Physician-in-Chief's Message
May 19, 2020
Dear Colleagues,

We currently have 29 adult patients in-house with COVID. I would like to thank all of you for your continued hard work! 

Our NICU continues to be at capacity and our clinic volumes are now at 80% of pre-COVID volumes . 

Our medical students are returning at the end of May and I would like to thank Kenya McNeal-Trice and Rick Hobbs for their leadership with our trainees during these unprecedented times.
UNC COVID Updates
Virtual Care
  • Telehealth charges have been going out to payers. Reimbursement and revenue cycle is working well!
  • The telehealth billing guide is attached and has been updated on the Pediatrics COVID-19 Clinical Resourses - Telehealth Visits and Billing site.
  • The notable change is that for APPs who are doing telephone visits, please use codes G2012 (<5 min), 99441 (5-10 min), 99442 (11-20 min), 99443 (21-30 min)
Your COVID-19 Questions & Answers
Response from Tom Belhorn

Q: I have two COVID testing questions. I tried to order the SARS-CoV-2 antibody test and was not able to place the order. Also I saw a memo about restrictions on rapid testing. Why is this test being further restricted?
 
A: The UNC antibody test for COVID can be ordered on any patient (no restrictions). There are a few different options (some restricted) listed in Epic, but to place the order for this test here at UNC just type “COVID IgG” as the order, look in the Database tab (far right at top) and you will find this test.
 
The memo regarding new restrictions for use of the rapid test was sent out this afternoon via email (linked) . Up until now UNC had a supply sufficient for only 48 tests per day (average). Last week many more than this were used, plus we now have been notified of a further reduction in the test kit allotment for UNC Hospitals. In order to prevent us from totally running out of this rapid PCR test, there is an urgent need for further restrictions for use. Hopefully this limited supply issue will be resolved (soon we hope) and use can again be expanded. We do have an ample supply of the batched COVID PCR tests available, and most testing will be performed with this test.   
Public Heath COVOD-19 Clinician Guidance
  • Please see the information and guidance for clinicians (attached) on multi-system inflammatory syndrome in children associated with COVID-19.
  • Further guidance from CDC is expected in the coming days.
  • Please share this with other clinicians.
  • We are requesting voluntary reporting of cases of this syndrome to the Communicable Disease Branch epidemiologist on call.
  • If you have questions, please contact the Communicable Disease Branch epidemiologist on call at 919-733-3419.
Study Suggests Steroids Tied To Severe COVID-19 In IBD Patients
L eading the news for the American Gastroenterological Association is a study led by Erica Brenner (Second year fellow in Peds GI) and Mike Kappelman (Professor of Pediatrics), along with collaborators at Mount Sinai in New York. The study data are already helping patients make more informed health choices.
 
Study Suggests Steroids Tied To Severe COVID-19 In IBD Patients
MedPage Today (5/18) reports that “increasing age, comorbidities, and corticosteroids and other anti-inflammatories correlated with severe COVID-19 infection in inflammatory bowel disease (IBD) patients, but tumor necrosis factor (TNF) antagonists did not, an analysis of a large geographically diverse registry of pediatric and adult IBD patients revealed.” Researchers “analyzed 525 IBD cases in the newly created Surveillance Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD) database, which includes data from 33 countries and 28 U.S. states.” As the investigators described in their study in Gastroenterology, “they calculated age-standardized mortality ratios (SMRs) to identify factors associated with severe COVID-19, defined as admission to an intensive care unit, use of a ventilator, or death.”
This video, from a young adult patient, describes how she has used SECURE-IBD data to return to work as medical intern, despite having IBD and being on immune suppression.
Survey - Impact of COVID-19 on Physicians

A medical student at Write State University, has asked physicians to participate in a research project assessing the effects of COVID-19 on physicians ( faculty physicians, residents and fellows ). The researchers are looking for as many responses as possible - as they are looking into the overall impact of the pandemic on all physicians, irrespective of COVID-19 case load.
This survey link will be open for 2 weeks.
 
A few details: The Department of Psychiatry at Wright State University is conducting a study to determine how physicians are being impacted by COVID-19. This study is anonymous and collects no identifying information. We will not collect IP addresses or email addresses. The survey takes less than 10 minutes to complete. The Wright State University Institutional Review Board has reviewed our study and determined that it is exempt from IRB review. Please share the link with any physician that you know.
We will continue to send COVID updates twice a week. Please let me know if there is additional material you would like included in these newsletters. 
 
Gratefully,
919-417-3130 (cell)