When the COVID19 pandemic took control of our lives in March, it feels like we are living in an alternate world that has been hijacked. Our daily way of life, as we knew it, has been taken away from us.  As we wait and hope for good news to come and a plan to slowly return to our usual way of life, many of us are wondering if we will be able to travel anywhere this summer.  Traveling is one of my deep loves and is like a “refresh” button in life for me.  Our family, like many others, has grown restless from staying home for 2 straight months.  Staying home and watching travel shows on Netflix  has made me think even more of all the places I want to go when this is all over.  

COVID19 has thrown many curve balls in the travel industry with unpredictable outbreaks and quarantines.  We have all heard  about the nightmare stories of people being trapped in other countries unable to find a flight home or, worse yet, being stuck on a cruise ship with no end in sight.  With virtually everything shut down worldwide, being somewhere else besides inside your home has been declared unsafe.

But now that most states in the US are now past the peak of COVID19 infections, several states and countries are slowly and cautiously opening up.  In Washington state,  we are anxiously waiting for guidance from local authorities on when, where, and what we are allowed to do.  It is clear that no one has a crystal ball on how this pandemic will play out this summer.  But there are some recommendations that most experts can agree on for now on how to be safer this summer when it’s unbearable to keep staying at home.

1. Don’t travel outside of the country unless it’s ESSENTIAL.   Realistically, it probably won’t be safe to travel internationally until we have a vaccine for COVID19.
2. If your state government allows non-essential travel, take a road trip instead of a flight.  This may be a good time to visit a lesser known beach or park instead of a popular one.  If you plan on traveling to a different state, consult the state health website to see what the restrictions are there.  Some states, like Montana, currently require out-of-state visitors self-quarantine for 14 days.
3. Rent a RV or stay in a vacation rental home instead of a hotel. You’ll come into contact with fewer people this way.  It will also be safer to prepare your own food than visit restaurants.
4. Keep on social distancing! Stay 6 feet away from those outside your family unit or please wear a mask/facial covering! Covering your nose and mouth means that you CARE about those around you. Wash and sanitize hands immediately and frequently when visiting public areas and touching things others have touched.
5. Choose activities that allow you to keep distance from others, such as hiking or beach combing an uncrowded park.  Eat outside on a picnic blanket instead of at a restaurant.
6. If you or a family member is at high risk of severe illness, please continue to stay home and don’t travel to remote areas.  I’m stating the obvious, but please don’t travel if you are sick.
7. Sadly, it’s time to cancel those large family reunions.  Our family recently had to make that decision to cancel a summer family reunion in Vancouver, B.C.  We also had to cancel my grandmother’s 99th birthday party in NYC.  These are difficult decisions but definitely the right ones to make during these uncertain times.

Sorry I haven’t contributed to this blog for several years.  My husband and I decided to have a second child before the baby making factory closed for good.  And we were thrilled when C got a baby sister!  Fast forward.  Now that C’s little sister is 2 years old, I’ve started to write again and provide some more helpful tips for traveling families.

It’s summertime (yay!) and parents are wondering which sunscreen to buy for their families.  On May 6, 2019,  a JAMA study showed that using sunscreen the correct way for just one day increased the amount of four chemical sunscreen ingredients (avobenzone, ecamsule, octocrylene, and oxybenzone) in the bloodstream to levels the FDA says triggers the need for more testing, potentially raising concerns.  While the FDA didn’t come out and say that these chemical sunscreens were unsafe, there is evidence that there may be concerning health effects, such as hormone disruption or increasing the risk of cancer.  Needless to say, this means that we need more studies to tell us whether these chemical sunscreens are safe or not.  You can view my interview on King 5’s New Day Northwest recently where I talked about this recent study.  

In the meantime, don’t stop using sunscreen!  Instead, I recommend that parents use a mineral based sunscreen, that is at least SPF 30, and has the main ingredients as zinc oxide or titanium dioxide.  Mineral based sunscreens are also less irritating for sensitive skin.  Apply it at least 30 minutes before going outdoors and reapply every 2 hours or after swimming.  If you’re also putting on mosquito repellent, remember to apply the sunblock first, then the mosquito repellent afterwards. Babies under 6 months should be kept out of direct sunlight.  But if sun exposure is unavoidable, it’s still better to apply sunblock and prevent your baby from getting a painful sunburn. Mineral based sunscreens do give you a white sheen which is probably why chemical sunscreens became so popular.  But personally, I find the white sheen helpful so I know which spots I’ve missed.

Lastly, please remember that the best way to protect against harmful UV rays is to cover up and stay in the shade as much as possible.  Have a wonderful summer!  It always passes way too quickly in the Pacific Northwest!

Even when you’re fully prepared for your trip, traveling with children is more likely to bring along something unexpected.  And when you’re far from the comforts of home, it is difficult to know what to do or where to go for help when you or your child is ill.  Here are some tips that may help:

• Strongly consider purchasing travel health insurance and medical evacuation insurance.  Before your trip, check with your health insurance provider to see if they will cover medical costs while abroad.   Before my trip to Asia, I purchased travel health insurance and medical evacuation insurance for our family. As a travel medicine physician, I’ve heard too many stories from colleagues of an ill person who had to fly to another country to obtain proper health care. One example was a child who was bitten by a monkey in Bali and had to be flown to Singapore to receive the proper anti-rabies treatment. The costs of a medical evacuation are astronomical (upwards of $100,000) and having an insurance policy that covers these unexpected situations is definitely something worth considering.  You can find out more about travel insurance providers on the US Department of State website on travel health insurance plans.
• Know how to contact your doctor at home for help while abroad.   When you’re traveling internationally and across different time zones, one of the most convenient ways to ask your doctor a question is to use your health care provider’s patient portal.  Our pediatric practice group, Allegro Pediatrics, now has a patient portal that allows parents to ask their child’s care team a question and receive an answer online.  So if, for example, your child gets a very itchy rash while traveling and you’re not sure which over-the-counter cream to use,  you could login to the patient portal and ask your provider this question.   You will receive an answer within 1 business day.  Being able to message your care team over the internet is far more convenient than having to call, especially across different time zones.  Keep in mind that when it is 1:30 pm in India, it is 12:00 AM in Seattle.  No one likes getting woken up in the middle of the night for a non-urgent question.
• Look up health care providers and facilities at your destination before your trip.  This is important especially if you or your child have a chronic health condition.  There are many trusted resources that list health care providers and facilities around the world.    If you purchased travel health insurance, you may need to call your insurance company’s 24 hour emergency hotline and they will inform you of the appropriate facility to go to.  The International Society of Travel Medicine has a directory of travel medicine physicians worldwide.  The Joint Commission International (JCI) has a list of medical facilities that meet a standard level of quality.  In case of an emergency, the US Department of State can help travelers locate medical services and notify loved ones of an emergency.  Before your trip, you can also enroll in the state department’s Smart Traveler Enrollment Program and they will send you travel warnings about your destination and be better able to assist you in case of an emergency.
• Be wary of counterfeit medications. Bring with you all the medications you think you will need for your trip, whether it be over-the-counter or prescriptions.  Pack it in your carry-on luggage!  When traveling abroad, be wary of counterfeit medications, including antibiotics and anti-malarial medications.  According to the CDC, “an estimated 10%–30% of medicines sold in developing countries are counterfeit.”  Not only can medications purchased in pharmacies overseas be fake but they can also be dangerous.
• Don’t travel if you or your child is sick. This is another good reason to buy travel insurance before your trip.

I’m planning a trip to Walt Disney World with my family next month and can’t wait to see how my 4 year old daughter will react. She tells me, “I can’t wait to meet Elsa in real life!”  Secretly, I am also excited to relive my childhood again.  As I’m planning the trip and booking the hotel rooms, I can’t help but remember what happened last year on January 5, 2015 in Disneyland.

This was the day when an 11 year old unvaccinated child along with 4 other people were diagnosed with measles after visiting Disneyland.  The outbreak spread quickly and by February 11, 2015, there were 125 confirmed cases of measles connected to this outbreak and the disease spread to 6 western states, Canada, and Mexico.  As of June 2015, a record number of 397 cases of measles were reported in the US.  This is the highest number of  measles cases reported in a given year over the last 20 years!  Almost all of these measles cases were imported from travelers, most who were not vaccinated.

Measles is a highly contagious viral illness that can lead to serious complications and death.  You can check out the CDC website on measles for more information about the disease and its possible complications.  On July 2, 2015, Washington state reported a measles-related death in an undiagnosed woman.  The CDC states that the virus can live for up to two hours in a room where the infected person coughed or sneezed. If other people breathe the contaminated air or touch the infected surface, then touch their eyes, noses, or mouths, they can become infected.  Measles is so contagious that if one person has it, 90% of the people close to that person who are not immune will also become infected.  This is incredibly scary for parents with children too young to be vaccinated or have other conditions that prohibit vaccination.

In 2000, the US declared that measles was eliminated.  However, measles is common in most other countries in the world, including parts of Europe, Asia, the Pacific, and Africa.  The CDC reports that every year, 20 million people get measles and  about 146,000 people die from it.  ‘Measles has been brought back to the US by unvaccinated travelers, which then has led to secondary outbreaks in the U.S.

The best way to prevent getting measles on your trip is to make sure you get all the recommended MMR vaccines your doctor recommends.  It is best to get these vaccines at least 2 weeks before your trip.  For people going on international trips, the recommendations for MMR vaccine is  different than the routine immunization schedule.  According to the CDC:

Before any international travel—

• Infants 6 months through 11 months of age should receive one dose of MMR vaccine.
• Children 12 months of age and older should receive two doses of MMR vaccine separated by at least 28 days.
• Teenagers and adults who do not have evidence of immunity* against measles should get two doses of MMR vaccine separated by at least 28 days.
• * Acceptable presumptive evidence of immunity against measles includes at least one of the following: written documentation of adequate vaccination, laboratory evidence of immunity, laboratory confirmation of measles, or birth in the United States before 1957.
• Infants who get one dose of MMR vaccine before their first birthday should get two more doses (one dose at 12 through 15 months of age and another dose at least 28 days later).

It was unfortunate that the “happiest place on earth” became the breeding grounds for  measles last year.  It certainly was not Disney’s fault.   This huge outbreak ignited a national debate about vaccinations.  With its growing number of anti-vaxxers, many US communities are at risk for more large outbreaks.  For my traveling families, I always urge them to get their MMR vaccines before their trip according to the CDC recommendations to provide maximum protection.   Their children, families, friends, and community will be thankful they did.

The seasonal flu vaccine has arrived in all of our clinics.  The WHO and CDC collect data from May-September and analyze the circulating influenza virus strains around the world.  Since it is winter in the Southern Hemisphere, other countries are able to identify the types of influenza virus strains that are causing most of the illnesses. This information gives us a clue about what to expect for our upcoming winter and flu season.

Influenza or “the flu” is highly contagious and kills healthy children and adults every year.  Each year, an average of 20,000 children under age 5 are hospitalized due to influenza complications.  For travelers, getting influenza is one of the most common illnesses that occur while away from home. Crowded airplanes, trains, and buses are breeding grounds for the flu.  Our clinic has seen a few cases of influenza this season already.

I always highly recommend getting the flu vaccine at least 2 weeks before the trip.  All children and adults over 6 months should be getting the flu vaccine every year.  It is best to get the flu vaccine EARLY in the fall season, before getting exposed to the flu.  People often forget that you can get the flu ANYWHERE, and even in warm, tropical locations year-round.  Getting the flu vaccine will not only provide the best protection against a miserable illness but also help to protect those around you and your community!