June 10, 2020

Dear Colleagues, We continue to face difficult times. I am truly grateful for the continued focus on providing the best care for all children and families. We have seen an increase in the number of pediatric cases with COVID. At this point, the children hospitalized have predominantly been Latino, highlighting the significant health care disparities associated with COVID. As we have learned, this disease is truly a multisystem disease. We continue to gain insight daily. Please continue to send questions to myself or Tom Belhorn.

UNC COVID Updates

Inpatient Care We are experiencing a very busy inpatient service.  Currently we have 3 total COVID positive patients in Children's - 1 is on ECMO. Please call PED COVID ID pager with questions about COVID management or testing Please call PED COVID ACUTE/PED COVID ICU with questions about admissions or bed placement for suspected or confirmed COVID positive patients.

Pediatric Specialty Clinic Follow Up Process Work flow and Support Sessions See the attached Optimized Workflow for Scheduling Follow Up Visits Children’s Specialty Clinics. The workflow will also be available on the Pediatrics COVID Resources page. Ryan Haushalter will be hosting the following WebEx sessions for Pediatric Specialty Clinic providers to help anyone with customizing the follow-up activity.

6/11-6/12 (TH, F) 8:00am – 9:00am Meeting ID - 160 378 4237 Meeting Password kMSNft35aD9 Click Here  to join.

6/11-6/12 (TH, F) 11:30am - 12:30pm Meeting ID - 160 441 4315 Meeting Password 8bsPyFMYV25 Click Here  to join.

Your COVID-19 Questions & Answers Response from Tom Belhorn  Q: I heard that children with COVID-19 can present with a rash. Is rash now one of the clinical findings we should watch for in this infection?   A: Although a variety of rashes have been documented in children with COVID, this does not seem to be a frequent finding (<20%). If present, the most common seems to be a morbilliform rash on the trunk, but just like in other types of viral infections there have been a variety of skin findings. One of the more intriguing form seen in a few children are “pernio-like lesions of acral surfaces” termed “COVID toes”; the child will have erythematous -violaceous macules on the toes (or fingers, elbows) occasionally with edema. Perhaps more importantly, in MIS-C some children will have a rash consistent with Kawasaki Disease, but again in MIS-C rashes may be more consistent with erythema multiforme, petechiae, or other types of lesions. So rashes are only part of this disease with a spectrum of presentations.

Travel Policy Updates The COVID-19 Travel Policy for Health Care System and Clinical Providers implemented in March was reviewed and redefined based on the evolving phases of the current situation. The updated requirements were developed based on recommendations that work best for our organization. The NEW POLICY now includes return to work requirements after travel and potential/known exposure to COVID-19. A few highlights include: Business travel outside of the state of North Carolina is NOT ALLOWED. Personal travel outside of the state is allowed without quarantine. Individuals are expected to adhere to the CDC Guidelines for Travel. If exposure or symptoms occur, please let your Division Chief know in order to determine next steps.

Join Us for an End of the Academic Year Celebration!!  Tomorrow, June 11 at 8a This annual event includes an award ceremony and recognition of our graduating fellows and residents. Join Zoom Meeting Meeting ID: 950 0542 2368 Password: 715755   Grand Rounds will be on summer hiatus until August 6, 2020.

Please attend our annual awards day tomorrow!   Gratefully,

sddavis@med.unc.edu 919-417-3130 (cell)