COVID-19 Update

We have received many questions regarding the vaccination for the corona virus. As such, the following has been prepared.

As with all medical decisions, the potential benefit of the vaccination needs to be weighed against the potential (or unknown) risk. COVID-19 vaccine development is a rapidly changing process and recommendations will evolve as more data are collected. Their use in special populations such as those patients who are pregnant or attempting pregnancy needs further study. Below are some important facts and recommendations as they are known today:

• Compared to non-pregnant populations, recent studies show that COVID-19 infections in pregnant individuals can be more serious and result in an increased risk of intensive care unit (ICU) admissions, need for mechanical ventilation, and even death. Data has shown this to be especially true in those with underlying health conditions such as diabetes, obesity, increasing age, cardiovascular disease, and among racial and ethnic minorities. As such, vaccination, so as to avoid these risks would have merit. Unfortunately, there are NO safety data specific to use in pregnancy yet. Despite this lack of information, given the development and mechanism of action of these vaccines, it is expected that the safety and efficacy profile of the vaccine for pregnant individuals would be similar to that observed in non-pregnant individuals. That said, there are NO safety data specific to a mRNA vaccine use in pregnant or lactating individuals, and the potential risks to a pregnant individual and the fetus are unknown.
• The American College of OB/GYN (ACOG) recommends that COVID-19 vaccine should not be withheld from pregnant individuals who meet criteria for vaccination based on the Advisory Committee on Immunization Practices (ACIP)- recommended priority groups. While safety data on the use of COVID-19 vaccines in pregnancy are not currently available, there are also no data to indicate that the vaccine should be contraindicated, and no safety signals have been generated from studies for the Pfizer/BioNTech vaccine.
• According to the ACOG practice advisory, vaccination is strongly encouraged for non-pregnant individuals within the ACIP prioritization group(s). They strongly recommend vaccination of individuals who are actively trying to become pregnant or are contemplating pregnancy and meet the criteria for vaccination based on ACIP prioritization recommendations. In nonpregnant patients the vaccination appears to be approximately 95% effective, and is likely to be just as effective in pregnant patients. Additionally, it does not appear necessary to delay pregnancy after completing both doses of the COVID-19 vaccine.

Due to the COVID-19 pandemic, your health and safety are forefront in our minds. We have implemented and continue to follow strict protocols our clinic has set in place. The safety of our patients and staff is our top priority. If you have been exposed to someone who has tested positive to or has COVID, we may request to reschedule your appointment. Please contact our office to report exposure and discuss appropriateness to keep or reschedule your appointment. During this time, we are asking all patients to reschedule their appointments if they are showing the following symptoms:

• Cough
• Sore Throat
• Fever
• Loss of taste or smell
• Body aches

As local and state health agencies continue to monitor the COVID-19 infection rates, we are noticing a rapid increase in diagnosed cases, hospitalizations, and ICU utilization in area hospitals that exceeds even the highest local case counts from earlier this year. With increased demand of healthcare resources to continue to combat COVID-19, we at RMCRM are continually tracking recommendations and guidance from county and state health officials as well as recommendations specific to our patient population as outlined by the American College of OBGYNs (ACOG) and American Society for Reproductive Medicine (ASRM).

At this time, surgical services and office-based treatment plans and procedures continue with appropriate measures in place to include wearing of masks, frequent hand washing, screening of all persons entering the office, and limiting office entry to patients only. We appreciate the willingness and understanding of our patients and partners to participate in these safety measures as well. Should access to care be restricted due to recommendations or mandates outside our control, though we recognize the inconveniences of halting care, we consider compliance with potential restrictive measures to be in the best interest of patient, staff, and community safety.

Per CDC guidelines: air travel increases the chances of getting and spreading COVID-19. Airports, bus and train stations, and rest stops are areas where social distancing is difficult or impossible. State and local travel restrictions vary from state to state and even locale to locale. As such, it is possible a state or local government may put into place travel restrictions such as stay at home orders or shelter in place orders, mandated quarantine upon arrival, or even state border closures. Travelers to other states should research destinations for their travel restrictions, infection rates, etc. This continually continues to be increasingly important to consider as some states are seeing a significant increase in reported cases, as opposed to a decline seen in some other states.

As of June 18, 2020 the latest public health order from Governor Polis is "individuals are encouraged to limit travel to necessary travel (not recreational). People who must use public transit only for purposes of performing necessary activities or to travel to and from work to operate businesses and maintain critical government functions."

It is critical for YOU to take responsibility for keeping updated by accessing reliable information outlets such as those provided by the CDC website: www.cdc.gov/covid19 . You must frequently check the website. This specialized information changes very frequently, and it is not possible for RMCRM to keep up with all of these changes and notify everyone as these changes are made.

We are pleased to announce that following the directives of the American Society for Reproductive Medicine, infertility testing and treatment can now be resumed in most locations nationwide with considerations given to appropriate safety precautions. As of May 4, 2020, we will be accepting appointments for consultations for new and return visits as well as for scheduling appropriate testing and treatments. For any questions, please call 970-493-6353.

Due to the coronavirus (COVID-19) outbreak, federal, state, and local mandates have required the clinic to suspend non-emergent in-person consultations, fertility testing, fertility treatments, surgery, and IVF. It is abundantly clear that no one is certain as to when these conditions/mandates will return to "normal". It is our belief that in-office consultations have certain advantages, and we have made allowances for the COVID-19 outbreak by temporarily suspending all in-office consultations. Nevertheless, we are all anxious to continue with our lives, even if this involves alternatives to traditional office visits moving forward. As such, beginning May 1st, we will begin scheduling consults once again for now and existing patients. Consultations will take place in the office (if allowable by regulatory agencies) or by phone if not yet permitted to resume face-to-face meetings. Please feel free to call the office with any further questions or concerns, or to schedule an appointment.

In coordination with federal, state, and local mandates regarding the management of coronavirus (COVID-19), our office has added restrictions and policies to protect patients, visitors, and staff during this time.

• All patients will be screened upon entry for recent travel history, symptoms of fever, cough, shortness of breath, or other upper respiratory symptoms. Should you have any such symptoms, please call the office (do not come in) to reschedule your appointment.
• Spouses, family members or other individuals will not be allowed in the office during the patient appointment.
• Anyone under the age of 16 years of age will not be permitted in the office (including the waiting area)