving forward, at least as I see it today and this could very well change, but sort of the format we're going to use this week, and I foresee this would be the format moving forward until things change. And that is, with each of these episodes, we'll start with just kind of a summary of where we are.

0:04:18

Tips, I want you remind you tips for protecting your family, what to do when someone in your family gets sick. I think it's really important to mention those things each and every week. 

Then, we'll also talk about something topical related to this pandemic. So, this week, we're going to talk about social distancing and flattening the curve. Which is going to be a little scary, to be honest with you. But I'm not going to make each and every week gloom and doom. There's going to be millions and millions of people who survive through this pandemic. And so, there's hope here too and we will not do all negative. We'll also focus on some positive stuff.

0:05:04

And in fact, then after we do a special topic, we're going to have an interview. And in my interview this week with Dr. Jaime Freedman who is a pediatrician in San Diego, we do talk about some of the hope stuff and the fun stuff and actually good things that hopefully would come out of this experience that we're all going through. 

So that then is sort of the format for future podcasts, a summary, reminders that are important, some special topic. Then, I'd like to really include an interview with pediatricians around the country and just see what's happening in each different communities because it's important to realize that wherever you are right now listening, you're not the only one with anxiety, you're not the only one with fear, you're not the only family that's going through this. There are other families out there too all across the America. And so, I do want to get the perspective and share it with you. 

So, as I mentioned, where we are, we're pretty much on track where you would expect a worldwide pandemic with a novel virus that no one really has good immunity against. We're where you would expect us to be.

0:06:14

So last week, I reported to you that there were just over 4,000 deaths worldwide from COVID-19. A week later, we're double that. It's just over 8,000 deaths worldwide. 

Italy has been really been very hard hit. And the reason is because just the sheer number of people who are all getting sick at the same time. And even if it's a small percentage of them that go on to need critical care and ventilators and that sort of thing, just the sheer number of people who are sick at the same time, even that small percentage that actually does have life-threatening problems, the total number is just too much for their medical system to be able to handle. 

And so, that is the fear that could that happen in the United States of America? It absolutely could. It may not happen everywhere at once. It's probably come to different cities at different times. 

0:07:10

And different cities will have different experiences with this. And a lot of the difference from one place to another is truly going to be how we practice social distancing and flattening the curve. And I'll explain why that is so important as we move on.

Here in Ohio, we are up to 88 confirmed cases. There weren't nearly that many last week. I don't remember what the exact number was last week. It was in a single digit a week ago. And we're up to 88 now.

Nineteen counties are involved in Ohio. We have 26 folks in the hospitals who are very sick with COVID-19. And so, that's the experience here in the Buckeye State. And I know that's the experience in probably your area as well. 

We have plans in place. We have fantastic leaders in Ohio. Governor DeWine and our director of Public Health, Dr. Amy Acton have really been all over this from the very beginning. And I've chronicled a lot of what they've been doing, what they've been telling us, what the instructions have been on Facebook, Twitter, and LinkedIn. 

0:08:17

So, if you're not connected with PediaCast on social media, please do find us and we'll get through this together. And there's lots that I'll be sharing on social media that will not make it into the podcast. 

By the way, as I looked at numbers, I mentioned this last week, fantastic resources, the Johns Hopkins University System Science and Engineering. And I'll put a link to that again in this program in the show notes this episode, 456, over at pediacast.org.

So, it's time, of course, to stop comparing COVID-19 to the flu. You still hear this a little bit that "Hey, don't forget the flu caused 50 million Americans to be infected since October. 22,000 deaths and this has only caused a much smaller number of fatalities." I think as of yesterday, we're just over 100 deaths now here in the United States. 

0:09:13

But I want you to keep in mind, we are at the very beginning of this. And before it's all said and done, there is going to be way more deaths from this pandemic compared to the seasonal flu. I think there's no question about that at this point.

So, it's time to not minimize this anymore. We really have to act now. Truly, we do. We have to act now. And the reason is because our public health officials, scientists, people who are informed epidemiologists who study pandemics, they're telling us that unabated, on the trajectory we're on right now, you can expect COVID-19 to infect about 220 million Americans and result in just over 2 million deaths from this particular virus in the coming months. 

0:10:08

Now, I don't say this to panic you. I say this to get your attention because the time to act is now. And now, these numbers, 220 million infections, over 2 million deaths, these are assuming that we do nothing, that we allow COVID-19 to spread through the United States of America unabated. 

But there are a lot of things that we can do to lower the number of infections and deaths from COVID-19. And medical experts and public health officials tell us we can reduce that burden by 60% to 70% through certain actions. And then, that will lower our number. Instead of counting them in millions, sort of best-case scenario, we could be able to get that down to about half a million, to about 500,000 or 600,000 deaths. 

And that's best-case scenario right now, unless some miracle happens, unless summer gets here, or spring and it goes away completely. Or a vaccine is fast-tracked and shown to be effective quicker than we expect.

0:11:16

But aside from those kinds of things or just a plain  miracle, we can expect hundreds of thousands of deaths from this. But if we don't act, then we are talking millions of people who may die from COVID-19. And this is the reason that states all across the country and cities everywhere are taking what just a few days ago folks would have looked at as extreme measures. 

Turns out they're not extreme, this is real. And we really want to reduce the number of American deaths from again 2 million down to half a million if we can. But the time to act is now. 

So, what do we do? Where do we go from here? Well, the first is, to just stop and take a few deep breaths. All of us collectively are feeling anxiety and fear, and many of us are parents and we see anxiety and fear in our children, and we want to be there for them and support them. And they’re watching our reactions.

0:12:18

And so, the first thing that you really have to do is just when you feel yourself really anxious to stop and take a few big deep breaths, in and out and just let yourself be. And you will feel, you will feel that anxiety wash away a little bit. 

On the other hand, that anxiety is protective. It helps us, "Look, we need to listen to our public health officials. I'm anxious about this, I want to look to what they're instructing me to do and follow those instructions so that we can flatten the curve."

The other thing that we can do is arm ourselves with good information. When you're on social media, you're seeing not always the best news and you see a lot of exaggerated headlines. And so, I would encourage you to get your information from trusted sources. 

0:13:09

One of those is going to be the Nationwide Children's Hospital COVID-19 Information Center. It has great information about this whole pandemic, when should you worry, what should you do. Of course, when should you worry, we're all going to worry. But in terms of your child's health and the specific symptoms that they're having, when would you worry about those symptoms, and what do you do about them, all outlined in that COVID-19 info page.

Also, some great blog posts, What Parents Need to Know About Coronavirus, How to Talk to Your Kids About COVID-19, How to Help Kids Deal with School Closings and Cancelled Plans. It's another blog post there that you'll find. 

And then, of course, the podcast that we did last week, you'll find that there on that page, but also wherever you find podcasts. And I'll put a link to it as well as all of these resources in the show notes for today's episode, 456, over at pediacast.org.

0:14:00

But last week, in PediaCast Episode 455, that was called "Coronavirus COVID-19: What You Need to Know." And really, we just covered lots of information about the virus itself, which is SARS-COVID 2, the disease that it causes which is COVID-19, coronaviruses in general, how they make you sick, what symptoms you can expect, how it's diagnosed and treated, complications, preventions, all of that packaged up for you. And it really forms I think a good foundation of evidence-based knowledge as we traverse this pandemic together.

So please do check out last week's podcast if you haven't already listened to that. Also, in the show notes, I'm going to include some resources from the Ohio State University Wexner Medical Center. They also have a terrific COVID-19 information page. 

One terrific blog post called How to Cope with COVID-19 Stress. Another, How to Talk to Your Children about Coronavirus and Ease Their Anxiety. So that's another blog post, again, all these links in the show notes. And then, of course, the Centers for Disease Control and Prevention. They have a terrific COVID-19 page as does the Ohio Department of Health.

0:15:13

And I'll put links to both of those in the show notes. If you're not in Ohio, Google your state's name and Department of Health. You'll find it easily and I'm sure they will have up-to-date information about this pandemic right there for you, easy to get to. So please do check out their information as well. 

All right, so what are the important tips that you need to know to protect your family? You've heard this over and over again. You're going to hear them from me each and every week because I want to remind you they are that important. 

We want to be washing our hands frequently. Soap and water is preferred. Alcohol based hand sanitizer works in a pinch. In addition to your palms and the tops of your hand, make sure that you are getting between your fingers, and including your thumbs. 

So really wash those hands well, 20 seconds when you're lathering. And pick a song to sing to and kind of get a little joy out of this. So, pick a handwashing song and hum it to yourself. Twenty seconds is the goal. 

0:16:12

Avoid touching your face with unwashed hands. Of course, stay home when you are sick. And this include cold symptoms even without a fever. If you have a runny nose, congestion, cough, please stay home.

Avoid close contact with people who are sick. When you cough or sneeze, do so into the inside of your elbow or into a tissue and then throw that tissue away and immediately wash your hands, very important.

Also, clean and disinfect commonly touched household surfaces every day. It's going to be really important to clean those surfaces and doorknobs and toilet handles, sink faucets, all these things that are touched, make sure that you clean and disinfect those daily with a household cleaner.

0:17:00

Also, you want to definitely refrain any contact, any significant contact with at-risk individuals. Even if you are seemingly healthy because we do know that healthy folks can have very mild symptoms or no symptoms at all but can still pass this to people who are at risk. And in particular, we're talking about those who are over the age of 60, those with heart disease, chronic lung disease, cancer. Maybe they are on chemo, any folks with immune system problems.

And with these chronic underlying conditions, we're talking about folks at any age, not just over 60. Any age with underlying medical conditions, you want to really minimize your contact physically with those folks. 

Now, they are still going to have needs, right? Especially if you are a high-risk individual, it's going to be really scary to think about going out grocery shopping or how you're going to get your meals. There's all sort of things that we need in life. And so, we are going to need to come together and provide that support, but you want to be able to provide it with as little physical contact, especially prolonged physical contact as much as you can.

0:18:09

It's best to visit online. Use FaceTime, talk on the phone, find out what folks need, get it for them and drop it off at the doorstep and let them pick it from outside. Wash your hands before you handle anything that you're giving to them.

So, just we really want to keep our distance now from those who are at risk. And you know, we've come to the time now when we really even have to start to maintain strict social distancing, which we're going to talk more about. And that just means listening to your public health officials and doing what they tell you to do in your community. 

And for most of us, that is going to be staying home except for essentials. So that's why I'm coming to you from home because I want to practice what I preach. I have to go to the hospital to take care of kids during my clinical shifts. But if I'm doing podcasts, I'm going to do it from home because that's the safest thing for me. And it's the safest thing for at-risk people that I may come across as I'm out and about.  

0:19:06

So that's the reason that the podcasts are coming to you from my home again, which is really full circle, because back in 2006, when we started PediaCast, I did it from home, before we had the studio at the hospital. So, it's kind of like coming back home.

It also means the quality is not as good because this is mobile equipment, but hey, we're here. And we're happy to get shows out for you.

Those are the ways that you can keep your family safe and protect your loved ones who are high risk. Now, what if your child gets sick? What if they have runny nose, congestion, fever, cough, shortness of breath, sore throat, nausea, vomiting, diarrhea? You know, all the illness stuff, what do you do when that happens?

Well, if their symptoms are mild, just give them supportive care at home. Lots of fluids, you can use fever reducers, and just be there, love them, support them, help them get through it like you would a mild illness any other time of the year. 

0:20:05

If they have moderate to severe symptoms, call your doctor. So, call your doctor before you just take them to get information about how your doctor wants to handle that. Some practices are doing well checkups in the morning, sick visits in the afternoon or vice versa. 

So, they may have a different protocol than what you're used to in terms of just going in. So, you want to call ahead and describe your child's symptoms. They may give you advice on what to do at home. They may say, "Okay, come on in but here are the rules." Or, "We're going to order a COVID-19 test for you." That could be a possibility and you might be able to avoid coming in.

Don't show up in urgent cares or emergency rooms without talking to your doctor first. And if you are going to go to an urgent care or an emergency room, not a bad idea to call ahead, let them know, let them be prepared that you're coming and what your child's symptoms are. 

Because if your child has COVID-19, you don't want to infect others who do not have it. And if your child does not have COVID-19, they just have a regular cold, you don't necessarily want them to get exposed to COVID-19 and then have that on top of the regular cold. So just want to be really, really careful. 

0:21:20

Now, if your child has severe symptoms that you're worried about, they're wheezing, they're having trouble breathing, they're making noises when they breathe, obviously, you need to get help right away.

And so, call 911 if you have to, if you're on your way into the urgent care or into the hospital, just call ahead and let them know, "Hey, we're on our way." If it's not quite up to the point that I need to call 911 but it's more serious than my doctor's not calling me back and I'm not sure what to do. 

So there is that sort of middle road where you're worried is apparent, not quite to the point of calling 911, but your doctor's busy, they're not getting back to you, and so you're just going to go in, just pay attention to any signage that you see and call ahead if you can.

0:22:03

So, we want to avoid just short of showing up when we can but understanding that there are still other medical emergencies that need to be attended to in urgent situations. So, if you're worried about your child, don't stay at home worrying about if they're too sick to be at home. Call your doctor or get them seen in that case. 

Okay, so in terms of flattening the curve, what does this mean? And I think many of us, if you've been paying attention to the news, you understand this idea of social distancing and what we mean by flattening the curve. 

The reason we're expecting the death rate to be so high is simply because the medical system becomes overwhelmed with the sheer number of critically ill patients all seeking help at once. We just don't have enough hospital beds, don't have enough ventilators. So, we have to slow the infection down and actually make it last longer. But if all those illnesses happen over a longer period of time, then we're less likely to overwhelm the system all at once.

0:23:05

So, you've seen the graph, right? With the dotted line that shows this is the current healthcare capacity. Then there's two curves, there's a big spike that goes way above the healthcare capacity. And that is if you let the virus be and takes its natural course and it goes unabated, you're going to have a lot of deaths, not only from people with COVID-19 who gets severe disease, but all the other things that happen in life, heart attacks, strokes, car accidents. 

People have emergent needs and if all the critical care beds and all the ventilators are filled up with overwhelmingly number of sick patients with COVID-19, there's less capacity for all those other things. And so, we have deaths not only from the virus but also from all these other things that happen as well.

And so, we want to really flatten that curve. There are two curves on that chart, one goes way up above the dotted line and the other one goes just below it and lasts longer, but we still maintain within the capacity of our healthcare system. 

0:24:09

And by the way, if you have not seen this graphic, it's everywhere. But if you've not seen it, I will have a link to it in the show notes at 456 over at pediacast.org so you can see exactly what we're talking about. 

So how do we flatten the curve? Well, it's with this idea of social distancing. And here's where it's up to us. There had been hardships called upon many generations in the history of this country. World War II definitely comes to mind, where a generation really stood up and made a sacrifice for this country.

Right now, it is our turn. And what we have to do is we have to listen to our public health officials, follow their instructions and socially distance ourselves so we do not communicate this virus back and forth, and especially to those high-risk individuals, put them at risk of this infectious disease. 

0:25:05

Now, you may be asking can this really work? Well, if we look back at the Spanish flu of 1918... And by the way, I just want to make a point quite off the top as we talk about the Spanish flu. The reason it's called the Spanish flu is not because it started in Spain. That's not the reason. 

We don't know where, the flu pandemic of 1918, we don't know where it started but it was during World War I and countries had censors so that the enemy wouldn't get information about what was going on in that particular country. And so, if you have a flu pandemic and lots and lots of people are dying, you don't really know that that's necessarily happening in the rest of the world. And you don't want your enemy to know that's happening because that's a vulnerability.

So, they got censored. The news of the flu everywhere around the world got censored. And people didn't know it was happening. And of course, all news kind of went through, flowed through those war censors because we didn't have the Internet and digital media, obviously, during that time. 

0:26:03

Well, Spain did not have war news censors during World War I. And so, the news of the pandemic, the flu pandemic, was released to the world through the Spanish press. And so, the perception was, "Oh, look what's happening in Spain." And so, that's how it became known as the Spanish flu. So an important part of history to understand why it's called that. We don't blame the Spanish for starting the Spanish flu. We just heard about it through them.

Well, during that epidemic, there were two cities that handled things very differently. So, St. Louis, they did what we are wanting to do now. And in fact, public health officials and epidemiologist, they look back at what St. Louis did as a model. And they did what we're asking the country to do today, what your public health officials are asking you to do. And that is to stay home. 

They canceled school. If you didn't have an essential job to public safety, you just stayed home. Yu didn't go to gatherings. You didn't go to church, you didn't go to parties, you didn't go out to restaurants, you just stayed home and socially distance yourself. 

0:27:14

Now, compare that to Philadelphia who held a parade and did not do any social distancing. And Philadelphia had many, many many more deaths, not only in terms of pure numbers because it was a larger city than St. Louis, so you wouldn't expect them to have large numbers. But the percentage of their population who died in Philadelphia was much greater than in St. Louis. 

In St. Louis, there was the protective effect of flattening the curve. And that's what we're trying to do with this pandemic. So, if you look at that chart, Philadelphia was the big spike that overwhelmed their health care system, whereas St. Louis was a longer flattened curve. And so, the illness lasted longer but there weren't the big spike in cases that overwhelmed. It stayed mostly within the capacity, and because of that, there were far fewer deaths.

0:28:07

So, what's happening in Italy right now is that spike where the healthcare system is overwhelmed. And they have to choose who gets put on ventilators and who dies. Doctors have to choose which patients are we going to intervene in? And that's just a horrible, horrible position to be in from all aspects, from the doctor's point of view, from the patient's point of view, from the family's point of view, everyone. 

So, it can be done. We can take what's expected to be unabated without interventions, 2 million deaths. We'd rather be in the hundreds of thousands, and we'd like for it to be none, but we have to be realistic. And so, we really do want to get that number as far down as we can. And it's going to take all of us coming together to listen to our public health officials and what they're asking us to do.

A couple of other things for you in the show notes, one is St. Louis versus Philadelphia. It's graphic of the 1918 Spanish flu experience and the difference between those two cities. 

0:29:11

Also, What is “Flattening the Curve,” and Will it Work? is a terrific article from Live Science that I would recommend. And then, I love this from the Washington Post. It's called Why Outbreaks Like Coronavirus Spread Exponentially, and How to “Flatten the Curve”. And it's got a little diagram with moving balls that kind of show you how infectious diseases like these pandemic viruses can spread exponentially.

So, it's really got a cool way of explaining it, so I would recommend that. All of these resources are going to be in the show notes for you. 

So, what does social distancing then look like in your area? Well, here in Ohio, and all of these directives have come out just in the past week, since our last podcast together. And as I mentioned, Governor Mike DeWine and our director of Public Health, Dr. Amy Acton, they have been superheroes in terms of advocating for Ohioans and leading us through what we need to do to socially isolate ourselves. 

0:30:07

And basically, this means staying home as much as possible. Work from home if it's possible. And in-person school has been cancelled at least for three weeks, probably longer than that. 

The bars and restaurants have all closed to in-restaurant dining. So, it's all carry-out and delivery and gyms, theaters, casinos, pretty much any indoor entertainment venue has been closed. 

They recommend avoiding gatherings of 50 or more. Although the federal government would even say 10 or more people in rooms is too many. You want to be less than 10. So, work meetings have all gone virtually to Skype. As I said, even producing a podcast has gone to home. 

Churches here in Ohio are streaming their services and finding ways to engage digitally with each other so we don't put at-risk people at more risk. 

0:31:01

What about daycares? So, the daycares are still open at this point. We have to keep in mind that in young children, COVID-19 may show up as very mild viral upper respiratory tract infection. Your little snotty nose, they don't have to have terrible cough and high fever. They may have just a very mild cold or no symptoms at all.

And both of those scenarios, the virus can be passed on to at-risk adults. So, we have to keep that in mind. So, if your child has to attend the daycare, realize even if they are completely normal, no symptoms at all, you have to sort of assume that they could be carrying COVID-19 and really keep your kiddo away from at-risk individuals. That's going to be so important.

And if you're able to find alternate care and not have your child in a daycare, that's probably preferable at this point from the safety standpoint. On the other hand, you don't want that alternate care to be a high-risk individual. 

0:32:06

So, you don't want to put your child in a daycare and then have grandma and grandpa watch him, because they're going to be at risk to grandma and grandpa because they are high-risk people. So, you got to keep all of this in mind. And of course, this is going to create hardships and we definitely are going to need to come together, as a country, as a community, as families, and help one another out.

There's going to be unemployment. Many people will lose their jobs. Here in Ohio, they're offering immediate unemployment benefits for any worker who does not have paid leave and that includes hourly employees. You've heard about economic stimulus packages that are being suggested now through the federal government. So, we'll see where that goes. 

And with school out, many kids rely on a lot of services for school beyond just education and that includes meals. Ohio is continuing to provide school lunches. Although how individual districts make that happen differs from one place to another. But that may be a source of how you can reach out and help your community, in terms of lunches and services and things that people need that were provided by schools and other social service industries within a community that provided those things, that can't do it as well now. 

0:33:20

And of course, we want to check in with each other and use social media for good. Let's come together. Let's stop the partisan bickering and really, we need to come together as Americans. Your community needs to come together and be there for one another. Really, check in with each other as much as possible. 

So, as COVID-19 continues, we'll cover lots more special topics like we just did with social distancing and flattening the curve.

Very important, please stay home. Let's flatten that curve and save lives. This is our calling. This is how Americans today can be the generation that step forward and did what we were called to do and save millions of lives. We can do that now within our grasp, but we have to take this seriously and that is by staying home, if it's safe to do so. 

0:34:11

So, we will cover more special topics and then I'm going to try to provide some interviews for you too from pediatricians around the country so you can find out what's going on in different areas. It always makes you feel a little better when other people are going through the same trials and challenges that your family is going through.

And, of course, that's happening on the community level but it's happening all across the country. And so, I did want to take the time to talk to other pediatricians and see what things are like for their families and their practices and their communities. 

This week, that's going to be Dr. Jaime Friedman. She's a pediatrician in San Diego, so I'll be very excited to get her connected with the studio.

Real quick, I want to remind you that the information presented in our podcast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individual. If you have a concern about your child's health, be sure to call your doctor. 

0:35:03

Again, call your doctor. See what they want you to do. If your child is having a significant medical issue, call 911. And if you really do just need to go to your doctor's office or urgent care, emergency room, please call ahead and let them know that you're on the way, especially if your child has fever or respiratory symptoms including cough.

All right, let's take a quick break. We will get Dr. Jaime Friedman connected with the studio and then we'll be back to talk with her about this pandemic. It's coming up right after this. 

[Music]

0:36:06

Dr. Mike Patrick: My guest today is Dr. Jaime Friedman. She is a pediatrician and serves as director of Marketing for the Children's Primary Care Medical Group in San Diego, California. 

She joins me to talk about the COVID-19 pandemic and in particular to share her experience in San Diego, as it relates to coronavirus in her family, medical practice and community. So please join me in welcoming Dr. Jaime Friedman. Thanks for visiting us today. 

Dr. Jaime Friedman: Thanks for having me. 

Dr. Mike Patrick: Really appreciate you taking time out of your busy schedule. So, I wanted to just do a quick check in right off the bat. How's your family doing with all of this, this craziness that is going on in our world today? 

Dr. Jaime Friedman: We're doing okay. My kids are teens, so having them at home isn't as impactful I think as young kids because they can pretty much take care of their selves as far as making food and cleaning up. Right now, their school actually did not prepare any academic work. So, they don't have a lot to do, but they find time to keep busy and I give them some chorea because I'm still working. So, I give them some things to do. 

0:37:13

And their dad is home. My husband has some medical issues so he can't go out in public. So, I've been mostly in charge of bringing home groceries and keeping everything clean. So, they're not alone. They're here hanging out, doing the best they can.

Dr. Mike Patrick: Do you guys have other high-risk relatives that you're checking in on, but you don't feel you ought to go necessarily and visit them?

Dr. Jaime Friedman: Yeah, my in-laws are in town. And I told them I would drop off groceries if needed. My mother-in-law keep going to Costco. And I'm like, "You kind of should stop." She loves Costco. So, I'm prepared to get it delivered to them and do what needs to be done. They seem like they're doing okay though. 

Dr. Mike Patrick: Yeah. And it really is a situation I think we're all going to have to come together and just help each other, especially folks who are in high risk groups for sure, checking in and doing what we can. 

So school is out. What other kind of social distancing measures are in place in San Diego? Is it just schools or they closed other things, too?

0:38:19

Dr. Jaime Friedman: Pretty much in the state, all main gatherings have been canceled. And so, sports are canceled and swim classes. I mean, this is stuff I'm hearing from patients as well. So, swim classes and dance classes and pretty much everything has been canceled. 

A lot of parents are canceling birthday parties. Obviously, big events. I mean, it's really trickling down to almost everything. Everybody is having something that they'd have to cancel. 

My kids had originally asked if they could have friends over. And I finally was like, "No, that's not the point. We're not going to do that."

Dr. Mike Patrick: Because the next thing you know, you have a classroom in your house, and it defeated the whole purpose.

Dr. Jaime Friedman: Right. I just don't need that in my house. I'm fearful enough as it is that I'm bringing home this virus from work. And again, with my spouse having some health issues, it's just that it's not something I can risk.

0:39:17

Dr. Mike Patrick: I work in our emergency department and my wife is a nurse in our urgent care system. And we both have the policy that when you get home, scrubs immediately go in the washing machine, and your body goes in the shower completely.

Dr. Jaime Friedman: This week, I've been keeping clothes in the garage. So, I change when I get home. And I actually started wearing my white lab coat from way way long time ago when I was working in the ER. It says emergency medicine on it because that's how old it is.

Actually, today, I'm going to put everything into the laundry. So, I've been changing when I get home. Then I clean my phone and then I wash my hands and I'm trying to do a lot of the wipe down when I get home, too. But really, until I get home, nobody from the outside world has been in the house. 

Dr. Mike Patrick: Yeah, that makes sense. Where are you getting your information? Where are you staying up to date? How are you doing that? 

0:40:16

Dr. Jaime Friedman: It's overwhelming how much information is out there. And even though I'm not super busy with patients because people are being told to stay away, I feel like I'm busier than ever just trying to keep up. I come home, and we're watching MSNBC or CNN. I'm reading emails all day from our chief medical officer. I'm looking at the CDC website. 

I'm talking with my partners. I'm seeing what people are putting on social media. Since I do a lot of social media, I'm constantly scrolling through. And it's really actually too much. 

As far as my practice is concerned, we are basing our practice and what we're doing on what our chief medical officer is kind of gathering from the CDC for us. So, we're doing everything in a very cohesive way so that we have the same messaging especially with our hospital, our children's hospital that we're integrated with. 

0:41:13

Dr. Mike Patrick: Yeah, that makes sense. I agree, it can just become overwhelming. And I find myself on social media way more than I feel is healthy for me. Because the longer that I'm on there and the more stories I see and click here and there, the more anxiety starts to well up in myself. Have you noticed that with you, too? 

Dr. Jaime Friedman: Yes, I totally agree. And then, you start reading about people on the frontline who are getting sick and doctors and, you know. I'm not trying to bury my head in the sand, but at the same time, right now, actually when I'm at work, because we're not seeing other patients, and we're not seeing it in kids yet in San Diego and my patients have relatively either they're coming for checkups or they're coming for normal stuff we see like croup and ear infections, I feel actually really comfortable at work.

0:42:06

And then I start to read the news or read post and then it's like, oh gosh, then I feel really more anxious. And so, I do have to put some limits on that because I got to maintain some sanity around my patients and around my family. 

Dr. Mike Patrick: I got to tell you, I feel the same way, like when I'm working even in the emergency department, I have PPE when I need it, we have policies in place. A lot of the kids who we think are potential risk get sort of sidetracked into testing if they meet the criteria for testing. And so, a lot of the folks then who actually get through are not respiratory things or they're injuries. 

And as I'm with my colleagues and other doctors and the nurses, you have the feeling that we're all in this together, and we're going to fight this thing. And then, when I get home and look at social media, then that's when the anxiety goes through the roof. 

So, I mean it is good to stay connected. But you want to measure it, right? 

0:43:04

Dr. Jaime Friedman: It's good to stay connected and stay informed. We want to have latest information. I think that for us, as doctors, this is so hard for us because we work on just years of experience and research and data and evidence based. I have a colleague in my office who's just very on top of everything. He reads up to date for almost every patient. 

So, this is so hard for him because every day, it's new information. And without consensus to say, absolutely, this is what we should all be doing, it's really, it's not in our real house to kind of fly by the seat of our pants like this.

Dr. Mike Patrick: What are you seeing from parents and families in your practice? What questions have they been asking you? What sort of concerns are you seeing among your families?

Dr. Jaime Friedman: Last week, a lot of it was should they keep their kids home from school? And also, a lot of letters, like, "Can you write a letter saying they definitely don't have it?" And I'm like, "No, I can't." 

0:44:07

And so, the schools being canceled actually took a lot of that pressure off of parents and off of us. Whether it's the right decision or the wrong decision, it was helpful from that perspective. 

This week, I'm seeing some patients who are very anxious about coming into the office. They don't want to be out in the world. They don't want to be exposed. They don't want to get anyone sick. They don't want themselves to be sick.

Some patients are really just tearful about the lack of testing. So, it can be really hard to reassure them because again what data we have now may not be the same tomorrow. So, nothing is a guarantee. But the main concern really for them is they don't actually want to be anywhere. Our numbers have dropped dramatically, totally tanked. 

Dr. Mike Patrick: I think people are taking this social distancing thing seriously. And that's my hope across the whole country that people are listening and whatever their local public health officials are advising them to do, that they see the gravity of this and take those things seriously.

0:45:09

So, it's good to hear because we found the same thing. Our numbers are way down in urgent cares and emergency departments. Again, I think because folks really are taking this seriously and staying home. Unless your kid really does have an issue, at least call your doctor and find out what you ought to do so they can be prepared for your coming, especially if they have a fever or respiratory problems. 

Dr. Jaime Friedman: Right. In our group, we really want to be there for our patients and while the messaging globally is, if you have mild symptoms, stay home or you don't need testing, or whatever, we're still letting parents know that we're taking every precaution. We're doing well visits in the morning. We're seeing sick patients in the afternoon. 

We're doing screening at the door. Parents who have been exposed or sick are either told to wait in the car if there's more than one parent or are given a mask.

We have our own PPE. We're doing deep cleaning each night so that we can be prepared for the well visits in the morning. I mean, especially kids who happen to be babies. They're on a schedule with development and immunizations, they need to keep their checkup.

0:46:11

And so, we're trying to keep a sense of normalcy but they're being told so much to stay away that I think they're afraid to come in. And so, we’re just hoping that they at least call or do a video visit because we have video visits in our group as well if they have question. We are available. At this time, we're available until we're told that we can't be. 

Dr. Mike Patrick: And I would think that would alleviate a lot of anxiety for parents because when you are told stay home and then you feel like what do I do if I'm worried? Who do I call? So, it's great to know that they can get a hold of you. 

And I think from other pediatricians that I've talked to around the country, even in our local area here in Central Ohio, really, the same way they're encouraging, you know, call us. If you're worried, call us and we'll give you some advice on what to do, where to go, how to get there, that sort of thing.

From a community standpoint, have you had the toilet paper problems like so many other places in terms of trying to find them? I mean, anybody who has toilet paper in their cart now, maybe they really needed it at that point. But are they running off the shelves? Like limit one at Costco. 

0:47:14

Dr. Jaime Friedman: What's interesting is the other day, I went into the bathroom in my office and looked at the shelving with all the rows of toilet paper. And I had this fleeting thought of like, "Wow, I could make some good cash with these." Obviously, I would never do that. 

Dr. Mike Patrick: Yeah, yeah. You'll get kicked out of Amazon Marketplace.

Dr. Jaime Friedman: Well, you know, when things started really ramping up and my husband and I talked about should we stockpile stuff? And it was like, yeah, no, even if there's an outbreak or pandemic, and this is a couple of weeks ago, the thinking is that this isn't like a natural disaster. We'll still have electricity and we'll still be able to go to the store. We'll still have running water. And so, but then you know he's like, "Well, we have fires here and earthquakes here, let's get stuff."

0:48:01

And so we ordered pasta and rice and toilet paper and paper towels before it was hard to get. So, we kind of got some stuff. But I'll tell you Friday after work, after schools were canceled when all of a sudden, everything just shifted. I went to two different stores. And it was bare, it was empty. I mean, except for ice cream which was I got ice cream.

I was able to get like sliced meat, I wasn't able to get chicken or ground beef or milk, canned. Anything pasta was out at that point. And, of course, the toilet paper and the cleaning aisle was empty. And since that time, I've been to three other stores and it's been hard to find.

So, I think that it's pretty much... I don't really understand the toilet paper issue. I mean, I guess if you're stuck at home and you couldn't leave, like if someone was truly quarantined and couldn't go to the store or you couldn't order on Amazon because of backup or whatever the case maybe and oh my gosh, really need toilet paper, obviously, that makes sense. But for most families who are home, at least one parent or a neighbor can go out and get your stuff. 

0:49:11

Dr. Mike Patrick: I don't understand it, either. It must just be one of those things. When everyone starts to doing it and you notice that it's going low, you think, "Well, we could be out for a while and I need to grab one of those, too." And next thing you know, they're just all completely off the shelf. 

Dr. Jaime Friedman: It's a snowball effect. You know, when I was growing up, I grew up in the East Coast, where we have snowstorm. So, the snowstorm was coming, it was really like buy bread and milk. That's what we'd go from the store. I mean, I was young, I don't remember, but if toilet paper was as much of an issue. But at that time, it was bread and milk. I guess now, the thing is toilet paper. 

Dr. Mike Patrick: Yeah, well, even my daughter was sending me, texting me pictures of Walmart that she was at, and the bread aisle, there was like a single loaf. And the meat aisle, there's a couple things of bacon. Like it was just cleared out, the Walmart was. 

Dr. Jaime Friedman: Cleared out.

Dr. Mike Patrick: And the water aisle completely gone. But from what I understand, they do have trucks coming in. It's not like there's a problem with the supply on the other end. I mean, the companies are still making the stuff and bringing it in, it just leaves the shelves as soon as they get it. 

0:50:11

Dr. Jaime Friedman: Yeah, so Sunday morning, I was like okay, I got to go back out to the store. So, I went to Trader Joe's because my friend texted me and said that they had chicken. I'm obsessing about chicken. And they didn't have it. 

And it was like for a moment, I just want to cry. I don't even know what to do. I don't know what's going to happen. I can't send anyone in my family out to the store besides myself. My son drives but my husband can't go out in public because he can get sick. 

So, it was just so stressful, and I asked them when is stuff going to come? He said, "Well, there's a truck now." So then, I went back to the back where they were unloading and these people, they're such heroes. We're heroes in the healthcare workers. I mean they have all a crowd around them of people waiting for stuff. And I was able to get some ground beef, but no chicken yet. So, I'm going to try today.

0:51:00

Dr. Mike Patrick: Yeah, I hope you're able to find some. In terms of inside your home, are classes, you said that they don't really have anything planned. And is that what they're going to do the rest of the year? Or is the school trying to get themselves to figure out what they're going to do?

Dr. Jaime Friedman: I hope that's not the rest of the year. According to our district -- I guess they weren't ready or prepared -- so this week was called a non-academic week. My kids are both in high school. So my son, he records music which is the studio that I'm sitting in. So, he's been working a lot and he does this digital composition stuff at school, so he's been doing that kind of stuff.

My daughter works on their yearbook, so she's been doing a lot of her spread. So they've actually found things to do. But as far as actually busy work or academic work, in our district, that hasn't come out yet. I'm hoping next week, there will some more information. 

Dr. Mike Patrick: I think that increases the anxiety, just that unknown. Even with what school's going to do, how long is this going to last. And the folks who then have graduations coming up. All those things are getting canceled at least here in Ohio, and then that causes stress. 

0:52:13

And, of course, with the sports stuff all ending, you just feel so bad for the students who have put so much time and effort.

Dr. Jaime Friedman: It makes me so sad to think about the seniors. And I just wonder when you look at the experience in China and South Korea, in two months from now, we can... There will be a time that we can emerge. 

We can't avoid the virus altogether. Yes, we have to flatten the curve. Yes, we have to protect the vulnerable people and I agree with everything that's happening currently. I just hope there comes a time, come May, come June where kids can start doing more things together, people can socialize, restaurants can open.

Maybe the school year doesn't come back in session in California, that's what Governor Newsom said. But I hope for the seniors, they can find something to do to sort of make it a little better, whether it's a graduation or a prom. We can't avoid socializing forever. 

0:53:16

Dr. Mike Patrick: I guess compared to 1918, we do have digital media to be able to connect like you and I are connecting now, and folks can, on social media and FaceTime and those sorts of things. I mean, it does at least help us not feel quite so isolated as maybe it would have in times past. 

Dr. Jaime Friedman: Oh yeah, definitely, I was on Vocal News this morning talking about what to do with kids when they're home. I mean, obviously, there's going to be more screen time and media use. And one of the things that they can do is like, "Okay, well, let's have a FaceTime party with our neighbors or our grandparents or our cousins or Skype," or use whatever resources. I know that my kids have been talking to their friends and their cousins on the phone.

So, we have a lot of resources. Even just being able to do the schoolwork on the computer, it's such benefit to keep them busy. Even though they're probably on the computer more than we want them to, at least they're doing some stuff that is mindful and keeps their brain kind of sharp.

0:54:16

Dr. Mike Patrick: Absolutely, I think that's so important. Of course, parents want to know, kind of check in with your kids. Let them know what they're doing and who they're engaging with and interacting with, that sort of thing. 

In our house, the computers are in public areas, not hidden away in bedrooms. And I think you're just being mindful of what your kids are doing but understanding that it's important for them to stay connected with their friends.

Dr. Jaime Friedman: Yeah, absolutely. I think when it comes to sort of non-social, non-academic screen time, then it's really important to have some limits on how many episodes of a show we're going to watch or how long we're going to spend on Minecraft because that's not the main thing they're supposed to be doing though. It's not really the point of school being closed right now. So, we still have to make sure we're paying attention to those things. 

0:55:03

Dr. Mike Patrick: Yeah, absolutely. What about exercise? Have you found time in your schedule for it?

Dr. Jaime Friedman: Exercise, what?

Dr. Mike Patrick: I mean, that could be quality time, anyway. But I think especially when there's a lot of anxiety and stress, I mean exercise can really help melt some of that away. 

Dr. Jaime Friedman: Yeah, I 100% agree. Over the weekend, I got my daughter out Saturday morning for a walk, but by Sunday, I was by myself. And then, by Monday, when I went to work, I had texted them, "You guys need to walk the dogs today." And then, yesterday, walk the dogs. And they're doing their own thing and I'm not here with them. But now, it's raining, so I don't know. 

[Laughter]

Dr. Mike Patrick: That makes it difficult to walk the dogs. My wife and I had been taking walks, too. In fact, the last couple of evenings, it's still kind of chilly but we've bundled up and took 20-minute walk or so. But both of us said, it felt really good. And it's a time that you're not on your phone. You're actually connecting with each other. But when we would come across a little crowd of people, we'd cross the street before we get to them. 

0:56:09

Dr. Jaime Friedman: Well, on Saturday, when I was walking with my daughter, I saw my neighbor across the street. And we talked, but neither of us made any attempt to kind of move closer, as she was talking to a different neighbor who was sort of further down the street. 

But yesterday, when I was driving home from work, I actually felt like this is kind of nice, like I could see pockets of families. Tons of people were out, jogging, walking, bike riding. There is a little bit of benefit to having this sort of free time to say, "Hey, let's just go out and get some physical activity." Now, of course, today, it's raining but it won't rain forever in San Diego, so that's kind of nice. 

And it reminded me of years ago, we have this power outage in the entire city. And no one could use their ovens or anything. And obviously, we were quarantined from each other, so everybody was out and at the park and riding bikes and hanging out and knocking on each other's door, and things like that. And it was like it kind of reminded me of that. Or when Pokémon GO first came out, it's like, "Yay, exercise", people are getting out. 

0:57:10

And so, it's really hopeful yesterday coming home, seeing all of this that, well, maybe everybody will get a little bit more exercise now that we're actually having to do that as our only way of getting out and getting fresh air.

Dr. Mike Patrick: Yeah, I totally agree with that. And also, just the number of things that are scheduled in our lives, everything has just all of a sudden been put on hold. I mean, there's whole projects that have just fallen by the wayside and kids who had to go to practice and then they had piano and taekwondo. I mean, we as a society are just so overscheduled and that leads to a lot of stress. 

Not that we want to trade that stress for the stress of a pandemic, but you do make a good point that it is nice to just kind of breathe a sigh. Do you know what I mean?

Dr. Jaime Friedman: Absolutely.

Dr. Mike Patrick: Just pause.

Dr. Jaime Friedman: Yeah, absolutely. My friends and I have been talking about this a lot. With all of the stress of A, avoiding getting sick, B, having your kids home, potential loss of income for all of us doctors included, the flip side is let's take this time to kind of get back to what's important -- spending time with our family, trying to find time to do yoga or meditate or exercise or whatever the case may be.

0:58:22

And while it's a really scary time and I don't really want this to be happening, I mean we have to look at some of the silver linings and figure out how to make it work the best. 

Dr. Mike Patrick: Yeah, I agree. One last topic I wanted to talk about, and I don't know if you have found this, we've been eating better meals actually, despite the fact that it's kind of hard to find some groceries. But we've been very, I don't know, creative maybe in our menu choices when my wife and I have made dinner together, which we hadn't really done in quite awhile and trying some new recipes. I don't know, that's another good thing I think that has come out of this is just in terms of the family meal may be coming back for awhile. 

0:59:10

Dr. Jaime Friedman: Yeah, I totally agree. So, when I was out on Friday night at the store and I couldn't find any kind of raw materials to cook from, the rotisserie chickens that they make, got two suddenly became available and I grabbed one. I was like, oh my god, this is great. And I was able to find lettuce. 

And I was able to go home and in the freezer like a garlic bud. And I was able to come, be like, "We have dinner." And I don't normally make dinner. I don't cook, I work really long hours. My kids tend to eat before I even get home.

So, it was so nice and because I was able to find some groceries here and there and be creative like I cooked to get on Saturday. And then, we have leftovers on Sunday. And Monday, when I came home from work, there was leftover that I could whip up something creative.

And I actually made that comment to my husband, like "Wow, we haven't had takeout in awhile." But at the same time, I want to support our local restaurants, too, so maybe coming up, we'll get some takeout. And I don’t' want to go through all of our ingredients either. 

1:00:17

But it has been an interesting thing that you were saying. At the same time, unfortunately, there's a little bit more junk food because I got so stressed that I couldn't find a lot of stuff at the store that I started getting like just throwing stuff in the cart, like pop tarts that I don't normally buy and sugar cereal.

So, there's definitely going to be... I think that's important too, is that when the kids are home, especially for the younger kids where you can kind of control what they're eating and make their lunch, I think need to try to keep lunches and meals sort of how they would do it during school. It's so easy to like to come home with all those fun stuffs and eat it within the first week. And then boom, you've been overloading on junk food.

Dr. Mike Patrick: No doubt. And I also love the fact that you say let's also support local businesses and do order. And even if you're a family that usually only eats at home, maybe this is a reason to support your local businesses and order out. 

1:01:10

Dr. Jaime Friedman: Yeah, we started brainstorming. I was like, well, I mean there's a lot a chains around us that I feel as need to support, I guess. And not that you shouldn't but we started brainstorming, like what are some of the independent places that we really like? Where maybe today since I'm not working or over the weekend, where we could do some takeout so that we could support them.

And then, we also talked about and I got to do this today, donation to food bank because they're still providing school meals. So, trying to do some, find some ways to support local businesses. I have a friend who owns a store that we love to frequent here in San Diego. And if I go out today, maybe I'll pop in there, even just get a gift card and be like, I'll come back in the summer and get stuff. Hopefully, they'll still be open.

So, it's concerning. I am concerned how we're going to be when this is all over.

1:02:02

Dr. Mike Patrick: Yeah, from an economic standpoint, absolutely. And not only supporting local businesses but I love that you're also supporting kids who are vulnerable, who may rely on schools for meals. And really, here in Ohio, the school districts are continuing to provide meals for families and then each district kind of determines how they make that happen. 

But the school food workers are still coming in preparing the meals. And then, in our local school district, then families can stop by the school and pick them up sort of curve side. 

Dr. Jaime Friedman: Yeah, we're having that, too.

Dr. Mike Patrick: And I think more and more in communities across America, we're going to see that. But for folks who live in a community that maybe the schools are out and they're not, this may be an opportunity to advocate for kids and make sure that kids in your community are being fed, especially the ones who are vulnerable and may not have access to meals.

Dr. Jaime Friedman: Yeah, absolutely. I mean, that's one of the things that we see with any kind of tragedy, I guess, or disaster or whatever it is. I mean, pandemic is sort of the first in our lifetime, but we've had a lot of other natural disasters and things happen. And I think just community coming together is one of the things that is always nice to see.

1:03:16

I mean, I'm seeing it on our local groups next door or our neighborhood Facebook page, I can babysit. I can get groceries if anybody needs anything. 
And it keeps popping up. And it's just very heartwarming to see that everybody's kind of in agreement and on the same page. 

And at the same time, even in circles where maybe there's not always this major belief in science, all of a sudden, it's taking that turn. We got to pay attention to the experts. We got to do this, everybody. We're all on the same page. We're all in this together, that kind of mentality. And it's like, wow, everybody's kind of waking up to we got to listen to the experts. 

Dr. Mike Patrick: Yeah, I mean, literally, a vaccine may save us. We really need a vaccine right now. 

Dr. Jaime Friedman: Yeah, basically.

Dr. Mike Patrick: And hopefully, folks are working on that part. I’m sure they are. In fact, I hear they are. 

1:04:07

Dr. Jaime Friedman: I heard in the news yesterday, or was it the year before? They interviewed a woman in Washington who had her first test coronavirus vaccine and they were asking how she was feeling. And I was just getting like so, she'll talk like here's this woman who is basically saving mankind. 

Dr. Mike Patrick: Absolutely, absolutely. Well, it's also reassuring to know that folks as far away from each other as Ohio and San Diego are having the same sort of experience in our community. There is some reassurance that we all are going through this together. 

Dr. Jaime Friedman: Absolutely.

Dr. Mike Patrick: Really appreciate you stopping by. I'm going to have links to all of your social media sites so that folks can follow you. 

Dr. Jaime Friedman: Oh, thank you. 

Dr. Mike Patrick: So, I know you have been busy supporting folks and lending a voice to this whole pandemic. So, on Twitter, Facebook, Instagram, Dr. Jaime Friedman. And again, I'll put links in the show notes for this episode, 456, over at pediacast.org so folks can find that easily. 

1:05:03

Also drjaimefriedman.com, I'll put a link to that, and the Children's Primary Care Medical Group in San Diego, we'll put a link to your practice page site as well. 

So, Dr. Jaime Friedman from San Diego, California, thank you so much for stopping by. 

Dr. Jaime Friedman: Thank you so much for having me and best of luck to you, guys. 

[Music]

Dr. Mike Patrick:  We are back with just enough time to say thanks once again to all of you for taking time out  of your day and making PediaCast a part of it. Really do appreciate that. 

1:06:00

Also, thanks to our guest this week, Dr. Jaime Friedman with the Children's Primary Care Medical Group in San Diego, California, 

Don't forget we have tons of resources for you in the show notes for this episode, 456, over at pediacast.org. So please do check that out. Lots of information, great stuff to share with others that you love, your family and your social media channels. Please do check out the collection that we've assembled for you. 

Again, I don't when I'll be back. We will try to get podcasts out as much as possible but please do have patience because my priority are the little patients. And so, when I'm needed, I'm going to go and there will be extra shifts and extra time and less time for podcasting. But you guys are important to me as well and I'll try to be here as often as I'm able. 

Don't forget, you can find PediaCast in all sorts of places. We are in the Apple Podcasts app, Google Podcast, iHeart Radio, Spotify, SoundCloud and most mobile podcast app for iOS and Android.

Our landing site is available at pediacast.org. It includes our entire archive of past programs, all of our show notes, transcripts for many of the episodes, written transcripts, our Terms of Use Agreement and a contact page if you would like to ask a question or suggest a topic for the podcast.

1:07:17

Reviews are helpful wherever you listen to PediaCast. We always appreciate when you take a moment to share your thoughts about the show.

 And, of course, we love connecting with you on social media. You'll find us on Facebook, Twitter, LinkedIn and Instagram. Simply search for PediaCast. And really, it's important to connect there. We can support each other in those social media channels. And I will be sharing things on a daily, sometimes hourly basis. 

Well, the podcast is a once-a-week thing because there's just so much involved in producing it. But it's much easier to communicate quickly through social media. And I am there and checking, so please do connect up with us. Again, just search for PediaCast, Facebook, Twitter, LinkedIn and Instagram.

All right, so hopefully, I'll be back next week. Two weeks, if not. We'll see, we'll see where this pans out. And in the meantime, please know that my thoughts and prayers are with all of you across this entire audience. We're all in this together. 

1:08:14

And until next time, this is Dr. Mike saying stay safe, stay healthy, stay home -- as much as you're able, please stay home -- and stay involved with your kids. So long, everybody.

[Music]

Announcer 2: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.

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