Physician-in-Chief's Message April 9, 2020

Dear Colleagues, I have nearly completed all my virtual meetings with the divisions. Thank you for attending these meetings and sharing important information! It has been great seeing so many of you virtually. I also appreciate the questions and I am working on getting answers to any questions I was unable to answer.

UNC COVID Updates

Inpatient Care - Physical Distancing Please remember that physical distancing rules apply in all areas of the hospital. This includes rounding teams, consultants and patient care staff. Please limit consultants coming to rounding on all services to more successfully comply with social distancing requirements Please feel empowered to remind our colleagues and staff about our physical distancing rules. Prevention is the best medicine! For the PICU - Due to physical distancing concerns, we are asking teams with more than 2 individuals on the team to call their recommendations into either the PICU fellow or attending in lieu of coming into the unit.  If direct communication within the unit is required, we ask that teams limit their presence to no more than 2 individuals. More than 3 individuals make physical distancing in the ICU environment impossible.  Communicate via conference call if more than 3 individuals are needed to communicate recommendations

Virtual Care A primary requirement when setting-up a Video Visit is that the patient has an active myUNC Chart account.  During visit scheduling, or anytime when contacting the patient, please encourage sign-up using this process detailed in this Tip Sheet. Please also review the information on our public website that we are sharing with patients via emails, social media, and other channels to help promote and support virtual care.

Ambulatory Care Moving forward all outpatient visits will be scheduled as face to face or video visit. Phone visits will only be used when the patient does not have computer or internet access.  Please submit request for virtual templates. These templates can be used any day of the week, morning or afternoon session and do NOT need to correspond with the providers clinic day. This will provide access for new patient, return and recall patients. Requests should be made to the BAS team. Newborns of mothers with COVID or with exposure to COVID need normal newborn care after discharge, including weight checks, lactation support and bilirubin measurement. This care can be provided with appropriate protection of staff, providers and other patients at the UNC Children's Primary Care Clinic on Franklin Street in Chapel Hill or at the Pediatrics RDC in Cary. Please contact Martha Perry, Ed Pickens or Sally Wood for more information.

Urgent Care UNC Children‘s Urgent Care at Raleigh remains open until Midnight 7 days a week for walk-in or scheduled appointments. NOW VIDEO VISITS are also available!! You or your patient can call 984-215-6435 to schedule an appointment. Check out the website for more details.

Your COVID-19 Questions & Answers Response from Tom Belhorn Q: When will we be able to expand COVID testing in children beyond those at highest risk?   A: All of us look forward to a time we can obtain COVID testing on many more children. Few children in the ambulatory setting meet the current guidelines for testing. We are able to be more liberal in testing symptomatic children being admitted to the hospital (see most recent guidelines on website), yet we would like to expand testing to cover additional situations. We are, however, still in a situation of finite and limited testing reagents / kits. Prior to the new shipment of reagents yesterday we were down to a 7-day supply for the tests done at UNCH; now we are more safely back up to a 10 to 14-day supply. We may also receive a shipment of the newer rapid test kits very soon. All factors including numbers of infected patients (especially with expected surge) and testing capabilities will guide decisions on these testing guidelines.   Pertinent Addendum : (Data since onset of testing - as of 4/9) ACC RDC 77 children <age 10 tested, 0 positive; Cary RDC 142 children tested, 1 positive; UNC Children’s Inpatients, 0 positive to date. As of now, very low number, but may not represent true epidemiology due to lack of broad testing!

Fit Testing Update Infection Prevention Recommendations: In accordance with  CDC Contingency Capacity Strategies for N95 respirators , we are transitioning from formal fit-testing to a user-seal check process. Please review  this tipsheet  for more details on how to perform a seal check.

Individual extended use mask guidance video is available HERE or watch the video above.

Temporary Housing Options This is an ongoing discussion but wanted you all to be aware that housing options are being explored for providers who are caring for patients who are COVID positive or COVID rule outs. Many of you have asked about the availability of hotel rooms or dorms. There will be more information forthcoming.

Thank you for all that you doing! Our video visits and phone calls have significantly increased this past week.  Please let us know if you have any technical difficulties with video visits. I continue to be amazed by the collaboration and mission focused culture of Children’s.

Gratefully,

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