COVID-19 requires innovations in pediatric health care
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As of April 2, only 1.7% of COVID-19 cases in the United States occurred in children. Still, the pandemic has affected the lives and practices of pediatricians, who have seen caseloads decrease significantly and have had to come up with innovative ways to continue caring for their patients.
“Our role in this pandemic is really unusual, which is that clinically we’re actually not facing severe illness in most of the patients that we’re seeing,” Elizabeth Meade, MD, FAAP, president of AAP’s Washington Chapter and medical director of pediatric quality at Swedish Hospital in Seattle, told Infectious Diseases in Children.
Why children appear less likely to become sick with COVID-19 is one of the questions researchers hope to answer in an NIH-funded study that will attempt to determine the rate of SARS-CoV-2 infection in children and the percentage of infected children who go on to develop symptoms of COVID-19.
The study also will assess the rates of SARS-CoV-2 infection among children with asthma or other allergic conditions and determine if they differ from the rates among children without these comorbidities, the NIH said.
Infectious Diseases in Children Chief Medical Editor Richard F. Jacobs, MD, FAAP, said the study will be “integral” to understanding SARS-CoV-2, the coronavirus that causes COVID-19.
“It presents a series of very interesting questions that will help better our understanding of the epidemiology of this virus and to some degree the biology of infection,” Jacobs said. “Each of these aspects will help us better prepare for future outbreaks and future viral pandemics.”
A ‘novel experience’
At a practice level, Meade said the pandemic has presented clinicians with “a really novel experience.” In a Q&A with Infectious Diseases in Children, AAP President Sara H. Goza, MD, FAAP, explained that pediatricians have found innovative ways to separate sick and well patients and to deliver routine care, such as setting up tents for vaccinations.
“Innovations are coming up everywhere,” Goza said.
(Editor’s note: To read Goza’s full comments, click here.)
Pediatricians can also play a larger role in their communities, Jacobs said. Recently, the AAP recommended that pediatricians work locally with schools and town officials to advocate for quarantines and social distancing measures.
“Pediatricians have always advocated for their patients, and that includes working collaboratively with all resources that impact public health,” Jacobs said. “This is part of our commitment to our patients and families.”
The AAP has released other pandemic-related recommendations and guidelines for clinicians, including a recommendation to separate newborns from mothers with COVID-19. Additionally, Goza lobbied HHS for emergency funds to help pediatricians stay open.
“The AAP continues to do a great job in providing pediatricians with guidance, ideas and recommendations as the pandemic is stressing their office practices, hospitals, and hospital-based practices financially,” Jacobs said. “As doctors start planning for a resolution of this pandemic, we will have a large number of patients who will be behind in immunizations, screenings, plus all chronic patient needs.”
‘Visits in a car’
Meade expanded on some of the ways that pediatricians are ensuring the safety of their patients as they provide care.
“Many offices are doing well-visits in the morning — meaning well-child care, regular check-ups — then deep cleaning the office, and then doing sick visits in the afternoon, and then deep cleaning again before the next day,” Meade said. “Pediatricians are also doing virtual visits or using telemedicine video capabilities to talk to families back home.”
Meade said many practices have been postponing well-child visits for children aged older than 2 years to minimize the spread of the virus. But she noted that pediatricians are able to see their patients in nontraditional ways.
“They are doing visits in a car. They’re having people come to the parking lot and physically going out to see them, rather than bringing them in and gathering with other people. The interesting thing about this is that pediatricians are always facing a unique set of challenges,” Meade said.
“Now that spread of the virus has slowed, pediatricians are working with public health officials in order to get children back into the office for routine vaccinations in order to avoid an outbreak of vaccine-preventable diseases on top of the coronavirus pandemic,” Meade added.
Jacobs, who is also a professor emeritus of the University of Arkansas for Medical Sciences, said his state amended telehealth laws to make it easier for doctors to have access to their patients.
“Many new avenues using telehealth and digital devices with live interactions can still be made available,” he said. “Laws have been amended to allow physicians to bill an office visit for these patient interactions. No facility fee is allowed in our state, so overhead and facility costs will not be recovered, but patient access can continue.”
Pediatricians are not only important to the safety and health of their patients but also their patients’ families, experts said. The AAP has issued numerous guidelines to help parents and caretakers, including tips for parents on how to deal with stress and how to keep children occupied during the pandemic.
“Pediatricians in particular do and always have had a focus on full family care,” Meade said. “In general, our focus is not just on the health and safety of patients but on the health of the whole family, including parents, siblings, other caregivers, grandparents — whoever is connected with helping that child thrive and develop.”
With practices facing difficulties related to the pandemic, Meade said pediatricians want to ensure parents everywhere that if their child needs to access care, someone will be there for them.
“I think that pediatricians are feeling this in the same way that we always do, which is that it’s really our job to help families navigate this, and to help families understand how to keep their kids healthy and safe, and to really keep themselves healthy and safe,” she said. “We are using some unique strategies at this time to make sure that community spread stays as low as possible, and that we’re protecting not only kids but their entire family and anybody else who is living with them.” – by Ken Downey Jr.
- Reference:
- Puopolo KM, et al. Initial guidance: Management of infants born to mothers with COVID-19. https://downloads.aap.org/AAP/PDF/COVID%2019%20Initial%20Newborn%20Guidance.pdf. Accessed April 8, 2020.
Disclosures: Jacobs and Meade report no relevant financial disclosures.
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