Children's Healthcare During COVID-19: Q&A
May 12, 2020
The following is a paid program from UChicago Medicine.
And welcome now to At the Forefront Live. Today we're going to talk about health care and children during this COVID-19 pandemic. Is it safe to bring your child to the hospital? How do video visits work? And are they effective? How do you keep your children and your family safe? Our experts will answer these questions and more that you will ask. That's coming up right now on At the Forefront Live.
And we want to remind our viewers that we'll take your questions live on the air. Just type them in the comments section. Also, remember today's program is not designed to take the place of a visit with your physician. Dr. John Cunningham, Dr. Ritu Verma, and Dr. James Mitchell join us today to discuss the health of your children.
Let's start with each of you introducing yourselves and telling the audience a little bit about what you do here at UChicago Medicine. And Dr. Mitchell, since you're actually on set with me, which is the first during the pandemic-- and we are keeping our distance. We've been very careful. Wipe down the surfaces and everything-- we'll start with you. And just introduce yourself to our audience and tell us what you do here.
Sure. Thanks a lot, Tim. I'm Dr. James Mitchell. I'm a pediatrician. And I'm the ambulatory medical director for Comer Children's Hospital. So I manage everything related to the clinics of our medical center.
Great. All right let's go on to Dr. John Cunningham.
Hi, Tim. And I want to welcome all our audience. My name's John Cunningham. I am chair of the Department of Pediatrics and the physician in chief of Comer Children's Hospital. I am a hematologist by training. And my responsibility is to lead all the pediatricians, all 180 at the University of Chicago.
All right. Dr. Verma?
So I'm Ritu Verma. I am a gastroenterologist by training. I am also the section chief of Gastroenterology, Hepatology, and Nutrition. I'm the director of the Celiac Center here at the University of Chicago. And I do a few other things along the way.
You all keep very, very busy. So let's just jump right into our questions. The first one that we have is, we're about a month and a half, two months into this coronavirus pandemic And the stay-at-home, shelter-at-home order. And I think a lot of people are very concerned. And obviously parents are concerned about their children's health.
So I guess my first question would be-- and let's go ahead and start with you, Dr. Mitchell. What are your concerns for children's health throughout this situation?
Sure. So my biggest concerns now are that parents have become so concerned, so afraid of medical centers or health care centers that they're not bringing their children in for regular care. And I've been practicing long enough to have seen the diseases of measles and polio and pneumococcal infection. So we really want to make sure that routine care is still taking place for those children.
And one of the things that we really want to stress as we do our program today is that it is safe for people to come to UChicago Medicine. There are appropriate precautions that are in place. But we also have video visits and televisits, which are very effective as well. And I don't know, Dr. Mitchell, if you want to talk about that or if one of our other docs want to discuss that a little bit. But these are ways that people can get help.
Absolutely. Our biggest concern has been making sure that we maintain access for our children to always get care, whether it is coming into the clinic, which are very safe, or whether we're now doing those as a virtual visit, a video visit.
And Dr. Verma, I think you are pretty well-versed in this area as well, dealing with some of the video visits and some of the off-site access that we have. Can you talk to us a little bit about that and maybe tell parents what they can expect?
Sure. So when the whole pandemic started, we had the stay-at-home order. So from our standpoint as physicians and clinicians, our first thought process was we need to be able to take care of our patients. And hence the telehealth platform was raised very quickly. And we adapted to that extremely quickly and very well.
And of course now, as you heard from Dr. Mitchell, there's limitations to our telehealth visits. So it's important for everyone to know that the hospital is open, is safe, and that we need to bring our children back in for immunizations, for well checks so that we don't end up with other diseases.
So we started the journey with the telehealth visits. We've done it well. We want people to come back. And we'll talk more about that. But keeping the future in mind, we will definitely keep our telehealth platform there as well because we realize that in order to take care of our patients, of our children, of our families, we need to be accessible to them with what works best for them, for their child's care, and for safety of everyone.
So for us in the on-site at Comer and also at the off-sites, we have both in-person and telehealth platform that's there. It just started off with the desire and the need to take care of our patients and families.
And Dr. Cunningham, I know you are at Comer Children's Hospital on a regular basis-- quite often, actually. Can you talk to us a little bit about what's going on there? And then I have another follow-up question for you that's in regards to a story that was in the newspaper this morning. And we've already had some questions online about it. But talk to us about Comer in general and the safety there if you will, please.
So our preeminent goal is to make sure that everybody who enters Comer is safe. That could be the children we are committed to care for, their parents, and also our health care professionals. So we have done significant work, as have many other institutions, to ensure that we're safe.
And in fact, we're very proud of our safety record at Comer Children's and at University of Chicago Medicine. In fact, we have the only Leapfrog certification in Illinois. That's the highest level of quality of a health care facility in the nation. There's only 32 institutions in the nation that have that.
Standing up to that reputation, we've done many different things. We've actually made sure that our waiting rooms are socially distanced. We insist that everybody is masked, whether it be health care workers or parents. And if you don't have a mask with you, we will provide a mask at the door.
We screen all our patients and parents and health care workers when they enter the building to make sure that we are the most safe place we can make it. We really do believe this is the time that we can actually provide safe care for every child who requires in-person visits. And as Dr. Verma and Dr. Mitchell said, we really need to you are just absolutely your child at time.
And Dr. Mitchell, you can see this video that's rolling right now. If you can walk us through what happens when somebody comes into Comer and just follow us through the video, if you will?
Sure. So when you first come in, you'll be stopped at the front desk on the first-floor lobby. We're going to look to see if the visitor, the caregiver has any symptoms that might be related to COVID-19 or flu-like illness. If there are no symptoms, then we will allow them to move on up the floor to the clinic areas. Everyone must wear a mask so that if they do not have their own mask, we will provide them one at that point.
They'll go on up the elevators to the clinic areas, where again we are going to have the seating appropriately spaced now so that folks are not grouped closely together. You're going to see all of our staff members are going to be appropriately masked. And in fact, the time in the lobby or in the waiting area is going to be much shorter now. We're going to be getting you into a room very quickly. So there's not a lot of time waiting.
And it's interesting. You'll see here in just a minute in the video everybody is masked up-- the parents coming in. And we saw that masks are provided for the children as well. Is that three and up? Is that--
So three and up are required to wear a mask. So younger children do not need those masks.
Yeah. And it's been great because people have been doing exactly what they're supposed to do and what they've been asked. And I think everybody is really laser-focused on keeping safe, keeping themselves safe, and keeping other people safe, which again is critical to that whole situation
And you'll even notice the little girl here in the monitor has her mask on. And she was happy to be on camera and was a little shy once we got the camera close to her but super cute. It was neat to see how it all worked. So again, the focus is keeping patients and families safe. And you all at Comer are certainly doing a wonderful job.
Dr. Verma, can you talk to us a little bit about-- I think it's important that people know that we are still open for business and doing procedures. I believe there's epilepsy surgery that happened and a transplant. Can you tell us a little bit about that?
So I think I just wanted to go back to where Dr. Mitchell had shown and talked about Comer. And you had shown the nice video that we have. I think people have to understand that all of us are parents, and we have children as well.
None of us-- the commitment that we have is that we will take care of whatever precautions need to be done safely so that we feel comfortable bringing our own children there. So I think that's an important message that I would like people to know.
Secondly, not only at Comer but even at our off-sites, there are very, very strict regulations that everyone follows in terms of screening, having masks, masks for everyone, the cleaning that's done in the office itself. All the off-sites truly are committed to that same safety as it is for the main site in Hyde Park itself
So we've taken aspects where the play room has-- the items of the play room have been removed so that, again, there isn't as much of a concern from infection in that standpoint there. I also can say that the Infectious Disease Group at University of Chicago and Comer Children's have worked very hard to put very, very stringent guidelines so that whatever we do is with the commitment that there is safety for the child and the family and the people working there.
So going back to procedures, being a gastroenterologist, obviously, we have procedures that we do-- and then the surgeons and so on. The group at University of Chicago, the surgical and anesthesia group, actually came up with the guidelines they call MeNTS. They are for the Medically Necessary Time-Sensitive procedures.
And these guidelines-- the scoring system was started here. And it is utilized throughout the country. Again, it goes back to the fact that we believe in the safety over anything else. So this scoring system was started here and is utilized elsewhere. And there's a pediatric component to that MeNTS score that's there.
So any child or adult getting a procedure done here at University of Chicago has this screening process that happens. Every person has a testing done 48 hours before-- very, very stringent to make sure that it is safe for the child, the family, and the caretaker who's going to be taking-- the person or the clinician who is going to be doing the procedure. So I just want to emphasize that each step has been thought through very carefully and that certain standards set here at University of Chicago are actually used throughout the country.
And yes, despite going through the pandemic, two fun sort of things-- and I'll mention the transplant. There was a liver transplant that was done successfully. And that happened at Comer Children's. And I'll have Dr. Cunningham talk a little bit more about the epilepsy patient. So again, safety is our first thing
Great. And Dr. Mitchell, we'll go to Dr. Cunningham in just a minute. We're going to try to establish a little better connection with him because he's kind of fading in and out. But I have a question for you.
We're getting our questions from our viewers. And I do want to remind our viewers that if you have questions for our experts, please just type them in, and we'll get to as many as possible. But here's one that came in. Is there any data that nonsymptomatic children can actually be infectious? Because I think with adults, we've seen that, correct?
Right. We don't know that part yet. We're treating them as though they may be infectious, which is why they'll have a mask as well. But we just don't know that part yet.
So as we talk about some of the things that are still happening in Comer and, of course, our entire campus, what would you tell a parent that says, you know, I'd like to come in and get my checkup for my child. Or I think my child needs something. But I'm just still a little nervous about doing that. Is there a way so they can prepare, maybe a televisit or something to even see if they need to come in?
So sure. First thing I would always say is talk to your primary care provider. They're going to be able to give you some good cues and clues about what the type of visit that your child is going to need, if we're going to be able to do that live face to face, or whether we're going to be able do that as a virtual visit.
We are doing both virtually every week. All of our providers have got sessions where they're doing all video visits and sessions where they're doing all face-to-face visits. So we're becoming even more and more comfortable with expanding what we can do as virtual visits.
We do a lot of mental health management as a virtual visit, where it's mainly talking. We are even getting better at the physical exam that we can do looking at different areas and having the parents help us with maneuvers so we can do a good physical exam as well. So the gap is really shrinking in terms of what we can't do with video that we have to have in person.
And it's interesting because I've heard from a patient who did the video visit. And her comment was that she really preferred it because she didn't have to wait, didn't have to leave her home, and really felt like the one-on-one visit with her physician was very-- even though they were in separate areas. But she still felt it was very connected and really, really thorough. So there are potentially some nice advantages there.
Right. We're enjoying them as we're still learning. But we're enjoying being able to still see our patients. We're enjoying the interaction both with the families and the patients because we get to see both. So we really think this is a very smart platform.
One of the things that I do want to tell our viewers is that if you're interested in these televisits or these virtual visits, it's really easy to do. You just go to our website, uchicagomedicine.org. And that's the easiest way to learn about it. There's a video there that shows you how to prepare and what to do.
And you can even connect or make your appointment to connect right there or with our phone number as well, which we have on the screen right now, 888-824-0200. So we're trying to make this as easy as possible because one of the fears is that patients are avoiding medical care when they really need it. We don't want that to happen.
So Dr. Cunningham, can you tell us a little bit about the procedures that Dr. Verma was talking about? I'm not sure. We had you reconnect, so I don't know how much of it you heard. But we were talking about epilepsy. And there was also a liver transplant, I believe.
Right. So Dr. Verma, can you hear me? Dr. Verma had discussed the liver transplant. I think what it emphasizes-- both that and doing epilepsy surgery, which I'll describe in a moment-- is the hospital had never shut down and always focused on medically necessary care. We are committed to the safety and making sure that we do the right things at the right time.
So to give you an example, our neurology team, which has got a world reputation taking care of children with intractable epilepsy-- in other words, children cannot be controlled-- their epilepsy cannot be controlled medication-- have developed new techniques for dealing with epilepsy using surgery. And we had a child during the height of the pandemic who needed epilepsy surgery. And we moved forward in a safe and effective manner.
I can tell you from checking with the neurology team today that child is completely free of seizures, something that they haven't had for many, many months. So those are the kind of cool things we're doing every single day at Comer Children's.
I think the thing that you're hearing from all three of us is that it's really important that we reinitiate care for all children requiring care. Whether it's the children who are going to need their physicals, well-child visits, or it's the children with diseases that have been diagnosed who are now continuing management or children with new problems that need to be addressed, there is nothing that is not medically necessary in pediatrics. I would encourage everybody who has a child to think about coming to speak with our physicians.
I've said this on the program before, and I'll say it again today. When you walk in Comer Children's, there's just almost a special feeling that comes over you from the facility and, more importantly, the people who work in the facility. And it's like no other place. And you can tell the children just get the most wonderful care there. And it's just a great place. So I have a tremendous amount of respect for you and for your team because you do fantastic work.
So more questions from our viewers-- we'll get to a few more of these. Interesting. How long do we anticipate that we use telemedicine as a replacement or as a supplement? And I got to think-- and Dr. Verma, I would like you to take this one. This may be a no going back, at least to some degree. I think we'll always have telemedicine moving forward. What are your thoughts on that?
In my opinion, it has to be both. I think not only are the families having a good time with telehealth, the providers are having a good time as well. Just in terms of the interactions, it's really great. So in my opinion, telehealth is here to stay. We do have to realize that there are some limitations. If you're getting allergy shots, you're having the immunizations, those things, you're required to be there. So it has to be both telehealth and in person.
The advantage of telehealth, of course, is if someone is far away, then we can reach out and still provide the care that we want to give to all the patients. So we're able to take care of someone who might be three hours away. So it's here to stay. I think that is the commitment that we all have to the community-- is that both the things are to stay.
I just want to add one thing from earlier-- is that parents should not-- if they have any reservations-- should I come in? Should I not come in? They should just pick up the phone. We have clinical teams in each section who are ready to answer the questions and to reassure you and really to be able to help you make that decision whichever is the right decision for your child.
But don't avoid medical care just because you're afraid of going somewhere or afraid of something. We will work with you and give you the best care that we can for your child. So just pick up the phone. And let us help you make that decision with you.
That's a great piece of advice right there. Dr. Mitchell, here's a question that came in from a viewer. I think it's a good question. What if your child has sensory issues and doesn't want to wear a mask? How do you deal with that situation?
So that's a great question. We would still try to work with the caregiver to make sure the caregiver's wearing a mask. We realize that some children are going to have a challenge with that. And so we're going to, again, put the patient first, making sure that we can keep them as comfortable as possible. So we would not force the issue at that point. And we would continue to do our care.
We, of course, will still have our mask on. But we would still be able to take care of that child. And if we thought necessary, we would really try to do a virtual visit if we had to.
And I think a point, Tim, that I would make is that we do have child life personnel, people who would work with the children. So if it is necessary that the child has to be in-person visit for the best care for the child, we have a whole team. So we would have social workers, child life, everyone to help with the child.
And I'm so glad you brought that up, too, Dr. Verma, because the child life folks that work here at UChicago Medicine and at Comer children's are really fantastic at their job. I've seen them in action. They connect with the children just in amazing ways, really, and with the family as well.
And it's pretty neat to see them work and do what they do because it does help make the children comfortable. And they can work wonders. And so I'm glad you brought that up. Another question from a viewer-- and anyone can take this one. I'll just throw this open to you. Are well visits separated from the sick visits?
I'll probably take that one. We absolutely do separate those. We are separating them in two ways. The first-- we're separating them in time. So we're using a large block of time of our clinics just for our well children where we do not bring the sick children in.
And secondly, we're separating them by distance. We have a separate waiting area for those children that are ill. They go directly to a different waiting area so they're not combined at all with the children that are well.
Interesting. Here's another question from a viewer. What has been your protocol for patients with highly suspicious AOM, but a household member is confirmed positive COVID-19 with no nonhousehold member available to bring the child in? That's a tough one. I'm not who wants to take that one.
So we're all taking deep breaths here. And I think that I will at least say I think we would first reach out here. If there's no one to bring the child, we would do a telehealth visit. We would absolutely do a telehealth visit to take care of what we can on the telehealth platform. And then telehealth includes a video visit. That is the best because you can see the child. You can see the family. You can see the interactions.
But there is a telephone telehealth platform as well. But I think if there is no one to bring the child and the only person at home who could bring the child is COVID-positive, in my opinion, if it was someone in GI-- and I'm sure the rest of the department would do the same-- is they would do a telehealth visit and help take care of the child.
So I can also speak to that, Tim.
So we actually have had several children like that at Comer. And we actually do that by a customized case-by-case basis. And so the most important thing is to make sure that we take care of the child. If the child needs to be seen in person, we need to get that child seen.
And it may be that the parent, even if they have COVID, comes to Comer. But obviously, we need to make sure that it's in a special area where the COVID-positive parent in no way could harm-- or their infection cannot harm any other child. So we have protocols in place specifically to deal with it.
Yeah. I'm so glad you said that, Dr. Cunningham and all of you, because the commitment here is that we are going to maintain access. We are going to make sure if children are sick that they will be seen. And they will be taken care of. And that's what's critical to all of this.
And we really want the viewers to know that if you have a sick child, please reach out. We'll figure something out and make sure that that child has access. So a couple more questions, and we're about out of time. So let's get to another couple of questions real quickly before our half hour is up just real quickly.
What advice do you have for parents of school-aged children with congenital heart defects, diabetes, asthma, et cetera who will be evaluating their child's eventual return to schools? And again, I think a lot of parents are concerned about the fall and what will happen if schools are open again in the fall. And I have no idea who wants to take that one. So I'll just throw that out there for whoever wants to get it.
So I think I'll take that question because I obviously take care of children who are immunocompromised. I'm a hematologist who takes care of the children with leukemia and transplant patients. I think the guidance from CDC and from ourselves is those children-- we should assess them on a case-by-case basis. And it's really dependent on relative risk. So a diabetic patient is different from, let's say, a children who's recovering from treatment for leukemia.
The most important thing is for everybody, regardless of whether they're immunocompromised or not, is to make sure that they're socially distanced and masked. And in that situation, it's highly unlikely that the child who is immunocompromised will be infected.
We should also note that, while we have many immunocompromised children in our community, the number of those immunocompromised children who got infected, even in areas where there isn't shelter in place, has been extremely low. So the risk to those children is much less than to our adult patients who are immunocompromised.
Great. A couple of shout-outs, then we're probably going to wrap up the program because we're out of time, one from a parent that says, I loved the telehealth visit. It's so easy and really helped my child avoid the anxiety of coming into the office. So there's one little advantage right there.
And then we also had-- oh, Dr. Bartlett is watching. Hi, Dr. Bartlett. And he says, thanks for the shout-out to the infection control team, which is a fantastic bunch here at the University of Chicago and have kept so many people safe.
So you all were fantastic. So thank you all for doing this today. And we're going to have another special At the Forefront Live with Comer Children's next week. So make sure you check your Facebook page for that one as well. That'll be a lot of fun.
That's all the time we have for the program. We'll have another Forefront Live next week, maybe two even. Please remember to check out our Facebook page for our schedule of programs coming up in the future.
Also, if you want more information about UChicago Medicine, take a look at our website at uchicagomedicine.org. There's all kinds of information there about COVID-19, about telehealth visits, just a treasure trove of information. You can give us a call at 888-824-0200. And remember, you can schedule your video visits either by that phone call or going to the website. Thanks again for being with us today, and I hope you have a great week.
Comer Children's Hospital at the University of Chicago Medicine is at the forefront of kids' health, shaping national standards of care from infants to young adults. Comer Childrens, welcome to the Forefront.
This was a paid program from UChicago Medicine.
John M. Cunningham, MD
John M. Cunningham, MD, is an internationally known expert in the treatment and research of childhood cancers and blood diseases. He serves as chair of the Department of Pediatrics and physician-in-chief of UChicago Medicine Comer Children's Hospital.Learn more about Dr. Cunningham
Ritu Verma, MD
Dr. Verma is a highly respected pediatric gastroenterologist and a leading expert in celiac disease. She works closely with her patients and their families to manage this condition.See Dr. Verma's profile
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