members nor pbs el paso shall be responsible for the views opinions or facts expressed by the panelists on this television program please consult your doctor [Music] in order to prevent the spread of the virus we all need to do our part one of the easiest ways to prevent that is by wearing a mask in order for a mask to do its job it needs to cover your nose your mouth and your chin first you should wash your hands with either sanitizer or soap and water before putting on a mask then pick up your mask by one of the ear loops to make sure that there's no tears or stains on the mask if it is dirty throw it away immediately if it's intact take both loops and put it over your ears like this and then press down on the bridge of the nose to make sure that it fits and there are no uh gaps once you are done with the mask please take it off the same way both ear loops pull it away and put it either in a ziploc bag or throw it away if it's a surgical mask if it's a cloth mask make sure to wash it with soap and water and keep it dry for the next use do not put your mask down at your chin or above on your forehead when you're starting to remove it as that just contaminates the mask thank you so much for doing your part to prevent the spread throughout the thank you dr days always helpful to know exactly how to put the mask on and off and how to adjust it again if you try to adjust it try not to do it from the nose but do it from the mouth or underneath that way you're not touching your face we have heard and falsely i might add that kids are immune to covid19 we know that this is simply not the case and yes indeed it is true that they are less frequent to ex to show symptoms when they are diagnosed with covalent 19 even if they are tested positive so we want to make sure that you know that children who are not showing symptoms but are tested positive they're still in danger if you have issues like asthma and that's what we're going to talk about tonight as we know this virus really attacks the respiratory system and we have two doctors here from el paso children's hospital that are really going to give us some tutorials on what's going on this evening's discussion is basically about children with covet it's not something you hear very often in fact you hear it i don't know if i have heard yet about children with the with the issues so it's going to be really interesting this evening to hear about that this is a live show so give us a call at 881.001 the texas tech paula foster school of medicine students will be picking up the telephones and they're going to be texting the questions our way so we'll be able to see that this evening's program is underwritten by the el paso children's hospital and we also want to thank the texas tech paulo foster school of medicine for providing the medical students that are manning our phones here this evening uh the medical students that we have today is melissa huddleson and then we also have sean bala so they've both been here before they kind of know the drill they're really good at getting your questions through and sometimes it's just nice to see a face oh sean you've got to uncross those arms you got to look friendly there you go so those are the two students that are going to be answering our phones i also want to say thank you hugely to the el paso county medical society for bringing the show to you each and every month and also for providing ppe to all kinds of health providers around the city and around the county so that's been very helpful as well good evening i'm catherine berg and you're watching the el paso physician [Music] so something that you don't hear about very often we're going to talk about children and covid um again you don't hear about it often in the very few beginning months it was like all kids are immune to this children are immune to this well they're not immune there are children that seem to bounce back really quick there are children that have tested positive and show no symptoms but there are some that do and if there's a respiratory illness that's something to really really be concerned about and so that's what we're going to be talking about this evening with me to me my right we have dr etai moreno and he is a texas tech physician and medical director of the pediatric hosp i like this pediatric hospitalist division el paso children's hospital we're going to talk about that in a second and then we have dr indy dominguez and he is a pediatric pulmonologist with the texas tech physicians and medical director of the pulmonary function lab at the el paso children's hospital so on that note i just like the word hospitalist and i'm just going to start with that in a moment so what i'd like to do dr moreno if you could talk a little bit about your all-day everyday duties prior to coven and then since kovid as well so i know it's it's all kids all the time the nice thing is that you we we could talk about newborns up till 18 19 20 even if there are young adults we can talk about that right so people kind of know what your background is so prior to and then over the last eight plus months so definitely well first of all thank you for having us catherine uh it's a pleasure to be here um i'll start off with exactly what a pediatric hospitalist is so it's basically a pediatrician that solely works in the hospital setting in in the in-patient study we don't have a clinic uh we don't work in er we basically just work in the hospital so the way we function we basically work hand in hand with your pediatrician uh if they see a patient of theirs that they consider that needs to be hospitalized that needs a little bit more in direct or intense medical care they will call us and we'll gladly take care of the patient we'll keep them up keep them updated with daily phone calls just to keep them in the loop regarding their patients care and management and then when they're time for to get discharged basically to go home we will once again reach out to the pediatrician and kind of do a proper sign off sending their their patient back to to their practice so essentially we're an extension of your local favorite pediatrician that will take care of you in the hospital i love that we're the extension of your local favorite pediatrician so you are their doctor in-house so to speak and the nice thing is they don't have to drive from around town you're right there exactly exactly so they can focus on their clinic because i'm sure they have many patients so we'll take care of the hospital side nice uh dr dominguez as a pediatric pulmonologist you have your work cut out for you um we have a very dusty town and just in general kind of take that same question and talk about what you did before covid how much different it is now and again it kind of gives our audience an idea of what you all do so first of all thank you for for the invitation i'm very happy to be here so a pediatric pulmonologist basically is a physician who take care about patients with respiratory problems and as you well mentioned earlier we take care from patients like newborns premature babies all the way up to 21 year old of age um before the kobe area mainly uh or the this episodes that we have now we have seen we were really quiet basically taking care of our patients patients mainly with asthma cystic fibrosis we take care of patients with a chronic condition that require mechanical ventilation at home and sometimes we also see patients with a congenital airway malformations that's our base uh usually that we see as a pulmonologist however after the pandemic started we have been really really challenged because as you well mentioned initially we thought this thing it was not going to impact the kids right but we we find out in a hard way that actually is not however we know still the adults are the ones are getting more more sick does the high impact kids really really get sick with quality so i'm going to use high impact kids i just like that wording because it's higher you know i want to say high risk by high impact and on that note um dr brano if we could if we can talk about um actually what i want to do and i want to do this several times throughout the show i want to talk about flu shots because i think that's so important as we're going into the we're actually in the flu season and um i'm going to talk about where people can get flu shots for free because it's so important in this time of covid you don't want the flu and then getting covet on top of that it just further complicates things so uh saturday at the el paso zoo it's fun to just go there and look at the animals through the gate anyway saturday at the el paso zoo again this is free 9 a.m to 3 p.m you can stay in your car in they're distributing flu shots there for absolutely free and you can even enter a drawing to get a christmas wreath i mean what the heck but again um the el paso county medical society is very good in staying on top of where people can do that and there's always a place to get a flu shot for free and ep strong is a website that you can always go to just think of el paso strong ep strong dot org to kind of help out with that so dr mano let's go back to um we're talking about high impact kids flu shots i would like for not me the host but for you as a pediatrician talk about why a flu shot right now is so important for the kids today it's incredibly important the way i see it is we're fighting a war and it's with coronavirus uh the last thing we need is to have another adversary so taking the flu shot it basically eliminates the flu from being an issue during this pandemic and you know we could focus our attention completely on kobe 19. you know dr dominguez does his part i do my part to really battle this pandemic with the people at home or our fellow el pasolins if they ask what they can do is you know obviously wear masks uh social distance avoid gathering but also uh get the flu shot so that's you know if all of us do our part um i'm hopeful that we'll get through it i i like the way he said that if all of us do our part i i'm going to kind of skip around some of the questions here and dr dominguez i would love for you to again as a pediatric individual sometimes you've got really really little ones and you got the teenagers teenagers and it's like somebody's birthday and you can't have a party and you can't go out and and be with your friends at graduation so the important part wearing your mask and the social distancing how do you explain to kids i give some pointers to parents and grandparents how do you explain the kids why it is that social distancing is a thing right now why can't they go to birthday parties why can't they why can't they why can't they is that something that parents have asked you about so it's a very common question i think it is very important to understand that this word that dr moreno is pointing out against covet is is very very difficult but one of the things that easy things that we can do is actually have a good distance a proper distance and there is the the reason is why because virus this virus actually we now know is is airborne so there are other types of buyers that only you're really closing contact that you're tossing and things like that you will get sick this virus is not right so if we have a proper distance we'll eliminate or decrease the risk to have an infection and by end uh um put at risk other people so i think it's very very important to to have this consideration and is there something specific that you tell the kids is that so that they understand but at the same time don't scare them i guess that's where i was going with my question of what parents should be able to tell the kids you know it is a war i guess at the end of the day you know these are let's talk about kids 13 to 18 right where they they get it they see the news they're on social media but they still think well it's just me and my eight friends or just me and my four friends it's so important for us parents to absolutely stay on top of that um and anytime you want to throw that in through the show feel free to do that um dr moreno i want to talk about something that is specific in the pediatric population which is multi-system inflammatory syndrome in children so it's misc and you said it's relatively new if not very new um and something that um we're getting closer to but there has anybody in el paso seen that case yet or is that just something that we're finding with covid that pediatric patients are are facing right so i personally have not seen it i believe we we might have had a case in our intensive care unit with with a child that presented with these symptoms and uh they fit the criteria for for misc but it's it's more it was definitely more pronounced you know in the east coast in new york that's where it all came from but you know we've been very fortunate that at least in my experience i don't know if dr dominguez could uh relate but i i really haven't seen it yet okay we're definitely on the lookout it is important to mention uh i was uh talking with my counterpart at juarez a doctor now i have encountered a couple cases of mic so it's something that it can happen okay so we do have a couple of cases yes now the the the important point here although is rare this syndrome because right now here at el paso our numbers are increasing statistically wise we're now at higher risk to have these cases now right so really we really need to take care of each other do our part as dr moreno said and try to do you know wearing the mask do social listening and try to avoid or try to do the things that we can do in our home right to try to prevent and stop this spreading of of going and there's something to we talked quite a bit about covet last week as well but the idea of in our area we like taking la familia with us everywhere we go right so if you're going to go grocery shopping and you take on you know mom and dad and grandma and grandpa come and this and that and the other just have one person go out to the grocery store i mean i see that and it just you know i just ugh so that's something that we can say to everybody find that one designated person that goes out and goes shopping and then comes back and when i say shopping it's you don't need to be going clothes shopping right now or barbecue grill shopping all that kind of stuff just kind of hunkered down at home uh when and if all possible so i completely agree katherine i think uh this it's what makes uh el paso so special it's what makes us so unique is that the family unit is such a big part of our lifestyle unfortunately this at this you know this year and for the for the near future we really have to step aside from that from that mentality and really you know going back to what we were talking about you know how do we talk to our 13 to 18 year olds that they think they're invincible so i play the grandma card i say i was like maybe you won't get get sick but grandma will sometimes that works sometimes it doesn't but i think we just have to we're running out of options here we just have to really drive this the information home and exactly you know if we have to scare them i guess grandma well it's a scary thing you know i i concur i tell i have a 23 year old and an 18 year old thankfully they're both nelly you know nervous nelly so they they get it um and i think because i've worked in public health all my life but i told them every time you go out assume that the person that you're talking to is got coven just assume that in your head and then cater and then i said also assume that you have coveted and you want to protect everywhere else that's just kind of the way i'm talking with them about it um but thanksgiving is a week from tonight literally seven days almost to the arrow people should be hanging around playing board games after dinner this and that and the other if you can this year in fact i'll ask you both what you're doing for thanksgiving you better tell me you're only gonna be at home with your wife and your one kid or two kids or whatever and that's it um but it's so important not to break that cycle this year because there's already the fear of what's gonna happen two or three weeks after thanksgiving if his people have let their guard down and and are with people we do we want to be with the families but we'd rather than be around a little bit longer as well um dr moreno i was going to talk actually yeah because pulmonary and again i want you guys to bounce back and forth with each other so flu season is coming and there are fevers there are fevers before coved you know what fevers existed so now we're in the time of oh god okay my kid has a fever when is it whether it's the flu whether it's covid when is it enough to actually go to the doctor to go to the emergency room um and let's say this is someone who doesn't naturally have a primary doctor let's just say this is someone who doesn't have a i can call that person i know what are what are we looking at as far as temperature and the the length of temperature like meaning one night two nights three nights etcetera so feel free to bounce i'll start with you dramatically so definitely like you said there was a fever before kobe though fever after uh it's just a matter of how persistent the fever how high the fever is and mainly the age so if we're talking a newborn by all means you know ghost that's that is not okay that needs to be evaluated by a by a medical professional immediately so you know from one day to 30 day old i would definitely uh go to your pediatrician or to the emergency room immediately okay if we're a little bit older you know we do have the luxury that we can kind of just see how how it responds if it's responding to medication but mainly you know if it's associated with other symptoms such as difficulty breathing or not eating or not drinking that could you know lead us to dehydration and that's where you know we would definitely probably need to be go to the er emerging carrier for decisions exactly it's really it's the combination of fever plus and i would say too and you hit it on dehydration if they're really young and it's still diaper age children if they have not urinated in five six seven eight hours that's that's something that means they're not getting fluids in them the fever and again if you don't have a thermometer i always think with my kids it was their joints if their elbows and knees were hot i could tell they had a fever even before i took the thermometer you don't like my grandma really let me feel your elbows come here come here all right get in the bathtub um dr dominguez let's talk about uh the breathing difficulty since that is your specialty um we're gonna get into specifically asthma in a little bit but right now let's talk about kids who don't have asthma and for some reason they are having an issue with breathing let's say they're they have cobia they don't know yet that they have covid but they're breathing funny when i say that what are we looking for so again it will depend on the age of the patient because the symptoms may vary but it is very important to start probably talking about the the newborn babies the infants even the prematures we have uh we have our preemie babies right our patients they have chronic lung disease they require oxygen sometimes these babies or infants they are very easy to present this characteristic number one they may start doing something that we call flaring of the of the of the nose meaning that when they're trying to breathe when you try to read you try to bring in there into your lungs right so because you need to do a big effort because now you have covered pneumonia right the the nostrils are going to expand a little bit so that's one sign that is very important to notice say that again that the the nostrils the nostrils of the nose are going to flare right so uh and then also we have different muscles uh we know that the diaphragm is the most important muscle of inspiration however we have other muscles the abdomen take part the chest take part right so when we breathe in these kids what they're going to happen because their chest is very easy to move you will see all this muscle seeking into this chest sometimes you see part of the neck sinking in and the abdomen instead of breathing at the pair of the chest will have something that we call abdominal breathing those signs are very characteristic of a kid who's in respiratory distress okay now in older kids children's adolescence 21 year old one of the characteristics will be shortness of breath okay this patient i i'm gasping for air i cannot fully complete a full sentence for example i'm trying to so you're having difficulty to even to talk that is very very different now in kids with chronic conditions sometimes you can go a little bit further you may start seeing a little bit change in the lips a little bit bluish grays the hands also start turning a little bit blue or gray those symptoms are very important and something that i forget to mention also kids infants especially they may start because their lungs are a little bit stiffer than an adult normally when they when they are sick what is going to happen they're going to try to maintain open those lungs so they will start making some some noises while breathing something that we call grounding so that that they do so they can maintain open so they will do imagine that they're pushing almost like it's a cough but not exactly they're not really coughing they're just pushing we call grounding and they will start having a head bobbin they will start moving moving around those symptoms are characteristics not to way call go to emergency department okay beautifully said um and that's what's so nice too because again it's it's kids are so much more complicated because you really do you have that entire growth area that you have them there um i was going to ask i've got questions coming in like crazy from the audience dr moreno what i'd like to do really quick you had mentioned some chronic conditions um every time you not every time often when we hear that somebody has passed away especially if it's someone young that there are underlying conditions what might be some chronic or underlying conditions in pediatrics um it's very different when i mean diabetes might be one right there immediately and then asthma but you hear a bunch of other ones when they're adults but let's focus on the kids and some other conditions that might complicate that so i think on the kids that it's that's definitely associated with with adults uh mortality and morbidity is obesity you know unfortunately obesity is becoming more and more common in the pediatric age so definitely you know you could have hypertension the same the same spectrum that is concerning for adults applies for the pediatrics but something like dr dominga said uh having uh being a premature infant having some chronic lung disease definitely would complicate uh a respiratory illness okay such as coverage okay um question here from the artist and this is a simple but a very very common question um my child doesn't give an age my child has been tested for covid does have covid but is asymptomatic should i bring him in question from the audience and i am going to follow that up with um i'm thinking the answer is no but i'm going to follow up with kind of the idea of what we've been doing anyway what are you looking out for you know i know i you feel like you probably just answered this but so question from the audience should i bring my child in so if the kid is asymptomatic there's no need to to go to to to either to see the doctor now we have the capability to do telemedicine so that will be one option so you can talk with the pediatrician or his physician and just monitor make sure that the patient is breathing fine make sure that the patient is eating well is it has a normal output again i don't know what is the age of the patient exactly but those symptoms is what you want to to look for signs of dehydration suddenly the patients start drinking a lot of water recently we have seen a little bit more increased incident of new onset of diabetes related to coffee you know i heard a little bit about so this is not only here in el paso we're seeing it around the globe okay so things like that that maybe uh we'll pass uh an advert that we will not notice but my kid is drinking too much water now spinning a lot he's waking up too much in the morning he's having difficulty to breathe he cannot talk he's running around he's not asthmatic or anything he's running around and he cannot uh you know maintain that effort with like within the spear so things like that you want to look but if continue to be asymptomatic make sure that he if he's above two years of base to make sure that he's wearing a mask try to be as solid as as much as much as can of the household make sure that nobody with any of chronic condition is near the patient and make sure that there's no obesity into the house right um beautifully to add on to that so it's uh i see it very simply if is my child acting normally is does he need oxygen or does he look like he's having difficulty breathing or does he need iv hydration if those answers is acting normally yes no oxygen needed no iv hydration so the answer is he or she does not need to come into the pediatrician or to the emergency okay if any of those answers is a yes then absolutely you know it's interesting a friend of mine who has kova just said yeah he could not get enough water he was just downing down and downing downing water great question from the audience and i know we talked about this already but let's re-emphasize this speak both of you said you're both from juarez went to school came back home thanks for coming home thanks for being homeboys and being back so that means you have family on this side you have family on that side absolutely question from the audience is if we're bringing family in to el paso for thanksgiving how is it that we can protect them so i'm i'm going i'm no i'm being i'm being sarcastic when i say that but obviously this decision's already been made right there are plans already in place um what might you suggest dr moreno i mean if there's a way to stop them from coming in this is where uh last week we were talking about how how comfortable we get because oh you're one of mine so you can't be sick you know you you can't have anything going on with you so this is a mindset that we need to break ourselves out of and i think that's why el paso is such a an issue so i'm going to let you take that on any way you'd like so just to put a perspective i have not seen my family since march so that's i mean that would answer your question and i don't plan on seeing them until you know this pandemic is over mainly because my parents you know they're they're elderly so for me it's it's not worth it i i would rather just plan for next year's thanksgiving okay well that's and if people are bringing people in it's not saying you should in any way shape or form it's gonna happen if it's going to happen anyway i almost don't want to say that but it's so important if you have to eat eat outside exactly keep your mass on maybe eat put the mouse back on and i know you're going to feel silly but it's so so very important right now again i have people in germany i'm from europe and so what's app every morning i'm like reading from my cousins and my you know aunts what's going on in el paso you know we're all over the globe as far as our news goes so dr dominguez i'm going to ask you the exact same thing for people who are telling you oh when my aunt comes over for thanksgiving or et cetera et cetera and i i can't stress this enough which is why i want you guys to bring it out and probably i will answer the same that dr martin i have seen my family since march the same thing and from the same reasons and uh it is very important to point out if it's going to happen it is going to be very difficult for you to protect them for real it will be very difficult so you have to understand that part uh there's no way because you will remove your mask you will eat even if it's outdoor you most likely are going to be together you will not sit in in a really long time and then if you're bringing more family it means that it's going to be crowded right so we don't recommend that at all like because at the end of the day uh something is going to happen something's going to be spilled remove the the the mask probably somebody didn't watch something may happen right and then we'll regret it at the end so my recommendation will don't do it exactly i have a question here from the audience that i'm actually going to turn into a statement uh the question is there are a lot of enclosed spaces at home either or either at social gathering places will masks protective equipment actually protect the children in that environment in general i think no i would say no no no no okay so that's so so important right now because we think yes and that's why we're in the situation that we're in um we're going to talk about asthma now there's a question here from the audience too what condition in children is worse for covid and how can i protect my child if he or she has asthma or other lung conditions dr dominguez this is your this is your time buddy so i will i will tell that first of all and i will read what dr martin says actually right now obesity diabetes will be the highest risk for patients that's very rare but some patients with high blood pressure also but in terms of asthma or any other chrome conditions since the beginning of the pandemic we were very worried about our patient very worried and still it is it is a risk however in the pediatric population specifically for asthma we have seen that actually we haven't been hit so hard actually that's interesting whoa okay what we think is is number one most of the time patients that have chronic condition especially asthma or any other lung chronic lung condition they already do all these things that we now we're doing they used to take care by themselves they know that if if that's a bad climate they will not go out they know if there's a gallery they prefer not to go they know that in winter they get sicker so they already used to so when they hear this covet is coming most of my patients they start worrying about and taking care because before even we we have all the all this information that we we have now that's one point the second point is most of the patient is talking about asthma if they are well controlled most likely they will be fine the patients that i had that i have in my practice they have asthma and they have been uh having copied none of them none of them have end in the hospital and this is because again they take the daily control medication okay okay and we're wondering and i don't have the answer and i think we don't know why but my my my personal opinion is i don't know if this is because of patients who have persistent asthma they're already on daily inhale steroids is that the reason why they they don't get as bad as other patients i don't know i don't know if that's the reason but what i can tell you is if they are well controlled and if they take the measures that we already spoke they will be well protected interesting i i would have thought almost the opposite of that that's uh my son who's 18 uh really had asthmatic symptoms when he was younger and really over the last several years i understand you kind of grow at it for a while and it comes back so i worry about him he's got an inhaler just in case he hasn't had to use it for anything but he's got his triggers um and you were talking about if you know that tree pollen in the fall is a trigger stress can be a trigger running in cold air can be a trigger um if these are things that you already know and i was going to ask dr meno if you wanted to add anything about asthma on that because i think in in my in my head i'm thinking my kid's got asthma i know he's got asthma so it scares me to death and i'm like dude you're at high risk um and still think that way but in general we're still looking at obesity and diabetes being the two big issues when it comes to pediatric uh issues with cova is that still correct yes okay going on back to asthma the the asthmatics that i get to see that basically end up in the hospital it's basically due to non-compliance so this is your asthmatic that for whatever reason they're not taking their controller as they should or they ran out of their inhaler so it comes down to being compliant like dr dominguez says if you're on top of it you you should not end up in my in the hospital right one of the in uh sorry to interrupt one please yeah one of the important things to to to add here is patient with asthma if i know my kid has asthma number one do i have an action plan and that's my action plan is very important because an asmr action plan will tell you in daily basis what you should do normally well i have to take this medication so and so daily so i can control my asthma but also you will have a plan specific if you have a asthma exacerbation as we call asthma attack right okay and then what is going to happen is that you know what to do step by step now if you don't have an asthma action plan it is important to talk to your physician or your asthma specialist to have it now the second point will be is my asthma will control bingo that's that's the thing and how can i know as a parent if my asthma is well controlled well number one is my child having symptoms two three times per week what symptoms well people think about wheezing noisy breathing but actually the most common symptom in asthma is cough is the most common symptom so is my kid coughing all the time a week trial week by week is my kid waking up in the middle of the night night symptoms like shortness of breath whistling coughing number three will be is my kid is able to run have symptoms with physical activity those are very important and then number four is my kid using his rescue inhaler daily two three times per week that means those are red flags that as a parent i can see and then talk to my pediatrician my physician of a family medicine doctor my pulmonology allergies anybody who can take care of asthma and talk about that because then maybe you have to tweak a little bit and i think right now that's this is the moment to try to go and look for uh to see if we are well controlled to talk to your doctor and make sure they're well controlled with asthma absolutely agree if you don't have that under uh wraps right now get that taken care of it's so important to have that plan and speaking of plans dr moreno i'm going to throw this your way i love that the audience is listening so it said here you mentioned about having one person going out to get groceries and that's what's recommended what steps should that person then take once they get home to ensure low transmission um what hygienic steps etc so in the beginning when we didn't know it's like have your groceries get bleach wash them all down you know i still i'm i'm the designated well it's just me and my son and all so i'm the designated person i go and it's a joke but it's like okay go to the laundry room i strip throw all my clothes there i go take a shower and it's still embedded in my head from the beginning um but that's me so in general let's say there's that one person talk to me as if it's me what do i do when i go home now i've gone grocery shopping i went to the pharmacy to pick up medication i've been out and about now i'm coming home and i've got six people at home correct so definitely i would still do that i know it might be a little extreme but the way i see it i mean it's worth it so you know if you do have the luxury that you could go shower change and to protect your family i think that's that's reasonable um even though you know it's definitely time consuming if we we've probably been doing that for the past seven months but i think it's it's an important measure to protect those that you've lost i think just in that point also if you're going to do groceries it is important to try to pick up timing that usually is not too crowded that's another way to do it when there's less people there it is very important and the other point that dr moriel is making i think that's probably the reason why we are the way we are right now in el paso is the covet burnout and we have to talk about it even as a physician is very tiring the nursing staff all the people who work in the hospital setting people who delivery the people who go to the um take care all the you know the service of lines that we have is very tiring you're in your house all the time but doctor now moreno and i we talked about all the time they saying he was telling this thing we have to just wait wait a little bit it looks like the vaccine is coming uh just we have to wait just hold hold for uh probably one two months and hopefully we'll be uh we'll be out of this it looks like there's a light at the end of the tunnel with these new developments of vaccines that are coming but as dr moreno uh as mentioned just just hold on wait a little bit and and then and then you know that's the way that we have to respond right now right and i think right now is a perfect time for all three of us to chill out for a second and say thank you you guys should because i know you have a ton of staff and you have a ton of staff look at that screen and anybody who you said hey i'm going to be on tv tonight and say thank you to them definitely thank you you guys make it worthwhile that's the reason why we we go to work is for you you guys make our work uh a little bit easier thank you yeah i think i think uh this is a work of everybody and not only one person i think the community uh uh the leadership that we have right now all the people who work behind the scenes uh those people that you don't see we talk about nurses doctors and and uh but we have to talk about the cops we have to talk about the firefighters we have to talk about uh all the the people who are trying to give uh an extra time in these difficult uh moments so thank you to all of them yeah now it matters i know we're talking about covid fatigue and all of us are you know they're but they're i've seen some faces where the face masks have been on every day and there's just sores from faces and around the ears and because this is an all-day everyday thing if you are blessed enough to be able to work from home or to be able to have school i've got a school question too um it is it is it's a small price to pay we're all going a little stir crazy i get it but at the end of the day we're all in this together and the more we take care of our collective we the faster we'll get through it that's so very important um dr moreno i have a question here uh from the audience if patients are suffering from diabetes either type 1 or type 2 will controlling and managing their diabetes help them reduce the chance of contracting covid or if not we can talk about at least their treatments i wouldn't say reduce the chance of contacting i would say reduce the chance of having complications because of covet okay so like we've we've kind of stressed all throughout the this time the only thing that's going to reduce the chance is face mass social distancing and staying home so if you could physiologically explain what it is about diabetes and maybe obesity physiologically what's getting in the way to create the complications with kovitt honestly i don't have a specific answer we really don't know but it's it's that combination of comorbidities maybe because you know obesity it's already it's troublesome to breathe on it normally and maybe complicating it with pneumonia pneumonia it just makes it harder i don't know yeah yeah and we we still share we don't know what is going on what we know so far is that the problem with kovit is uh i think the best example is in kids is the mic right multi-inflammatory syndrome right so what happened is we have an extraordinary release of inflammatory products in our body so we have a strong inflammatory response of our body obesity by itself is a inflammatory state constant inflammatory state diabetes also so any type of condition that they give you this constant inflammatory state will be um yeah it will probably get make make worse the problem with kobe again that's what we think we don't know for sure what is going on i think we're learning day by day and probably what we're saying right now today if there's a likelihood that tomorrow is not correct um but we're learning and this is this around the world we still trying to figure out about kobe yeah and that's you said i mean i you know opened the show last the first time we did a show on covet is the fear of the unknown and we know a lot more but we don't know near enough what we'd like to know at this point um as you were talking about what we don't know um i've heard i've read and i i really try to just stick with all the medical stuff and not read crazy things out there peer-reviewed medical studies yes but blood clots is a big issue um i don't know if that is pediatric is that more in the adult population does it seem to be carrying between both i have no idea i'm just throwing that out to whoever wants it i think it's looking more like an adult problem also okay we again we've been fortunate that we haven't seen it uh very much in in pediatrics okay yeah and and the reason why is uh and i'm not going to be too technical for our audience but there are certain um protector factors that they have in kids that will diminish the risk to have a blood clot so that's why and we're not talking about the normal that we had certain um um not hormones but certain certain products that the kids produce that they decrease their risk okay now again if you have other comorbidities right and we go to the same cycle like obesity diabetic you are prone to to have this type of problems i am i'm reading this one cold i'm just going to read this out i haven't read yet so for families in el paso that rely on uh grandparents to take care of grandkids how can the grandparents take care of themselves great question and prevent transmission from the grandkids the babies are going out to play don't go out to play especially if the kids are really small is the question here from the audience too um oh so the question is sorry i didn't read the rest of it if the kids are too small to be wearing masks so so so the recommendation that for the american uh come on pediatric and probably your dr mark can correct me but uh it looks after two years of age you can you it's okay to use it's safe to use the face mask before before that age is it's not recommended that it can be clustered okay is that because of breathing because it's difficult for them yes it can be especially in uh kids they are less than one year of age they they use a risk of having saturn then uh so anything that is not only a mask uh anything that is around the face can be okay yeah it can be hard yeah and i can just see them trying to grab everything off too um wait this is a tough one i almost don't want to give it to you because it could turn political but i'm just going to throw it out and see what you guys have to say so what are the thoughts about kids going to school they're like private schools are open public schools are not um if cool if kids have special needs it's something that that they you know it's part of their routine to go to school in general since you are pediatric doctors i get to ask you guys that i probably wouldn't other doctors that we have on for covid so what are you hearing what are you telling your patients again i'm going to both you dr barrett so you every pediatrician is always going to advocate for school for the your your child to go to school in person school there is an infinite amount of benefits i would argue like dr dominguez will say we just have to hold on let this pass so my humble opinion would be to try to avoid it i know there's definitely definitely a high stress environment i know it's it's uh not the same educational environment it's not the same actual education period but in my opinion i think it's not worth the risk i think we just have to make do with you know zoom classes or just just be creative and how we could educate our kids when this passes we could you know maybe add some extra schooling to make up for for the ones that we missed but again and we can look at this as a snapshot in time and this is the way i'm explaining it my son this is his senior year so he's zooming his his senior year in high school and i said honey you will look back in the history books we talked about this last week too the history books what there's going to be in the history books 10 years from now about these let's say 11 12 you know 18 months or whatever it's a snapshot in time and things are just off and crazy they will get back on dr dominguez you were going to say something yes i think this is a very difficult question to answer extremely difficult to answer number one we're seeing increase in uh patients with a child abuse we're seeing patients that they have a special needs that they they don't have they cannot have a care we see families that they don't have any other possibilities but they take the kids to to school but then we have the other end there's a lot of people who's dying so the reality is very difficult question to to answer i think there's a very small subset of people they really need to go to school patients with a special education now myself i have a kid who has a special education and we have the ability to do everything at home he's not going to school he's not going but i have another parents that actually they don't have any other means to teach them and it's essential to kids who has a special needs to have that that uh that education now talking a patient patients or kids with with normal uh iq like uh neurotypical kids those patients those kids probably they can they can wait they can hold on which is the majority right so i think at the end the people that probably needs to go to school should be very very very very minimal however right now is not the time because we need to have very low uh infectivity rate and right now we're very very high right so i think it has to be what less than five percent the recommendations to go back to school so right now we're not near there so at this this moment it is not the time to go back to school but again let's say we were like five percent is a it's a again very difficult right question to to to us yeah it really is it really is um is it the el paso children's hospital that has the cares clinic yes okay i want to bring that up just a smidge because i think that's so important uh just for child abuse that's happening a lot you know just because what's going on just mental health um if there's a place that somebody needs to call to kind of get some help to if you could talk a little bit about the cares clinic that you guys have yes definitely so curious clinic uh shout out to vanessa andres so they make my life a lot easier so having that support or that that option to be able to consult them and rely on them for their expertise is critical when we're taking care of these children that may or may not be suffering some some type of movement so you know there they have the ability and the expertise to to really investigate and really you know help the parents if in assistance of any type that they that they that they need they have the relationships with you know cps the social worker and everything so they they make uh my life a lot easier yeah and it's it's such a thing and again if you are uh curious about what extensions there are for help again you can go to el paso children's dot www.elpasochildrens.org and you will see a link there to the cares clinic and and take information from there um if you have a more direct place let me know we are kind of at that point of the show where again we're still being bombarded with questions but i want to make sure that we've covered most of what you all want to cover before you go home tonight so dr dominguez i'm going to start with you if we have touched base on something that you want to expand on let's do that or there's something that we haven't said yet that you really want to talk about i think for the pulmonary stand point of view i think my recommendation or something that i want to make sure that the audience understand is if we have any chronic condition like asthma chronic lung disease like patients with bpd brocco puma dysplasia cystic fibrosis patients with mechanical ventilation make sure that you have control your disease make sure that you need have all your supplies in set make sure that for example you have asthma and you have a certain medication make sure you have at least one or two refills in if not please call your physician make sure that you have a plan what to do in case of right and always observe and then something that i think at the beginning we try to talk this question would never answer it is like how we address how we talk to the kids and and i think you know what they're very smart they are very small so i have seen patients that they don't the kids that they don't like to wear the mask is because parents they don't allow them to do the parents that they they use them as the kids they don't have any problem whatsoever so the best way to to to to help these kids for the anxiety and the stress is let the parents to talk to them make it not too scary but explain what is going on at until you will when you start talking to a kid you will you don't need to do a very broad explanation you will he will most of the time they will be satisfied really quickly so you just start talking make sure that you talk to them all the time not in a scary way and they will understand and they i think that way the kids will have less stress and then i think it is very important to talk that point okay i and i agree and i like the idea about the plan and you're right kids are smart and they to me i think role models they see everybody else wearing masks it's like oh well i guess i'm supposed to wear my mask it's just a natural thing sato moreno have we missed anything so far i know there's a lot to cover i just want to close so you know cover 19 it's a once in a century pandemic right it's it's vicious and ruthless it doesn't care who you are what you do you know there's no one we have been fortunate enough that it's been kind to children or for whatever reason we haven't seen it as deadly in the children population as it has been with adults but by no means do not mistake uh its kindness with weakness and you know just in any second it could just decide and start uh taking uh attacking our children and then we'll really be in trouble so you know what we said so far is everybody just do the do their part just hold on uh the light is is there's a light at the end of the tunnel we just have to get there right now we're in a difficult situation here in the city that we all love but we just we rather really gotta kind of work together and get through this together so we could all make it to 2021. agreed uh questioning her from the audience the uh there's a person that said you know we didn't really explain about the grandparents so at the end of the day again if you're worried about the kids make sure you know you guys can have separate places in the house too yes wash everything that's theirs etc breathing space you know we talked a little bit last week about you know the different receptors that we have in our face including the eyeballs um and we don't talk about that a lot because but if you can wear glasses that would be great face shields are available on so many websites that's not even funny i think they're two dollars a piece or something like that um i'm starting to wear a face shield out as well because it just makes me feel better it helps with people who have anxiety because it's like you feel like you're a little bit more protected so as you said getting through it together i'm sorry this keeps dinging i have it off but um i don't not a question i wanted to tell again the audience if you are looking for a free flu shot getting a flu shot is so important right now it's not coveted but if you happen to have the flu shot you have a little bit of defense there and it kind of kicks up your defense systems anyway in in your body so at the el paso zoo on saturday from 9 a.m to 3 p.m it's a drive-through vaccination time um and so and they're to get people to go uh they're saying that you can have a drawing for a christmas wreath there's two christmas wreaths that they're giving away but bottom line is that could be your family activity on saturday don't go anywhere else don't go to a big box store but maybe put the family in the car and go get your flu shot that would be one thing that we can say let's do that um i want to say a huge thank you again to melissa huddleson and sean bala you guys have been really rocking it i've got another question here from the audience to go but i want to give out these websites really quick again if you are uh just interested in what's going on in the world of covid and all the information statistics numbers etc ep strong so think of el paso strong ep strong dot or you can go there and every day it's updated as to where testing sites are what's going on with numbers and there's a lot of just helpful links on there so we're directing a lot of people that way and also for children specifically el paso children's dot org is a website that you can go to when we're talking about the cares clinic that's so incredibly important um with a lot of people having to stay home there's a lot of stress people who are not able to work et cetera there's a lot of stress right now so again there's the cares clinic at the el paso children's hospital you can google that and or you can go through with the el pasochildrens.org and to watch this show again because i know it gets really really fast and sometimes the information just gets thrown out there you can go to www.pbselpaso.org and then if you want to do it through the el paso county medical society that's epcms.com so the tv station is dot org because it's a it's a pbs so public broadcasting system and then again el pasocountymedicalsocietyis.com and that's epcms.com i want to say thank you once again to dr dominguez and dr moreno i know this went so so fast i want to say a huge thank you to the el paso children's hospital for underwriting the show and a huge thank you again to the el paso county medical society because we have pledged for the rest of the year we're doing only shows that are covered related with a specialty that goes uh on the side of that so stay at home we're here there's a very limited crew at pbs right now the students came here and you saw them they have the big plastic barrier between them and they're not allowed to go close to anybody so we're really taking it to heart and again thank you for being here we are all in this together um let's have a nice thanksgiving but do it with as few people as humanly possible i'm katherine berg and you've been watching the el paso physician [Music] [Music] you