Q&A with a Family Doctor: Tips for a Happy, Healthy, Safe Birth

There are lots of articles out there about birthing styles, the best ways to give birth and how to prepare for birth. However, despite what they might tell you, it turns out there is not one “right” way to give birth.

We sat down with Dr. Juliana Wynne, a family doctor at Virginia Mason Edmonds Family Medicine, to talk about some of the choices when it comes to giving birth, common questions her patients ask her and any advice when it comes to handling the unexpected … when you’re expecting.

What are some ways patients can prepare for birth?
The best way patients can prepare for birth is by educating themselves. I recommend that patients bring up any questions they have about it with their provider. Patients can take birth classes – these can be accessed virtually, including at Virginia Mason. Expecting parents can talk to friends and family about their experiences. I recommend finding reliable resources about birth, such as the book “The Mommy Docs’ Ultimate Guide to Pregnancy and Birth” by Yvonne Bohn, MD; Allison Hill, MD; Alane Park, MD and Melissa Jo Peltier. In general, I think it’s important to feel informed going into labor.

What are some common questions your patients have? 
Patients often ask me about my role as an FM/OB (family medicine obstetrics) provider. I am a family doctor that provides prenatal, obstetric, postpartum and newborn/pediatric care. At my office, patients tend to see one prenatal provider. Our goal is to be the provider that is present for their labor and delivery in the hospital. I believe that the biggest benefit of seeing an FM/OB provider is the continuity of care, from the first prenatal visit, to the baby’s birth, to the newborn care in the office and the post-partum visit, to pediatric care as the child continues to grow older. I really get to know the patient and her baby, and often get to know the whole family. This leads to a whole-person and Ethnic toddler listening to her mothers pregnant tummywhole-family approach to care. 

Patients also ask about who will be in the room with them during the birth. Generally, the people in the room include their partner, me, their nurse, and a nurse for their baby. If needed, we have additional support staff available at all times, including additional nurses, the NICU (neonatal intensive care unit) team, and an obstetrician on call.

 What birthing styles are out there? 
Just like every mom and baby is unique and different, so is every birth. There is no one right way or style to give birth. As a provider who cares for women who are delivering babies, my goals are to do everything to ensure that mom and baby are safe, and that mom feels informed and in control.

How do you help moms choose the best birthing style for them? 
Again, there is no one right way to give birth and there are many options when making a plan. There are options for who you see for your care. You can see a midwife, an obstetrician, or a family medicine physician that does prenatal care, like myself and my colleagues at Virginia Mason Edmonds Family Medicine. There are options for where you give birth. You can give birth in a hospital, in a birth center, and some women choose to give birth at home. There are different people to lean on for support during labor, whether it be your partner, family, friends, doula, provider, nurse or a combination of all of these people. There are different ways to cope with pain during labor, which include utilizing a birthing ball, a hot bath, movement (walking, dancing), utilizing your breath, using nitrous oxide which is available in some birth locations, IV pain medicine or an epidural. When it comes to the actual delivery, there are also different positions to try.

A birth may not go as expected. How can patients prepare for this? 
It is helpful to keep an open mind going into your labor. Sometimes our plans change. For example, I hoped very much to have a natural vaginal delivery myself. However, after a long labor, I had a healthy baby via cesarean section. I felt that I did everything in my control to have a vaginal delivery, and yet was prepared for the possibility of needing a cesarean section (my little one was projected to be 9 pounds, and he was!). 

It’s important to share your goals with your provider so that we can best help you achieve them and advocate for you. Helping you to achieve your goals is our goal. 


Juliana WynneJuliana Wynne, DO is a family medicine doctor who provides prenatal, obstetric, women’s health, adult and pediatric care at Virginia Mason Edmonds Family Medicine. She is board certified by the American Board of Family Medicine.

Boost Self-Care by Knowing Your Numbers

**By Teera Crawford, MD**

When you think about self-care, you might think of yoga, meditation and journaling – not measuring your blood pressure.

However, tracking your critical health numbers – blood pressure, cholesterol, hemoglobin A1C and waist circumference – goes a long way in ensuring both a healthy body and healthy life. Staying on top of these will help you take charge of your health, especially as we continue to navigate the pandemic.

Of course, this is easier said than done, and learning how to identify and keep your numbers in check requires a bit of work up front. However, it is advantageous to keep up to date with this practice in the long run. Read on to understand what these numbers mean, why they’re important and how to incorporate monitoring them into your self-care routine.

Blood PressureBlood pressure

Measuring your blood pressure consists of familiarizing yourself with two numbers: systolic and diastolic. Systolic tells you how much pressure your blood is exerting on the blood vessels with each heartbeat, and diastolic tells you how much pressure your blood is exerting when your heart is relaxing. For reference, an elevated blood pressure is one that is greater than 120/80. Measuring blood pressure can be done from the comfort of your home and is as easy as purchasing and using a quality blood pressure cuff. Pro tip: when you buy a new blood pressure cuff, it’s a good idea to have it checked against the blood pressure cuff used at your doctor’s office to ensure its accuracy.

Total cholesterol

Cholesterol is a fat-like substance that your liver makes and is found throughout all of the cells in your body. Maintaining a certain level of cholesterol is important to keep your body functioning, but an elevated total cholesterol (a measure of the total amount of cholesterol in your blood) is more harmful than helpful. For reference, an elevated total cholesterol is one that clocks in at greater than 200. Obtaining this number requires blood tests done in a laboratory and should be checked at your doctor’s office every five years or so.

If your cholesterol errs on the higher side, or you have a family history of high cholesterol, you’ll want to get this checked a bit more frequently. Work with your doctor to set up the appropriate plan for you to keep this in check.

 Hemoglobin A1C

The hemoglobin A1C test measures the amount of blood sugar (glucose) attached to hemoglobin, or protein in your red blood cells. Hemoglobin A1C is a type of blood test typically used to screen for diabetes and can tell you your average blood sugar level over the three months prior. For reference, a measurement greater than 5.7% indicates a prediabetic range and means you’re at a higher risk for developing diabetes, while a measurement greater than 6.5% means you have diabetes. Check in with your doctor to help develop the right plan for you to stay on top of your hemoglobin A1C.

Waist circumference

Waist circumference is exactly what it sounds like – the measurement of your waist, which can fortunately be conducted at home with a flexible tape measure. Starting at the top of your hip bone, wrap the tape measurer around your body until it reaches the starting point. For reference, your waist circumference should typically be less than 40 inches for men and less than 35 inches for women. Pro tip: try to relax your body when measuring your waist to produce the most accurate reading.

Elevations in any of these numbers can lead to cardiac, vascular and other organ abnormalities over time, and Overweight Woman Measuring Waist in Gymmonitoring and staying on top of them is vital to healthy living. According to the CDC, heart disease is the leading cause of death in the U.S. and elevated numbers increase your risk of developing heart disease.

Frequent exercise is a surefire way to keep everything under control but unfortunately during the pandemic, going to the gym is not an option for all. Alternatives to the gym include online exercise videos that can be done at home or getting outside for a walk or run around your neighborhood.

In addition to exercise, it’s important to communicate about these measures openly, honestly and frequently with your doctor to set yourself up on the right path to healthier living. Pairing these efforts with your other self-care methods of choice will keep you living your best life.


Teera.CrawfordTeera Crawford, MD, is board-certified by the American Board of Internal Medicine and specializes in women’s health, preventive care, diabetes and weight management. Dr. Crawford practices at Virginia Mason Lynnwood Medical Center

 

Show Your Heart Some Love with These Five Tips

**By Mariko Harper, MD**

February is American Heart Month, a time dedicated to encouraging you to take control of your cardiovascular health. As the pandemic rages on, leaving those with poor heart health at a higher risk for developing severe illness from COVID-19, the need for education around optimizing heart health is at an all-time high.

While most of us are spending more time at home these days, there is no better time to incorporate your cardiovascular health into your self-care regimen. Here are five ways you can put your heart health first during COVID-19:

Spend time getting in tune with your cardiovascular health

Learning what your cardiovascular numbers are, such as your total cholesterol, bad and good cholesterol (LDL and HDL), blood sugar, body mass index and blood pressure, is crucial for building up your heart health. Once you know how to identify these, you can then figure out how to regularly monitor them, as well as ways to keep them under control.

We know this step can seem difficult, or be a lot to take in. Fortunately, the American Heart Association offers a myriad of resources available on its website to help, such as how to monitor your blood pressure at home, understanding what your blood pressure numbers mean and how to improve your cholesterol. Ramping up your physical activity is another way to keep your cardiovascular numbers in check.

Incorporate physical activity into your daily routine

Regular exercise has proven to have substantial benefits for heart health. Daily movement can potentially lead to lower blood pressure, stable blood sugar regulation and healthier levels of cholesterol.

Incorporating physical activity into your daily routine may be easier than you think. Whether you pick up the habit of taking leisurely strolls around the block, or decide to partake in more vigorous workout activities, any movement is good movement. Regular exercise can also provide a tremendous outlet for stress.

Find outlets to reduce stress

It’s no secret that stress levels play a large role in your overall heart health, and that higher stress levels can even make you more susceptible to heart disease. Though a number of stressors in our lives may be out of our control, especially during the pandemic, forming healthy outlets for stress can help you manage.

Finding new hobbies, or embracing old ones, is a great place to start. Maybe you’ll find that you’re secretly an art aficionado, or a master baker or chef. Or maybe yoga and quiet meditation are more up your alley.

Look out for key signs of heart trouble

While most heart health efforts are focused on prevention, it’s also important to be aware of and look out for signs of heart trouble. Though chest discomfort is the most common symptom of a heart attack, many patients don’t directly experience chest pain, but may experience an intense heaviness or pressure, rather than a sharp, stabbing pain.

Other common symptoms to be aware of include sudden shortness of breath, and aches in your arm, shoulder or jaw. Less common symptoms can include nausea, lightheadedness and breaking out in a cold sweat. If you think you or a loved one is potentially experiencing a heart attack, do not hesitate to call 911.

Don’t shy away from routine or emergent medical care

COVID-19 has brought about an absolutely devastating death toll on its own, but research shows that it is also preventing people from accessing the health care they need. Nationwide since the start of the pandemic in February, there has been an increase in deaths due to ischemic heart disease, which is caused by narrowed arteries not being able to carry enough blood to the heart.

Ignoring or delaying both emergent and routine medical care for your heart can lead to an increase in risk of major cardiovascular complications, as well as an increase in the mortality associated with COVID-19. We have robust safety protocols in place here at Virginia Mason to keep you safe during the pandemic, and highly encourage you to not ignore medical emergencies, or even pause your routine medical care.

If heart health is something that you haven’t considered much in the past, this information can be a lot to process. Think of improving cardiovascular health as part of self-care, and keep in mind that all progress is good progress.

While these tips are a great place to start for getting your heart health back on track, be sure to bring up any cardiovascular concerns with your primary care provider.


Dr.HarperMariko Harper, MD is board-certified in internal medicine, cardiovascular disease, nuclear cardiology and echocardiography. She practices at the Heart Institute at Virginia Mason. Dr. Harper specializes in general cardiology, echocardiography, nuclear cardiology and hypertrophic cardiomyopathy. 

Triumph Over Diverticulitis: Nancy’s Story

There’s not much that slows Nancy Fauls down. She was one of the first female skippers to race schooners in the Pacific Northwest and knows how to stay calm and keep everything moving forward. Then in January 2019, the Port Townsend resident experienced a lower abdominal pain that was overpowering. “I’d never felt anything like it before,” she remembers. “I could hardly breathe or move. I was doubled over.”

Nancy went to the local emergency room and then to her general practitioner who prescribed antibiotics to curb bacteria growth. The medication didn’t have much impact on her symptoms and she spent several days lying flat on her back. A month later she experienced the intense pain again and her doctor referred her to Virginia Mason. Because of the distance from Port Townsend to the hospital and the severity of her pain, she was transported by ambulance and ferry boat to Virginia Mason Seattle. Diagnostic blood tests and a CT scan indicated her pain was caused by diverticulitis.

Diverticulitis occurs when a diverticulum (a bulging sac that can form on the colon wall and push outward) becomes inflamed or infected. The condition is most common in people whose diets are lower in fiber and higher in processed carbohydrates.

“Diverticulitis used to commonly be seen in patients who are 50 to 70 years old, but now we’re seeing it in younger patients,” says Virginia Mason colorectal surgeon Vlad Simianu, MD, MPH. The culprits, he adds, are often obesity, smoking and a diet of highly processed and packaged foods.

Free of diverticulitis and enjoying life again.High fiber diets can prevent the colon diverticula from forming, he says, because the fiber results in smoother elimination without the damage that can occur with the pressure on the colon that is caused by constipation. And as Nancy experienced, damaged sections of the colon wall can become thinner and burst.

“Once the disease occurs, diet changes may help the symptoms but they are no longer the cure,” says Dr. Simianu. “The truth is once you have diverticula we don’t really know what drives them to become inflamed and infected, and therefore can’t be sure whether a specific medicine or lifestyle change will prevent a flare.”

Often the diseased portion of the colon must be surgically removed.

“These days the surgery is much easier on patients,” says Dr. Simianu. “It is minimally invasive, usually requiring three to five small cuts in the abdomen, as opposed to traditional surgery which involves one large incision. Patients heal faster and their stay in the hospital is reduced.”

In Nancy’s case, the nine inches of her colon with the disease were removed using robotic technology. She was back home three days following her surgery. She’s made some lifestyle adjustments, lost 50 pounds and is enjoying an active life in the beautiful town she calls home.


A version of this story originally appeared in the Virginia Mason Health System Annual Report

Yes, You Need a Flu Shot This Year — And Here’s Why

**By Christopher Baliga, MD**

Flu season is fast approaching, which means it may be harder for you to tell the difference between a flu symptom and symptoms associated with COVID-19. Those affected with either illness have the potential to run a fever, feel sluggish, and develop a cough and body aches. The good news is, you can protect yourself and others from both diseases by wearing your mask and getting a flu vaccination.

With so many myths and rumors floating around about whether the flu shot is necessary this year, it’s important to listen only to medical experts on this matter. We’re here to provide the facts you need to help keep yourself and those around you healthy.

Since I wear a mask, do I still need a flu shot?

Yes. While masks are helpful in reducing the spread of pathogens, they are not as effective for preventing the flu. By combining mask wearing with  the flu shot, you will lower your risk of catching the flu while protecting yourself from COVID-19 and other respiratory viruses. Just as important, getting a flu shot means you are less likely to spread the disease to others.

Flu.signWon’t a flu shot increase my chances of catching the coronavirus?

There is no evidence to suggest that getting a flu shot will impact your risk of contracting COVID-19. But what we know for certain is that a flu shot will reduce your risk of getting the flu.

Does wearing a mask protect my immune system?

Wearing a mask has no effect on your immune system itself. It does reduce your risk of catching COVID-19 by up to 80%, but wearing a mask does not change your immune system on its own.

Some of us might remember the days when people were opposed to government mandates requiring the use of seatbelts in cars. Similarly, we’ve seen pushback against wearing masks in public. Just like wearing your seatbelt can save your life, masks help reduce your chances of catching COVID-19, while the flu shot reduces your risk of contracting the flu (or reduces the severity of illness if you do get sick). But unlike a seatbelt which only really protects you, masking and getting a flu shot also helps protect those around you.

If you’re in search of where to get a flu shot this year, consider visiting a Virginia Mason drive-thru/drive-up location, open through Oct. 23. Find more information on the location closest to you here.


Baliga, ChrisChristopher Baliga, MD, is board-certified by the American Academy of Internal Medicine in infectious diseases and internal medicine. He practices at Virginia Mason Seattle Medical Center. Dr. Baliga specializes in infectious diseases, HIV/AIDS care and travel health. 

Managing Screen Time in a Virtual Learning Era

**By Traci McDermott, MD**

Many students this year are attending school virtually. This means around eight hours of their day will be spent in front of a screen — far more than the recommended 60-minute daily screen-time limit. This can pose a lot of challenges for parents, who are dealing with having to manage their child’s schooling while balancing working from home. Parents may feel guilty about not being able to limit the amount of time their child is spending on screens.

While you may not be able to control the amount of screen time your children must spend in class, there are many things you can do to help offset your child’s screen consumption outside of school.

Set limits

Take advantage of automatic shut-off settings in order to limit screen time. It’s also more important than ever to ensure you are sitting down and talking with kids about safe internet content and safe use of social media.

Whenever possible, try to limit additional screen time outside of virtual learning to quality social connections with family members or friends. Live chats over Facetime, Skype or Caribu are better than quick texts, SnapChat or other social media platforms that don’t involve real-time conversations. Zoom meetings or practices that help keep kids engaged in their community and with other kids should be prioritized over free screen time use.

Take breaks

No matter if you are a child or a parent, in school or at work, everyone should build a habit of spending 10 minutes away from a screen each hour. You could do this by using a simple kitchen timer or by turning on automatic shut-off settings on your device.

family dance partyMake breaks from school work at home physical – not a game or video on the screen. Turn on music and have a make-shift dance party, or let kids create their own dance routine. Use painters’ tape to create hopscotch on the floor, or encourage them to learn a new active skill, like juggling.

Get physical

Parents should try to prioritize exercise or active play with their kids for 60 minutes most days. This will take away time spent in front of a screen.

If your child has an already established physical routine due to team sports or practices during normal times, do your best to keep a similar schedule. Your child might be used to a 30-60 minute practice two or three times a week at, say, football practice. Encourage them to continue that same schedule by keeping their bodies moving in some way on their own. With no games to attend on the weekends, the whole family could instead go for a walk or run, or have your own scrimmage in the yard (or closest open green space).

You can even consider virtual physical classes, like online workouts. Yes, this is inviting another screen into your child’s day, but in moderation, these encourage kids to move and exercise, which is beneficial to the body as a whole. Also, many dance classes have been shifted to virtual, which help kids keep social connections and stay active. This can be a good indoor option once the weather cools down.

Unplug at night

 Consider setting a limit for your child to ditch the phones, video games and YouTube videos no less than an hour before bed each night. Some parents even opt for “family charging stations,” where all electronics live at night to help kids (and parents, too!) unplug when it’s time for sleep.

Of course, these tips are not one-size-fits-all. While many families are able to easily set limits for their children, there are just as many where setting limits will pose a significant challenge.

If you’re worried that your child is still spending too much time in front of a screen even after following these steps, make sure to look for the following warning signs. Seek medical help if your child:

  • Develops problems sleeping
  • Develops regular/daily headaches
  • Has significant weight change (either gaining or losing)
  • Has emotional withdrawal

Good luck! Remember, making sure your child’s sleep and exercise needs are met will significantly reduce the overall time spent on screens, while boosting their readiness for virtual learning.


Traci.McDermott MDTraci McDermott, MD, specializes in Pediatrics at Virginia Mason University Village in Seattle. Dr. McDermott is an American Board of Pediatrics-certified practitioner.

Helping Your Child Wear a Mask During COVID-19

**By Rebecca Partridge, MD**

If you are a parent of a young child during the pandemic, you know firsthand how hard it can be to explain what is going on and why your child must wear a face covering when in public places or around people outside of your household. I’m sure many of you have felt like giving up on having your little ones mask up.

As a parent myself, I recognize that teaching children the importance of wearing a mask has its challenges. Still, I’m here to tell you that even if your child is struggling with this new directive, you can do it! It’s just going to take time and persistence. Current CDC guidelines state that anyone able to wear a mask, excluding children under 2 years of age, should do so in order to keep each other safe. Advice for younger children includes prioritizing mask wearing for times when it is difficult to maintain a distance of 6 feet from others, such as in carpools or when standing in line. 

mom-maskAs a mother and a physician who sees many parents struggling when it comes to teaching their young children why and how to wear their masks, I’ve come up with a few kid-friendly tips.

Get them excited about it

I’ve found that kids respond well to masks featuring their favorite cartoon characters or other designs that excite them. By providing your child with different choices in terms of the color, shapes, styles and features on the mask, you can turn something that is foreign and uncomfortable into something exciting and actually fun. Many children love to look like Spider-Man or Minnie Mouse; if their mask gives them an opportunity to “become” their favorite characters, your child is more likely to wear it. Parents should also express their own enthusiasm for masking up when around their kids to serve as an example that hopefully gets followed.

Gradually increase mask time

I’m hearing from many parents that their child is willing to try on the mask, but that they can only keep it on for a few seconds before they get bored and take it off. Parents should work with their child on wearing a mask for short periods of time to start and then graduate to longer periods of mask wearing. Try doing a countdown with your kids, distract them by playing their favorite video or giving them their favorite toy. Provide praise and positive attention when they keep the mask on. Do this until your child is able to keep the mask on for the time needed to run an errand in public or other activities you’d like to enjoy with your family.

Read stories with your child that include mask-wearing characters

For children who are having a really hard time tolerating wearing a mask, consider reading books to them about the topic. Book characters might go into the steps of putting on a mask or its importance to protect one’s health and those around them. Hearing and seeing these behaviors in a child-friendly format might resonate with your child, helping them better understand why mask-wearing is so important.

Don’t give up!

It will take time to get your child used to wearing a mask. Continue to employ these steps and your efforts will pay off. If your child is still having trouble after trying some of the advice above, you might consider a face shield. Although a mask is the best way to keep your child and others safe, a face shield is a good option for parents of kids who might be more sensitive to touch or having things touching their faces. In these cases, a shield can be a good introduction in teaching your child to wear a mask later on. 

Meanwhile, don’t forget to give yourself credit for everything you’re doing to support your family during such a challenging time. Good luck and be well!   


Rebecca Partridge

Rebecca Partridge, MD, is a Pediatrics specialist at Virginia Mason Issaquah Medical Center. Dr. Partridge is board-certified by the American Board of Pediatrics. Her medical interests includes general pediatrics, Down syndrome and emergency pediatrics.

Prioritizing Your Health During COVID-19

**By Donna L. Smith, MD**

Reports indicate nearly one-third of U.S. adults have avoided seeking medical care because they are worried about contracting COVID-19, and experts are concerned about deaths from non-COVID-19 illnesses that could be due to people not seeking treatment. This trend is alarming.

As a physician, I will always encourage people to be active participants in caring for their health. While staying healthy is understandably a top priority for all of us right now, it is also a time when many people might be tempted to minimize and deprioritize symptoms of serious illness. Although hand hygiene, social distancing and masking are key actions to avoid infectious diseases such as COVID-19, it is also important to seek prompt evaluation and treatment for any other health concerns. This includes care for yourself and for those you love.

Don’t ignore symptoms

A single symptom could be just that, or it could be an indication of a more systemic health condition. Though not always the case for every concern, it is often better to identify the cause of symptoms sooner rather than wait until they progress.Staying current with your health care is important, even during a pandemic.

Pay attention to changes in your body; you know your body best. An acute increase in symptoms, a new symptom that persists, or something that persists and then increases could all be causes for concern. Don’t hesitate to reach out to your health care provider when concerns arise.

Get it checked out now, for better future outcomes

Delayed care can result in a need for more involved treatment later. Diseases such as cancer are a prime example of this.  It is important to have routine, recommended screenings for diseases such as cancer, especially if you are at increased risk.  With regular screenings, diseases can be detected earlier and result in better health outcomes.

If you have chronic disease, regular check-ins are essential

For those living with and managing chronic disease, a change in daily life patterns, including eating habits, exercise routines and social activities, can leave you stressed and vulnerable to developing new or increased symptoms. Make sure to keep up your regular check-ins with your health care team to ensure you are taking the best actions to optimize your health.

Health care facilities have COVID-19 prevention top of mind. Here at Virginia Mason, we rigorously screen patients for symptoms, and have a separate entrance for those with respiratory illness. We provide masks to all patients and visitors upon arrival. We’ve arranged our waiting areas to provide at least six feet of distance between patients. And of course, we always have intensive cleaning processes in place including disinfecting all surfaces and handles in exam rooms after each patient visit.

There are virtual options for care available as well. Call or send portal messages to talk with care team members and determine if virtual care or in-person is optimal for you. And, if you prefer in-person visits, be certain to tell the team member of this preference, and they will advise accordingly.

We encourage you to continue seeking medical care even in the time of COVID-19 to protect your health and the health of your family, whether it’s virtually or in-person. When you do seek care, Virginia Mason providers are ready and able to help.


Dr. SmithDonna Smith, M.D., MBA, is Executive Medical Director and Associate Chief Medical Officer of Virginia Mason Medical Center. Previously serving in multiple medical leadership roles at Virginia Mason, she is responsible for oversight of the health care system’s hospital and clinics. Dr. Smith is board-certified by the American Board of Pediatrics and also specializes in primary care. She practices at Virginia Mason University Village.

Why You Should Vaccinate Your Child, Even During a Pandemic

**By David J. Schneider, MD, FAAP**

The Centers for Disease Control (CDC) recently reported a plunge in vaccination rates for children, with numbers suggesting childhood vaccination rates essentially halting from March to April 2020 during the height of coronavirus concerns.

While many families continue to stay home to prevent the spread of COVID-19 until there is a proven, safe and effective vaccine, parents shouldn’t delay seeking health care for their children, particularly routine immunizations.

Current unvaccinated children for vaccine-preventable diseases do not have a higher risk of contracting COVID-19, but they do have a higher risk of contracting other preventable diseases, like meningitis, whooping cough and measles that can potentially lead to worse outcomes. Measles is still spreading globally, with two outbreaks in Washington state last year. Measles is more infectious than the novel coronavirus and young children, pregnant women and immunocompromised children are at an increased risk for complications and have a higher fatality rate.

As a pediatrician who supports children’s overall health, my advice to parents is to not delay health care for your child if you are worried about COVID-19. Aside from vaccine-preventable diseases, delays in care for your child can slow the detection of congenital or developmental issues, diagnosis of new problems or treatments for chronic illnesses.

At Virginia Mason, we are doing new things to help put parents’ worries at ease. We are separating well and sick children into different clinics at physically distant locations so that parents and kids who come in for routine care will have decreased likelihood of being exposed to kids who are unwell. We are doing extra sanitizing of each exam room between patients, using personal protective equipment (PPE) for all visits with full PPE for sick visits, masking all patients at the entrance, and making it possible to maintain a six-foot physical distance from other people within the clinic.

This outbreak has reminded us how important vaccines are, as they help prevent the quick spread of infectious diseases and the horrible consequences that come with an outbreak.   –David Schneider, MD

Patients who are scheduled in the “sick clinic” are asked to wait in their car and they are called when we are ready for them to come in. They are led directly to a clean exam room to avoid possible exposures in waiting rooms and hallways. For visits that do not require in-person care, we offer video visits and have seen a significant increase in this service.

Everyone carries some level of risk for contracting COVID-19. Fortunately for children, most cases of COVID-19 appear to be mild, but there are some children who develop more severe symptoms and complications. It’s important to continue good hand washing, physical distancing and maintaining hygiene practices to help avoid infection.

This outbreak has reminded us how important vaccines are, as they help prevent the quick spread of infectious diseases and the horrible consequences that come with an outbreak. When a COVID-19 vaccine is available, it will be important for everyone to stay up to date with the vaccination to achieve herd immunity and avoid a devastating outbreak like we are having now.


Dr David Schneider_2019David Schneider, MD, FAAP is board-certified in general pediatrics. He practices at Virginia Mason Bellevue Medical Center. Dr. Schneider specializes in pediatric and adolescent medicine, with special interests ranging from well child visits and sports-related injuries to LGBTQ health and mental health concerns around ADHD, depression and anxiety.

Tips for Summer Travel During COVID-19

**By Chia Wang, MD**

Summer is underway and many of us are feeling restless and ready to get out and enjoy the warm weather. Some of us are itching to see family and friends whom we may not have seen for a while. But is it safe to travel this summer amidst the ongoing COVID-19 pandemic? There is no question that in terms of catching the virus, isolating at home is the safest thing to do. However, each person must weigh their individual risks, and for those who are very elderly, or who have underlying risk conditions, staying at home until there is a vaccine or until rates of transmission are very low is still the best advice.

To travel or not this summer also depends on where you are traveling to. Personally, I would be hesitant to travel from a place where viral transmission rates are low to one where transmission rates are high. Conversely, if traveling from somewhere where transmission rates are high, you would want to consider carefully whether you would be putting others at risk by traveling, and take steps to mitigate any risk, such as bringing your own food and water and monitoring for symptoms. I would also caution against traveling to a place where being able to practice physical distancing would be difficult, such as to a dense urban area or visiting someone with a very small apartment.

People must take into account their own risk profiles, as well as their own comfort level with risk.  –Dr. Chia Wang

Here are some things to keep in mind if you choose to travel this summer:

Couple tandem bikeConsider your mode of transportation

Travel by car is generally preferred to plane travel, because you have more control over your surroundings, and you are not breathing the same air as many strangers for hours on end. That is not to say that plane travel is unsafe in terms of COVID-19, but car travel is generally safer. However, if you need to travel cross-country, and traveling by car would involve multiple hotel stays and eating at many restaurants, particularly if traveling through virus-hot spots, then plane travel may actually be safer than car travel.

Choose lodging that minimizes contact with others

The virus does not seem to be transmitted as easily outdoors as indoors, so choosing hotels or lodges with doors that open to the outside, instead of into a hallway, are also choices that may make you safer. Avoid lodging that requires you to use an elevator. The less contact you have with other people, whether other travelers, or staff at hotels and restaurants, the safer. Staying in private homes through services like Airbnb, staying in cabins, tents or RVs are all ways that you enjoy less risky travel.

Wearing a mask while indoors, or when around people while outdoors, is one safety measure that is recommended. Washing hands frequently, and avoiding touching the face, are also important.

Bring the appropriate supplies

Masks and hand sanitizer are the most important things to bring when leaving the home for most reasons. For road trips, bringing things that will allow you to minimize contact with others is helpful, such as extra food and drinks, and day trip supplies including sunblock, bandages and pain relievers such as Tylenol.

Think outside the box – or just think outside

Camping, hiking, biking, and outdoor adventuring seem like activities that will allow families to adhere best to physical distancing guidelines. Sitting outdoors at a scenic location reading a book or just nature-gazing can also be a nice change of pace for those who are tired of being cooped up. For those who prefer the comforts of home rather than sleeping on the ground and using a Porta-potty while camping, “glamping” may be a great option—with beds and flush toilets and hot showers, but still in tents that are well-distanced from each other and lots of fresh air. Overall, for travel this summer, trips that emphasize time outdoors are the safest. People must take into account their own risk profiles, as well as their own comfort level with risk. Until transmission rates have dropped much further than they have so far—basically until there is a vaccine—the safest option for most people is still to stay home.


Dr.WangChia Wang, MD, is an infectious disease specialist at Virginia Mason Medical Center in Seattle. She is board-certified by the American Board of Internal Medicine. Dr. Wang also specializes in HIV/AIDS care and travel health.