COVID-19 Q&A Medical & Physical Health

No one has been left untouched by the COVID-19 pandemic. Schools and stores are closed as we practice social distancing. More parents are working from home, and anxiety’s on the rise as we try to keep everyone safe and virus-free. In this episode of Just Kids Health, pediatric specialists Alice Sato, M.D. and Christopher Maloney, M.D. field questions from parents related to COVID-19 and children’s health. They’ll also share extra precautions to take during this uncertain time and what Children’s Hospital & Medical Center is doing to curb the spread.

Topic Breakdown

1:41 – Changes at Children’s as a result of COVID-19
4:38 – Working with other health systems and public health agencies
6:52 – The future of COVID-19
10:40 – Changes inside primary care and specialty clinics
14:23 – COVID-19 care at Children’s
15:25 – What COVID-19 looks like in children

Transcript

Here at Children’s Hospital & Medical Center in Omaha, Nebraska, it’s all kids — all day, every day. Our pediatric experts are here to answer your questions and weigh in on hot topics, helping you keep your child healthy, safe, and strong. We’re here for you. Listen in.

Dr. Sato: Hello, my name is Dr. Alice Sato. I am Associate Hospital Epidemiologist and an assistant professor of pediatric and infectious disease at Children’s and UNMC [University of Nebraska Medical Center].

Dr. Maloney: And hi, I’m Dr. Chris Maloney. I’m the Chief Clinical Officer and Physician-in-Chief for Children’s Hospital & Medical Center, and a professor in the Department of Pediatrics at UNMC.

We’re here to talk about some questions that the community has asked of our organization. We’re just going to take one at a time and go through.

Changes at Children’s as a result of COVID-19

Dr. Maloney: The first question is, what’s changed at Children’s as a result of COVID-19?

And my answer is everything.

This has rocked our world as it’s rocked your world. And so most of life as we knew it before COVID has changed. We didn’t really have a visitor policy, and now we have a visitor policy. In fact, it’s pretty strict. We allow one healthy parent per child. That’s in the hospital, that’s in the clinics, that’s in our Emergency Department.

That’s very different than what we used to do where we could allow 6 or more. However, we have to protect you as the community, and protect our staff. In fact, we have screening at every one of our entrances. And what they’re doing is trying to identify if people in the car have been exposed or may have COVID. And if they do and they need to be seen, we’ll put a mask on them and the whole family. However, if it’s not an urgent visit, we’ll actually ask them to reschedule. So know that if you’re sick and coming to our building, you may actually be asked to reschedule.

We’re doing a lot of social distancing. And when we can’t social distance — we even started putting masks on people before that. Now, masks aren’t a solution or a treatment for the prevention. It’s just like a belt and suspenders. Pretty sure your pants aren’t going to fall down.

We’ve also changed some things inside our doors. Our gift shop is closed. Food services have changed. We’ve taken down our salad bar, for example. And our facility dogs aren’t on site anymore.

If you want to learn more you can go to childrensomaha.org/covid.

Dr. Sato: The main thing we’re trying to do is keep everybody safe. We want it to be as safe as possible for our patients, for their visitors, for their parents or guardians that are with them, and for our staff. So what we are trying to do is prevent transmission of disease in both directions. We’re trying to prevent everybody from getting sick. There’s concern that somebody could spread disease before they even know they’re sick — that’s why we have masks on our staff and we offer masks to people coming to our facility that have any symptoms that might be due to COVID. We offer ways for people to clean their hands, and we offer tissues to people in the room. And get people into a room with a closed door if there’s any concern that they might cough.

Working with other health systems and public health agencies

Dr. Sato: So the second question we’ve received is, “How is Children’s working alongside other health systems and public health agencies in the state and community to handle this pandemic?”

We work with a number of community, state, and government partners. We collect our numbers internally, so we’re looking at many, many features of care and resources available within our institution, and share that information with other institutions to make sure that we’re all meeting our needs. We share them with the governor’s office and the state. We share them with the local health departments and the Nebraska State Department of Health, as well as with government officials. And this is pretty comprehensive. We’re looking at things like how many beds do we have, what type of beds do we have, what capacity does our emergency room have, how fast — what’s the so-called “burn rate” of our use of PPE (personal protective equipment)? How many masks do we have and how fast are we using them? We look at our staffing and how many of our staff have to be out due to illness or concern for developing COVID.

Dr. Maloney: Yeah, Dr. Sato. I believe this pandemic has really brought our community together. Every morning at 9:00 we have a community call where we have a set agenda and we go through that agenda to really understand what’s going on — not only in Omaha, but over the entire state of Nebraska.

I’ve also been talking with all of the chief medical officers in the Omaha area to understand how they’re dealing with this pandemic and crisis, basically on all of the topics that you talked about, as well — staffing, resources such as mechanical ventilators. Right now, we’re well ahead. We’re doing really good because we’re working together. And I anticipate that when this pandemic comes to resolution, we’ll continue to work together as a community to provide excellent healthcare.

The future of COVID-19

Dr. Sato: Question 3 — “How do healthcare leaders think this pandemic is going to go from here and when will it end?”

Well, everybody knows this is a very tricky question and there is no simple answer. And unfortunay, I think it has multiple parts.

What do I mean by that? I think we are looking at an incoming wave of COVID itself. We’re looking at this new virus entering our community, where everybody pretty much is susceptible, which means everybody can get infected. We’re looking at this first wave. We’re doing what we can with social distancing, we’re handwashing, trying to cut down our exposures to each other by wearing masks, to slow down the rate of infection spreading in the community.

This has, of course, interrupted people’s regular care. Other diseases haven’t gone away. So we really think it’s important to still pay attention to other health issues. We think it’s important to do our best to prevent and manage other diseases, as well. But we’re worried that there will be some consequences to people who’ve been avoiding getting care for other issues, and maybe have put off getting care for things that they really should have been getting care for. And so we’re worried that there will be a secondary wave of people ill with other things.

Another part of this is the mental health piece, and my understanding is that there will be another podcast to talk about this. Stress is a real thing and people are going to have their own concerns and stressors from this wave of infection. But further than that, until we have good prevention methods such as a vaccine to prevent other people from getting infected, we’re looking at seeing another wave of infection that could happen again in another few weeks, in another few months — hard to know. But as long as people are by and large susceptible to getting the infection, we do have to worry that there will be new outbreaks of infections where we’ll have to do pretty much similar things. Where we’ll have to make extra sure that we’re being extra safe and preventing the spread of infection again.

Dr. Maloney: Yeah, I agree, predicting the future is really hard to do and I think this one is impossible. In fact, if we do a really good job at social distancing, flattening the curve so that we have just a few people that get infected over time, that time is likely going to be weeks and months. And that’s probably good for our community, as from a healthcare standpoint. It’s probably not that good from an economic standpoint. So there’s a fine balance there. So we really need to do our part in keeping away.

As you (Dr. Sato) mentioned, we don’t have a treatment for this virus. We don’t have a way to prevent it, there’s not a vaccine, and so the only way that we can really get away from this virus is to social distance. And that’s what we need to do.

Dr. Sato: We have been able to increase the number of tests that we’re able to run. We’re looking into having more local testing. And that will help us in the future in order to rapidly find who’s infected and do our best to keep any new introduction of virus into our area to as few people as possible.

Changes inside primary care and specialty clinics

Dr. Maloney: So now let’s start talking about your children. What are we doing differently about caring for children inside of our clinics?

First of all, we’re trying to do as much virtual care as we possibly can. And that’s looking at you through a screen. Your computer, your tablet. We have software called Children’s Connect that we’re using. In fact, our virtual visits over the last ten days have increased by a factor of 500. And that’s fantastic because it allows for that continued social distancing. At the same time, the doctor may need to see your child, especially in our specialty clinics, where they have to listen to your (child’s) heart or lungs or have a test done. And so we’re making that as safe as possible as well, by limiting the number of people that are being seen. We’ve closed down our waiting rooms so you’ll come in and you’ll go right to one of our examination rooms, and then you’ll leave as well without waiting. So those are a couple of the things that we’re doing.

In addition, for our primary care, we’ve separated our clinics into well-checks and ill-checks. So you should call your clinic to identify if they’re well or ill, and who their partner clinic is. It may be a little inconvenient because you may have to drive a little bit further either for a well or ill check, but it’s very important to keep you safe. And once again, as we previously talked about, vaccinations for the common illnesses are still urgent. You should go in for those visits. Don’t put those visits off. The last thing that we want to have is an illness related to a vaccine-preventable disease.

Dr. Sato: Right, so primary care offices are available to talk with you, to guide you about whether your child’s illness is something they do feel needs to be seen in an office or not. We also have a COVID19 help line — that’s (402) 955-3200 — and that can help you sort through those questions about where the most appropriate care would be for your child. If you’re worried about their symptoms, is it something that needs to be seen or not be seen?

If your child is sick and really needs to be seen, we can definitely see them. You can come to our emergency room, you can come through. We have a separate respiratory care center we’ve set up to be as safe as possible for any child with respiratory symptoms — cough, wheezing — with specially trained staff who are ready to take the best care of your child as they can. If they need testing, specifically for COVID-19 or for SARS-CoV-2, we can do that safely in that center.

COVID-19 care at Children’s

Dr. Maloney: We were asked if Children’s has cared for any kids with COVID-19, and the answer is probably.

We have many children that present with fever, cough, shortness of breath, and we test them for the routine viruses this time of the year. And if those are all negative, we test for COVID-19. None of the children that we’ve taken care of with fever, cough, or shortness of breath have needed intensive care, and all have been discharged to home within just a couple of days.

Dr. Sato: That said, I think we should be clear — our ICU is well prepared to receive any children that may have COVID-19. We have plans in place for how to safely care for them. We can offer them all the usual support services that they would need for any severe level of illness.

What COVID-19 looks like in children

Dr. Sato: So the next set of questions that we’ve been asked is about the risks of children developing the disease. How does it affect children, how do we tell that from normal things like allergies? And then, as a parent, how should you be keeping an eye on your child and your family? What is the best way? If they start to get sick, should you be worried about whether you give them ibuprofen or an NSAID or another treatment?

Children overall have been doing better with this disease. Less severe. Fewer children have been getting hospitalized around the world and in this country compared to adults, especially older adults.

The CDC just published figures on children in the United States between February 12 and April 2, so right up to date. And of that group of children that were submitted to the CDC — 2,572 children — they were aware of about 6%. They reported 5.7% were hospitalized with three deaths in that group. Which is only 0.1%. Which is still as bad as seasonal flu but much lower than the rates not seen in children.

Children are less likely to have what we now consider more classic symptoms that we see in adults. In adults we see fever, cough (usually non productive so not bringing up a lot of stuff) and shortness of breath. So it’s a little harder to gauge. They don’t have as much in terms of gut symptoms necessarily as adults. It’s a little harder to tease out how they might present. Fever might not start out at the beginning, so I personally don’t recommend checking your child’s temperature on a regular basis. Most parents are pretty good at having a feeling for when their child’s getting sick. If you’re going to take a temperature, you obviously need to use whatever type of thermometer you have. We generally recommend taking a rectal temp for babies under 3 months old or under the arm axillary temperature. For children 3 months to 4 years old, rectal temperatures are harder to take, so we tend to do more armpit or ear temperatures, or temporal where you scan it across the forehead type thermometer. And if you have the right kind of thermometer, and your child is 4 or older, they can do under the tongue, as well.

The data — the information we have — does not show one way or the other whether ibuprofen or other NSAIDs are more of a risk for people with COVID. We recommend using normal dosing by age and weight. The FDA also does not have evidence that these types of medications make it better or worse. It may be that people who were sicker were more likely to take these medications, leading to the initial concern. That said, you can certainly use acetaminophen, — the brand name most people know is Tylenol — as your first-line medication. Make sure to dose it carefully and be sure that you’re not giving over-the-counter mixed medications — multi-symptom medications that also say they may contain acetaminophen, so that you don’t give them too much.

Dr. Maloney: Dr. Sato, I think those are great answers and I have really nothing to add. I do want to reiterate that moms really can tell when their children have a fever. They hug them all the time and they know when the temperature is normal and when the temperature is high. And so keep loving your children. That’s the most important thing you can do.

Well, I hope that we were able to answer a few of your questions. Thanks for sending them in. If you have additional questions, don’t hesitate. This is rapidly evolving, and we’re going to learn a lot more tomorrow and next week than we know today and what we knew last week. We really appreciate your patience, we really appreciate your trusting us, and continue to come back and listen to other podcasts.

Dr. Sato: I’d like to say my thanks as well for allowing us to answer your questions and to try and help our community with this new disease. We really are living in — and I know this is an overused word — unprecedented times. We are happy to keep working with you. We stand at the ready to provide care to your children. In this podcast series, you will learn other ways to help. And we think that we’re really here to be your partner and to help you with the best care for your child and your family.

For the latest info about COVID-19, visit childrensomaha.org. Thank you for listening to Just Kids Health.

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