You’re scared about coming in. We’re scared about you NOT coming in.
COVID-19 has been life changing for all of us. I pray to the toilet paper gods as I head to the grocery store. I Google how to substitute egg whites in a recipe (hint: chickpea water—who knew)? And, I bring my college kid home—with boyfriend and dog in tow— for a really, really long spring break. (This is actually a bonus, because I realize how much I have missed her.)
What is unique is how COVID-19 has totally changed my practice of medicine. After being a pediatrician for 25 years, I thought I had it figured out!
Pre COVID-19: It’s about being there. It’s about giving shots—more on this later. It’s about reassuring new parents that they should trust themselves. It’s about explaining normal child development (tantrums will happen and kids weirdly like to eat carpet pile sometimes), assessing for delays and atypical development, and teaching parents to have realistic expectations (you cannot make your toddler eat, sleep, or poop on the potty). It’s about educating kids about making healthy lifestyle choices. It’s about having those crucial conversations with teens. Then, throw in a few million ear infections, sore throats, rashes, dislocated elbows, and wheezers.
Enter COVID-19: It’s about being there…it’s just more challenging to be there. Here is my new “normal”.
If I get sick, I cannot take care of patients. I have to assume everyone is contagious—even the cute little ones. Children show little or no signs of infection and people can be contagious two days before showing symptoms. I suit up in full PPE gear for every patient. I bought paint coveralls and welder eye protection shields at Home Depot and a few hundred KN95 masks from some guy who knew a guy in China…I’m not asking any questions. My neighbor, landlord, and even patients’ grandparents have donated supplies and made cloth masks for us. The response has been touching and extraordinary. When this is all over, I will enjoy not dressing up as Buzz Lightyear to see a patient.
Our staff is all in. We have daily huddles to discuss best practices for protecting staff and patients while we are caring for them. We had an Alamo moment when I drew a line in the sand and gave everyone the chance to head for the hills. No one left. Not to be dramatic, but we are risking our own lives to care for our patients because we love your kids and it’s just what we do.
Families are scared. I know what you are thinking. The last place you want to go right now is a place where sick kids hang out. But please do not be afraid if your child needs medical care. We have taken cleaning to a new level. The entire office is bleached nightly. All surfaces are cleaned thoroughly with a germicidal product between every patient. Schedules have been shifted so only newborns and well children are seen in the morning. Parents and patients get their temperature checked before entering and must wear a face mask. 90% of sick visits are done with telemedicine video conference calls. And for the few patients who need in-person sick visits, I meet them in their car out in the parking lot. I have considered delivering cherry limeades with my ear exams.
Do not delay vaccines. Collectively, our greatest fear right now is getting COVID-19.
But we cannot forget about the 15 other infectious diseases we DO have vaccinations for and kids need those shots now—not when this COVID-19 nightmare is all over. Eventually we will relax our shelter in place guidelines and all germs will spread again. If kids miss out on their shots, we will be in trouble. That’s why the American Academy of Pediatrics (AAP) advises that children remain on schedule for well checks and vaccinations–0-2 year old well checks and 4 year well checks, 11-12 year old, 16 year old visits are essential and should not be delayed.
We are living the nightmare that made previous generations embrace vaccinations. In the 1940’s and 50’s, polio virus outbreaks arrived in the summertime. Swimming pools, movie theatres and amusement parks shut down to prevent the spread of the virus. Some people died. Others were paralyzed for life. Some people survived by being placed in iron lung machines to assist with breathing until they recovered—hospital wards were filled with rows of patients in these crude devices, gasping for air. Our predecessors welcomed the arrival of the polio vaccine in 1955. Since 1979, there have been no cases of naturally occurring polio in the US. We still give the polio vaccine because it is a plane flight away. And who can forget the Great Measles Reboot of 2018/19 (with over 140,000 deaths mostly in children under age 5) and the 2015 Disneyland Mickey Mouse gets Measles fiasco. Before measles vaccine in 1963, there were 3-4 million infections in the US annually. And worldwide, 2.6 million people died every year from it. The UN predicts that 117 million kids will miss out on measles vaccine because global vaccination programs are on hold due to COVID-19.
We don’t want to end up with a measles outbreak because we fell behind on protecting kids with vaccinations we do have.
Virtual housecalls! Within a matter of days, I quickly adopted telemedicine videoconferencing as a way to continue caring for patients. The previous barriers to implementation (not getting paid for it and health privacy concerns on various platforms) magically disappeared with COVID-19. And, honestly, it’s pretty great. My patients are on time and no one is having a tantrum (well, almost no one). Parents are less distracted because they don’t have to entertain their child while trying to have a conversation with me. I do a virtual housecall and observe a child in his natural environment, playing on his own turf (not an artificial one in the exam room)—and this is powerful. I’ve taught parents how to examine an abdomen, feel for swollen lymph nodes, and look at a child’s tonsils with a spoon for a tongue depressor and flashlight. There is no turning back now—I anticipate telemedicine visits within the medical home will be an essential part of patient care going forward. Now, we need insurers to get on board for telehealth well visits to be a covered benefit as the AAP recently issued strong guidelines regarding this issue.
This is a scary time for all of us and our goal is to take care of our loved ones, which takes many forms. But we are all in this together!
We are all adapting to the new normal—both personally and professionally. So, it’s natural to feel a bit down right now.
As someone who takes care of newborns (the best part of my job!), I’m happy to report that people are still having babies. It is a great reminder that life goes on.
Stay healthy and safe!
-Dr Ari Brown