COVID-19 frequently asked outpatient questions

Frequently Asked Outpatient Questions
COVID-19 Main Page
Knowledge Based Questions
Everyday Life Questions
Cleaning and Disinfecting
Covid-19 in the Workplace
Public Safety Questions
Travel Related Questions
Pregnancy and COVID-19
Children and COVID-19
Pets/Animals and COVID-19
Keeping Spirits High in Quarantine
Vaccine Related Questions

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Roukoz A. Karam, M.D.[2] Aisha Adigun, B.Sc., M.D.[3] Neepa Shah, M.B.B.S.[4] Oluwabusola Fausat Adogba, MD[5]​ Vidhi Patel, M.B.B.S. [6] Bosky Soni, MDbosky.soni@gmail.com

Synonyms and keywords:

Knowledge Based Questions

1) What is COVID-19?

• Coronaviruses are zoonotic, meaning they are normally transmitted between animals and people. The coronavirus disease (COVID-19) is caused by a new strain of coronavirus (SARS-CoV-2) that has not been previously identified in humans. It was first reported to WHO on the 31st of December, 2019 in Wuhan, China.

2) What tests are used to diagnose COVID-19?

• The FDA has so far approved two types of tests for diagnosing COVID-19; a molecular test that detects the virus's genetic material using a lab technique called Polymerase Chain Reaction (PCR) and an antigen test that detects certain proteins that are part of the virus.

3) How accurate are the COVID-19 serology tests?

• CDC’s serologic test is an ELISA-based test to detect SARS-CoV-2 antibodies in serum or plasma components of blood. It uses purified SARS-CoV-2 S protein (no live virus) as an antigen (designed by the Vaccine Research Center at the National Institutes of Health).

• CDC’s serologic test is designed to detect antibodies produced in response to SARS-CoV-2 and minimize cross-reactivity to antibodies generated to other common coronaviruses that cause less severe illnesses, such as colds. However, potential cross-reactivity cannot be completely ruled out.

• CDC’s serologic test has a specificity of greater than 99% and a sensitivity of 96% based on initial performance evaluations. It can be used to identify past SARS-CoV-2 infection in people who were infected at least 1 to 3 weeks previously.

4) Can COVID-19 be transmitted through the air over long distances?

• When a person with coronavirus coughs or exhales, droplets land on objects and surfaces around the person. Other people then catch the virus by touching these objects or surfaces, then touching their eyes, nose, or mouth.

• COVID-19 can be transmitted when people breathe in these droplets. Therefore, it is important to stay at least 2 meters away from a person who is coughing or sneezing.

5) Are face-masks effective against COVID-19?

• The use of face-masks has been demonstrated to slow the spread of COVID-19.
• Studies conducted in community and healthcare settings observed that the use of face-masks was helpful in reducing the spread of the virus.

7) What is the source of the virus?

• Scientists and public health officials are working hard to identify the source of the SARS-CoV-2 which is the virus that causes COVID-19. The initial transmission appeared to be from an animal source, but there has been person-to-person transmission in countries.

8) How does the virus spread?

• The virus that causes COVID-19 is thought to spread mainly from person to person, mainly through respiratory droplets produced when an infected person coughs or sneezes. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. Spread is more likely when people are in close contact with one another (within about 6 feet).

• COVID-19 seems to be spreading easily and sustainably in the community (“community spread”) in many affected geographic areas. Community spread means people have been infected with the virus in an area, including some who are not sure how or where they became infected.

10) Are countries with warmer climates immune to COVID-19?

• From the evidence so far, the virus causing COVID-19 can be transmitted in ALL AREAS, including areas with hot and humid weather.

12) Can antibiotics treat COVID-19 ?

• No. COVID-19 is caused by Virus SARS-CoV-2 Virus. Antibiotics work only for bacterial infections. However, if a COVID-19 positive person is co-infected with bacterial infection, antibiotics may help.

13) Can you have COVID-19 without a fever?

• Yes, one can be diagnosed with COVID-19 without having a fever. Although a majority of patients diagnosed with COVID-19 have fever as a symptom, there are patients who develop other symptoms like shortness of breath, cough and fatigue without developing a fever.

15) Is there a vaccine for COVID-19?

• No, currently there is no vaccine that can prevent COVID-19.
• Researchers from all over the world are working on developing a vaccine for this virus, and are hopeful that a viable vaccine will be developed in the coming months.

16) Can COVID-19 be spread through feces?

• There is a lot of research being done regarding this, and there is no conclusive evidence that COVID-19 can be transmitted through feces.

17) Can COVID-19 be transmitted through food?

• There is no current evidence that the COVID-19 virus can be transmitted through food.
• It is highly encouraged to frequently wash hands with soap for at least 20 seconds before eating or handling food.
• Additionally, all food packaging and frequently used surfaces should be cleaned and disinfected thoroughly.

19) Can COVID-19 be transmitted through water?

• There is no evidence that COVID-19 can be transmitted through water.
• Disinfection and chemical treatment of water by water treatment plants has demonstrated the removal of the virus.

21) Does drinking alcohol inactivate the coronavirus?

• Drinking alcohol does not inactivate the coronavirus and does not prevent one from catching the virus.
• Additionally, excessive use of alcohol can lead to a weakened immune system, leading to a greater risk of becoming sick.

22) What are the symptoms of COVID-19?

• There are several different symptoms of COVID-19. Below are the majority of them:
  • Fever or chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea
• This is not a comprehensive list and it will be updated as more research is conducted.
• Please see your doctor if you feel sick or if you have come in contact with anyone who has been diagnosed with COVID-19.

23) Where do I go to get tested for COVID-19?

• With the availability of viral tests becoming more common, there are several locations to get tested for COVID-19.
• The best way to find a testing location is to visit your state's health department website, which will have a detailed guide on available testing locations.
• Here is the list of all United States state and territorial public health department websites provided by the Center for Disease Control and Prevention (CDC): State and Territorial Health Department Websites
• Several of these testing locations do not charge for getting tested for COVID-19.

27) What is Herd immunity?

• Herd immunity can be defined as the reduction in the number of cases of particular contagious disease/infection in the population which is not previously immunized, aiming to immunize that proportion of population.

28) I got my tonsils removed 3 months back, am I more vulnerable than the general population?

• Currently, there is no research linking the removal of tonsils and the vulnerability of getting sick with COVID-19. There have been several studies that have been performed to check the relationship between getting a tonsillectomy and its effect on the immune system. These have found that in a majority of cases, there is no negative effect of removing tonsils on the body's immune system.

30) I have been on HCQ for many years for an autoimmune condition, does that make me immune to COVID-19?

• Studies have shown that the use of hydroxychloroquine for prevention does not decrease the incidence of COVID-19; and does not make one immune to COVID-19.

32) I am a consented organ donor, if I die from COVID-19 can my organs still be used for transplantation?

• Unfortunately, if someone passes away due to COVID-19, their organs are unable to be used for transplantation.
• Although the risk of transmission of the virus through transplantation is low, the American Society of Transplantation current guidance is not to use a COVID-19 positive patients's organs for transplantation.
• This guidance may change in the future as more research is conducted and more information is known about the COVID-19 virus.

34) Should an immunosuppressed patient take any drugs to prevent contracting the virus during their hospital visits?

• Currently, there are no drugs that can be taken to prevent from contracting COVID-19.
• Immunosuppressed patients have weakened immune systems, and have a higher risk of getting sick from COVID-19. These patients should continue their regular treatment plan and continue taking their regular medications.

36) Are there any trials to study the long term effects in immunity, relapses, the effectiveness of drugs in patients?

• Yes, there are more than 450 different trials in the United States that are studying different aspects of COVID-19; and researching immune responses and effectiveness of drugs. For a full list of current clinical trials that are being conducted, please visit: COVID-19 Clinical Trials
• Trials being performed to research the immunity response to COVID-19 are primarily being carried out by the National Institute of Allergy and Infectious Diseases (NIAID); amongst others around the world. Example Trial 1 Example Trial 2

Everyday Life Questions

59) As a business owner, how can I protect my staff?

• Screen the staff by taking temperature and disinfect hands with soap and water, wear a mask/face cloth, practice social distancing with 6 feet apart, disinfect frequently touched surfaces multiple times in a day and self-monitor for any symptoms of coronavirus like high fever, dry cough, muscle pain, and other flu-like symptoms.

Cleaning and Disinfecting

• All of the information below has been compiled from the CDC, WHO, and the FDA websites.
• According to a study performed by Arthur Chang et al it was found that there was 20% increase in the number of chemical exposures as reported by the National Poison Data System in the U.S for a period of 3 months from January 2020 to March 2020 as compared to the 3 months duration from January 2019 to March 2019.

89) How do I clean and disinfect surfaces?

• Use soap and water to clean the surfaces which will help in cleaning the dirt. Afterward, use disinfectants to kill the microbes. Here is a list of disinfectants approved by the EPA (the United States Environmental Protection Agency). Always use disposable gloves.

90) What surfaces at home should I disinfect regularly?

• High contact surfaces such as; doorknobs, sinks, dining tables, Phones, Laptops, light switches, keyboards.

91) What products can I use in disinfecting the home?

• Here is a list of disinfectants approved by the EPA (the United States Environmental Protection Agency). The EPA list mentions the EPA registration number not products by brand name. Check your cleaning/disinfectant products for the EPA registration number on the disinfectant.

92) Can I use bleach to disinfect at home?

• Yes, use bleach 5 tablespoons per gallon of water.

93) How often, and when do I clean hands with soap and water while at home?

• Wash hands before and after cooking, eating, cleaning surfaces, laundry, touching any supplies brought from the store.

94) Do I have to separate the laundry of a COVID-19 infected family member?

• You can mix laundry. Be sure to wash hands before and after doing laundry.

95) What precautions can I take as a caregiver to my family in quarantine?

• If you are the caregiver at your house, provide support with basic needs i.e; give medicines as per doctor's advice, give medicines to help with symptoms (i.e acetaminophen to lower fever). It is very important to watch for warning signs like - Trouble breathing, excessive pain in the chest, lack of response to verbal stimulation, confusion, and bluish discoloration of lips. Clean and disinfect the house as per the above recommendations. Have a separate bathroom if possible. Wear disposable gloves and wash hands with soap and water afterward when handling laundry or utensils of infected persons. Limit contact, wear a scarf or cloth face mask when around the sick person at home. Check if you are getting any symptoms like fever, dry cough, muscle pain, and other flu-like symptoms. As a caregiver, you should quarantine yourself for 14 days if you have come in contact with the sick person whether you are symptomatic or not.

96) I don't have symptoms but my family member has tested positive should I quarantine myself?

• Yes

97) How do I clean fruits and vegetables?

• First wash hands before and after washing vegetables with soap and water and thoroughly wash fruits and vegetables in water take extra care if you are eating raw.

98) How can I stay safe while shopping for supplies at the supermarket?

• Wear a mask and try to keep a 1-meter distance from other people. Use disinfectant wipes to sanitize the handle of the shopping basket and trolley handles. After coming home make sure to wash hands after properly cleaning vegetables, and other food products with plastic containers should be sanitized with disinfectant wipes as its found that the corona-virus can stay on the plastic container for 72 hours, 4 hours on the copper vessel and 24 hours on cardboard.

Public Safety Questions

99) Does a mask really decrease my chances of getting infected?

• CDC recommends that people wear a cloth face covering to cover their nose and mouth in the community setting. This is an additional public health measure people should take to reduce the spread of COVID-19 in addition to (not instead of) social distancing, frequent hand cleaning and other everyday preventive action. A cloth face covering is not intended to protect the wearer, but may prevent the spread of virus from the wearer to others. This would be especially important in the event that someone is infected but does not have symptoms A cloth face covering should be worn whenever people must go into public settings (grocery stores, for example). Medical masks and N-95 respirators are reserved for healthcare workers and other first responders, as recommended by current CDC guidance.

100) What kind of face mask gives the best protection against COVID-19?

• The CDC recommends a cloth face covering. A cloth face covering is not intended to protect the wearer, but may prevent the spread of virus from the wearer to others. This would be especially important in the event that someone is infected but does not have symptoms. Medical masks and N-95 respirators are reserved for healthcare workers and other first responders, as recommended by current CDC guidance.

Travel Related Questions

103) What precautionary measures can my family and I take when we travel?

• Clean your hands often, If soap and water are not available,use a hand sanitizer that contains at least 60% alcohol, make sure you cover all surfaces of your hands and rub your hands together until they feel dry.
• Avoid touching your eyes, nose, or mouth with unwashed hands.
• Avoid close contact with others, maintain a safe physical distance of at least 6 feet.
• Wear a cloth face covering in public.
• Cover coughs and sneezes.
• Pick up food at drive-throughs, curbside restaurant service, or stores.
• Make sure you are up to date with your routine vaccinations, including measles-mumps-rubella (MMR) vaccine and the seasonal flu vaccine.

105) What should I do if there was a sick passenger on my flight?

• When booking your ticket for a flight be sure to provide your contact information, so you can be notified if you have been exposed to a sick passenger on your flight. The current federal regulations mandate that all pilots must report all illnesses and deaths to CDC before arriving to a U.S. destination. According to CDC disease protocols, if a sick traveler is considered a risk to the public’s health, CDC works with local and state health departments and international public health agencies to contact exposed passengers and crew.

106) Should I delay my vacation?

Due to the world wide spread of the virus, it is advised to delay your vacation. A lot of countries around the world have lockdown protocols in place and international or domestic travel is highly regulated. CDC recommends that all travelers defer all cruise ship travel worldwide. Recent reports of COVID-19 on cruise ships highlight the risk of infection to cruise ship passengers and crew. Like many other viruses, COVID-19 appears to spread more easily between people in close quarters aboard ships.

107) Does a particular mode of transportation increase my risk of contracting COVID-19?

• When using any type of transportation, follow these general principles:
• Practice hand hygiene and respiratory etiquette (hand washing for at least 20 seconds before and once you reach your destination or use hand sanitizer with at least 60% alcohol, avoid touching your eyes, mouth, nose and mouth with unwashed hands, Cover your coughs and sneezes with a tissue or use the inside of your elbow. Throw used tissues in the trash and wash your hands immediately with soap and water for at least 20 seconds or use hand sanitizer with at least 60% alcohol.
• During travel, try to keep at least 6 feet (2 meters) from people who are not in your household — for example, when you are waiting at a bus station or selecting seats on a train.
• Wear cloth face coverings.
• Wear a cloth face covering when physical distancing is difficult.
• Note: Cloth face coverings should not be placed on:
  • Babies and children younger than 2 years old
  • Anyone who has trouble breathing or is unconscious
  • Anyone who is incapacitated or otherwise unable to remove the cloth face covering without assistance
• Cloth face coverings are meant to protect other people in case the wearer is unknowingly infected but does not have symptoms.
• People who are sick or have recently had a close contact (closer than 6 feet for at least 15 minutes) to a person with COVID-19 should not use public transportation and should stay home except to seek medical care.
• Individuals who are at higher risk of severe illness from COVID-19, such as older adults, people with disabilities, and people of any age who have serious underlying medical conditions, should limit their travel.
• If you need special accommodations or assistance while traveling (for example, help with a wheelchair lift or with carrying bags), if possible, take a transportation “buddy” with you (preferably from your household) to help you during travel.

109) Should I wear a face-covering throughout my trip?

• The Center for disease control CDC recommends that everyone wear a cloth face covering over their nose and mouth when in public, including during travel. Wearing a cloth face covering may slow the spread of the virus. Additionally, keeping a safe distance of at least 6 feet of physical distance from others and practicing other everyday preventive measures like hand washing is also recommended.

Children and COVID-19

126) How can I protect my child from contracting COVID-19?

• You can encourage your child to help stop the spread of COVID-19 by teaching them to do the same things everyone should do to stay healthy.
  • Avoid close contact with people who are sick.
  • Stay home when you are sick, except to get medical care.
  • Cover your coughs and sneezes with a tissue and throw the tissue in the trash.
  • Wash your hands often with soap and water for at least 20 seconds, especially after blowing your nose, coughing, or sneezing; going to the bathroom; and before eating or preparing food.
  • If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. Always wash hands with soap and water if hands are visibly dirty.
  • Clean and disinfect frequently touched surfaces and objects (e.g., tables, countertops, light switches, doorknobs, and cabinet handles).
  • Launder items, including washable plush toys, as appropriate and in accordance with the manufacturer’s instructions. If possible, launder items using the warmest appropriate water setting for the items and dry items completely. Dirty laundry from an ill person can be washed with other people’s items.

128) Is COVID-19 transmitted via breast milk? Can I breast-feed my child?

The limited studies on breastfeeding women with COVID-19 have not found the virus in breast milk. The main concern is the parent or caregiver infecting the baby through respiratory droplets. Precautions should be taken to keep your baby healthy, including washing hands before touching and feeding your baby and wearing a face mask if you are experiencing symptoms or confirmed positive with COVID-19.

• If you have COVID-19 and choose to breastfeed:
  • Wear a cloth face covering while breastfeeding and wash your hands with soap and water for at least 20 seconds before each feeding.
• If you have COVID-19 and choose to express breast milk:
  • Use a dedicated breast pump (not shared).
  • Wear a cloth face covering during expression and wash your hands with soap and water for at least 20 seconds before touching any pump or bottle parts and before expressing breast milk.
  • Follow recommendations for proper pump cleaning after each use, cleaning all parts that come into contact with breast milk.
  • If possible, expressed breast milk should be fed to the infant by a healthy caregiver who does not have COVID-19, is not at high-risk for severe illness from COVID-19, and is living in the same home.

129) What is Multi-system Inflammatory Syndrome in Children (MIS-C)? Is it fatal and what precautions are to be taken to avoid it?

The CDC as well as several other government agencies are working with state and local health departments to learn more about the multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 and gather more information as quickly as possible about how common it is and who is at risk. As new information becomes available, it will be provided to parents and caregivers as well as healthcare and public health professionals. MIS-C has been described as inflammation (swelling) across multiple body systems, potentially including the heart, lungs, kidneys, brain, skin, eyes, and gastrointestinal organs. Signs and symptoms of MIS-C include fever and various symptoms such as abdominal pain, vomiting, diarrhea, neck pain, rash, and feeling tired.

If your child has any of these symptoms, other symptoms of COVID-19, or other concerning signs, contact your pediatrician. If your child is showing any emergency warning signs including trouble breathing, persistent pain or pressure in the chest, new confusion, inability to wake or stay awake, bluish lips or face, severe abdominal pain, or other concerning signs, seek emergency care right away.

135) What are the other signs I should regularly monitor for other than the Temperature of my child?

• Reported symptoms in children include but are not limited to cold-like symptoms, such as fever, runny nose, and cough. Vomiting and diarrhea have also been reported.

Pets/Animals and COVID-19

136) Is it currently safe to adopt an animal from a shelter?

• Based on the limited information available to date, the risk of animals spreading COVID-19 to people is considered to be low. There is no reason to think that any animals, including shelter pets, play a significant role in spreading the virus that causes COVID-19.

137) Can humans contract COVID-19 from animals?

• At this time, there is no evidence that animals play a significant role in spreading the virus that causes COVID-19. Based on the limited information available to date, the risk of animals spreading COVID-19 to people is considered to be low. A small number of pets have been reported to be infected with the virus that causes COVID-19, mostly after contact with people with COVID-19.

• Pets have other types of coronaviruses that can make them sick, like canine and feline coronaviruses. These other coronaviruses cannot infect people and are not related to the current COVID-19 outbreak.

• Since animals can spread other diseases to people, it’s always a good idea to practice healthy habits around pets and other animals, such as washing your hands and maintaining good hygiene. For more information on the many benefits of pet ownership, as well as staying safe and healthy around animals including pets, livestock, and wildlife, visit CDC’s Healthy Pets, Healthy People website.

138) What do I do if my pet gets sick after being in contact with a sick person?

• There is a small number of animals around the world reported to be infected with the virus that causes COVID-19, mostly after having contact with a person with COVID-19. Talk to your veterinarian about any health concerns you have about your pets.

• If your pet gets sick after contact with a person with COVID-19, do not take your pet to the veterinary clinic yourself. Call your veterinarian and let them know the pet was around a person with COVID-19. Some veterinarians may offer telemedicine consultations or other plans for seeing sick pets. Your veterinarian can evaluate your pet and determine the next steps for your pet’s treatment and care.

139) Should my pet be tested?

• No. At this time, routine testing of animals for COVID-19 is not recommended.

140) What should I do if I think my pet has COVID-19?

• Do not take your pet to the veterinary clinic yourself. There is a small number of animals around the world reported to be infected with the virus that causes COVID-19, mostly after having contact with a person with COVID-19. Talk to your veterinarian about any health concerns you have about your pets.

141) Are animals responsible for the COVID-19 outbreak in humans?

• Previous outbreaks of novel viruses i.e. SARS and MERS were traced to horseshoe bats and passed through other species, such as palm civet and camels. Ongoing research is trying to identify the suspected animal source for the COVID-19 outbreak and as well as any other intermediate hists.

142) Is there currently a COVID-19 vaccine for pets?

• At this time, there are no known vaccines for pets.

143) Should my pet wear a face mask in public?

• NO! There is no evidence that face masks will protect your pet from COVID-19. The use of facemasks by pets can cause other breathing difficulties.

Keeping Spirits High in Quarantine

Taking care of your mental health

• Mental health is an important part of overall health and wellbeing. It affects how we think, feel, and act. It may also affect how we handle stress, relate to others, and make choices during an emergency. People with pre-existing mental health conditions or substance use disorders may be particularly vulnerable in an emergency such as a pandemic. Mental health conditions (such as depression, anxiety, bipolar disorder, or schizophrenia) affect a person’s thinking, feeling, mood or behavior in a way that influences their ability to relate to others and function each day. These conditions may be situational (short-term) or long-lasting (chronic). People with preexisting mental health conditions should continue with their treatment and be aware of new or worsening symptoms. If you think you have new or worse symptoms, call your healthcare provider. Look out for free and confidential resources that can help you during this time.

Coping with stress

• Public health actions, such as social distancing, can make people feel isolated and lonely and can increase stress and anxiety. However, these actions are necessary to reduce the spread of COVID-19. Fear and anxiety about a new disease and what could happen can be overwhelming and cause strong emotions in adults and children.Some healthy ways to cope with stress include:
  • Know what to do if you are sick and are concerned about COVID-19. Contact a health professional before you start any self-treatment for COVID-19.
  • Know where and how to get treatment and other support services and resources, including counseling or therapy (in person or through telehealth services).
  • Take care of your emotional health. Taking care of your emotional health will help you think clearly and react to the urgent needs to protect yourself and your family.
  • Take breaks from watching, reading, or listening to news stories, including those on social media. Hearing about the pandemic repeatedly can be upsetting.
  • Take care of your body.
  • Take deep breaths, stretch, or media.
  • Try to eat healthy, well-balanced meals.
  • Exercise regularly.
  • Get plenty of sleep.
  • Avoid excessive alcohol use and drugs.
  • Make time to unwind. Try to do some other activities you enjoy.
  • Connect with others. Talk with people you trust about your concerns and how you are feeling.
  • Connect with your community- or faith-based organizations. While social distancing measures are in place, consider connecting online, through social media, or by phone or mail.

Helping children cope

• Children and teens react, in part, on what they see from the adults around them. When parents and caregivers deal with the COVID-19 calmly and confidently, they can provide the best support for their children. Parents can be more reassuring to others around them, especially children, if they are better prepared. Not all children and teens respond to stress in the same way. Some common changes to watch for include: Excessive crying or irritation in younger children, Returning to behaviors they have outgrown (for example, toileting accidents or bedwetting), Excessive worry or sadness, Unhealthy eating or sleeping habits, Difficulty with attention and concentration.

The following are Ways to support your child:

• • Talk with your child about the COVID-19 outbreak.
  • Answer questions and share facts about COVID-19 in a way that your child can understand.
  • Reassure your child that they are safe. Let them know it is ok if they feel upset. Share with them how you deal with your own stress so that they can learn how to cope from you.
  • Limit your family’s exposure to news coverage of the event, including social media. Children may misinterpret what they hear and can be frightened about something they do not understand.
  • Try to keep up with regular routines. If schools are closed, create a schedule for learning activities and relaxing or fun activities.
  • Be a role model. Take breaks, get plenty of sleep, exercise, and eat well. Connect with your friends and family members.
  • Spending time with your child in meaningful activities, reading together, exercising, playing board games.

References

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