Original Articles By Dr. Lavin Featuring Expert Advice & Information about Pediatric Health Issues that you Care the Most About

COVID-19 UPDATE: March 24, 2020 A Glimmer of Good News from the World and An Update from the Practice

By Dr. Arthur Lavin

A Glimmer of Good News from the World  

Last night, some very preliminary reports from Italy and San Francisco indicated some very early indication that the surge of the rise of cases in San Francisco and Italy has slowed, for the first time.

We hope this turns out to be the first sign of a solid trend.  If it is in fact, a new direction, it will be the first time a nation outside of East Asia has slowed the epidemic.

And, as readers of Real Answers know, it would be the first time our nation’s strategy of isolating cases at home, instead of the East Asian practice of isolating out of the home, might work.

Stay tuned, if these first bits of indications hold, we could see the surge start to ease, but ONLY if the three strategies of our approach are held to strictly, by everyone:

  1. Close schools and colleges
  2. Isolate infected individuals at home
  3. Follow shelter-in-place guidance.

This surely no time to relax our guard.  Every doctor in the world agrees that there is not magical date next week that the epidemic’s threat will lift.  If the surge is easing, it is only because of Italy and San Francisco’s intense efforts.  Easing now would guarantee a roar of new cases.

An Update from the Practice

A Contained Exposure 

As the virus spreads, we are all preparing ourselves for finding out someone we know or work with will come down with the illness.   No one is fully able to avoid that risk, including doctors and staff.

We were reminded of this reality when we found that one of our staff turned out to have COVID-19.  Fortunately, she is doing very well.  The first day of her symptoms, we discussed the appearance of very, very mild symptoms and asked her to go into voluntary quarantine and be tested, which she did very promptly.   Her only contact in the office while contagious was the day of Monday, March 13 (contagion begins on average 12 hours before the first symptoms), and the morning of Tuesday, March 14 and she has been out of the office since.   Her test was taken on Wednesday, March 15, but results were not reported until yesterday.

During this entire period, we have been in consultation with public health authorities and remain committed to follow their expert guidance.    Last week, while awaiting the results of her testing we consulted with the Cleveland Clinic Department of Pediatric Infectious Diseases, the Ohio Department of Health, and the Cuyahoga County Board of Health.  All three were in unanimous agreement that the recommended course of action was:

  1. Keep the office open.
  2. Closely monitor staff for any symptoms.  You should know over the last week, the doctors and staff in the office have been free of ALL symptoms.

This morning, we were honored to have a call with the Commissioner of the Board of Health of Cuyahoga County, who spoke with our whole team in detail.  Dr. Allan is a nationally recognized, highly regarded public health official.   He reviewed our situation and let us know according to national standards that are kept up to date constantly, that his Board of Health continues to strongly support the current plan, even now that we know the test on our one staff member is positive.

We have also informed all people exposed last Monday and Tuesday, and were pleased to learn none had symptoms even one week later. Although some illnesses become evident as long as 14 days past exposure, most illnesses become evident about 5 days after exposure.

And so at this time the office remains open.  We still encourage families to embrace the virtual paths available for medical care that are available in our office and so easy to use.

Further Updates from Your Practice

  • Coverage of virtual visits- by video and by phone

The government of the state of Ohio has informed us that they are, during this emergency of pandemic only, authorizing the state of Ohio to cover phone calls and video visits as regular office visits.   We are adopting this advisory, and anticipate that commercial insurers will have to respect this emergency opening of coverage of phone and video medical care

As a result, during the course of this pandemic, we will be advising people to seek our help primarily through the use of evaluation by formal, scheduled, telephone consultations, and our video platform AP Televisits

This also means, during the course of this pandemic, we will be charging for scheduled telephone consultations and of course, for AP Televisits.  We anticipate that insurers will cover these charges, especially since the government of the State of Ohio has indicated this is their policy during the pandemic emergency.  Our staff will of course be happy to work with you to move them to do so.

  • Continued success of AP Televisits

As the move to stay at home continues, we are all the more thrilled with the ease and success of AP Televisits.  Families report high satisfaction with this service, and we, Drs. Lavin and Hertzer, feel it offers a high level of service while allowing families to stay at home.

If you have not had an AP Televisit and would like to set one up, just call us at the office, 216-591-1515, our staff can get you set up easily.

  • Policy on Health Supervision Visits (Check-Ups)

The public health experts have studied the question of seeing children for health supervision visits at this stage in the pandemic.  The current recommendation is for infants to continue to come in for their check-ups through age 18 months to complete primary and first booster immunizations.  The concern is that if the nation abandons these first immunizations we could face more epidemics of more diseases.  So if your child is a newborn-18 months old, we will recommend we continue to see you here in the office for their regular check-ups.

For children ages 2 years old and older, routine health supervision visits (check-ups) should be postponed a month or two, when hopefully the danger of the pandemic will begin to ease.

These recommendations will be reviewed and updated as the pandemic directs.


  1. We may be seeing the first slowing of the COVID-19 pandemic outside of East Asia, in Italy, and San Francisco, we hope these first hints become solid trends.
  2. The coronavirus, however, is not near halting, and still continues to spread, so we all face the challenge of doing what we can do to slow its spread.We at Advanced Pediatrics find that we are in a position now to help slow that spread, and are pleased to do so in full compliance with public health direction.
  3. As of now our office remains open.  We will continue to advise people with symptoms of respiratory illness to seek our help through consultations by phone or by AP Televisit.
  4. Health supervision visits, or check-ups, are still advised to continue from birth to age 18 months.  Children 2 years and older should plan to reschedule for later when the pandemic eases.
  5. For as many needs as can be met by virtual medical care from Dr. Lavin and Dr. Hertzer, we will be scheduling families for telephone consultation or AP Televisit as you and your family see fit.

We once again hope that everyone comes through this challenging time well, and are pleased to do our part to help that happen.

To your health,
Dr. Arthur Lavin



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