Physician-in-Chief's Message
May 1, 2020
Dear Colleagues,
 
Please see updates below. Please note we have outlined recommendations regarding infants born to COVID positive Moms.

There have been several questions about proper PPE and Dr. Belhorn has addressed this in his Q & A today. Thank you for your incredible dedication to the children and families cared for at UNC Children’s.
UNC COVID Updates
Inpatient Care
Thank you everyone for all your efforts!
  • Given recent cluster of COVID + pregnant patients, our process for newborn patients has been reviewed and clarified. In summary, Recommendation for babies being ruled out for COVID due to COVID positive mothers whose mothers choose separation:
  • 34 week and below go to a designated pod in the NCCC.
  • >34 6/7 weeks and in critical condition will go to PICU.
  • Non-intensive care babies will go to 6 CH on PMA, PMB, or MCH service; primary service will consult Peds COVID team at their discretion. (Dr. Sweeney to follow up with Kelli Benson about having a 5WH RN come to L&D for newborn care during the first 90 minutes).
  • NCCC resuscitation team can help with triage and/or transport as warranted.
  • L&D will contact NCCC for deliveries of COVID positive patients at their discretion.
  • Please contact Ped COVID acute pager for placement or patient care issues or Ped COVID-ID pager for testing or treatment questions.
Ambulatory Care
  • Schedulers are using the Notes section in the EPIC clinic schedule to communicate information about the visit. While we continue to schedule video visits via American Well, you may use Doximity and WebEx Teams as alternate video platforms. The schedulers will be documenting in the Notes section whether your patient will be on a smart phone or computer for the visit. This will help decide if Doximity or Webex teams is the better alternative. Please stay tuned for improved communication efforts by out team. 
  • Nursing staff is triaging patients prior to clinic. This seems to be working well. We appreciate all their help to support video visits. Please remember they are not IT specialists but will do their best to assist with technical difficulties. If your divisions clinics are not being triaged, please contact clinic leadership so we can assist your division.  
  • Thanks to everyone for your continued work on video visit. The virtual care team is continuing to work to make video visits as successful as possible. Please contact Ryan Haushalter at Ryan.Haushalter@unchealth.unc.edu if you have concerns or need assistance.  
Your COVID-19 Questions & Answers
Response from Tom Belhorn

Q: I just read a policy that said we do not need an N95 mask when obtaining a specimen for COVID-19 in an asymptomatic patient. I thought we always had to use an N95 mask for getting COVID specimens. Which is correct?
 
A: We are now entering a “new era” at UNC where we have additional testing supplies and can expand testing to select asymptomatic individuals. Up until now we have been testing patients who have symptoms likely to represent COVID-19. For these patients we have used “Special Airborne Precautions” including gown, gloves, eye shield, and N95 mask when we obtained the NP specimen. The CDC originally classified the process of obtaining an NP swab as one of the “aerosol generating procedures” along with intubation, bronchoscopy, et al., but later changed this classification for an NP swab. As we are now able to test select asymptomatic patients (i.e. those thought to not have COVID-19 but needing that confirmation), the CDC guidance is that “Special Droplet / Contact Precautions” [the same as Special Airborne Precautions but with a surgical mask instead of N95] provides excellent protection in this circumstance and should be used by the provider obtaining the test. [Just of note, many institutions are using Special Droplet / Contact Precautions for all COVID care except aerosol-generating procedures and this is considered safe and protective for healthcare providers].
UNC Pediatrics Alumni and COVID-19 Advocacy
Kenya McNeal-Trice shared few folks that aren't in Chapel Hill anymore, but these UNC pediatricians are doing big things right now too. 

  • Rushina Cholera, MD PhD (@rushinacholera) - UNC SOM Class of 2016 and UNC Peds Residency Class of 2019 put out a fantastic piece this week in Pediatrics on Immigrant Health and Xenophobia during COVID-19
  • Tiffany Shin, MD - UNC SOM Class of 2011 and UNC Peds Residency Class of 2014 was on Latina 106.9 radio Triad and WGHP Fox 8 this week talking about telehealth during COVID-19 for Spanish-speaking patients (and is too humble to let me send you all the links). 
  • Kelly Kimple, MD MPH - UNC SOM Class of 2009 and UNC Peds Residency Class of 2012 is Section Chief of NC DHHS's Women's and Children's Health Section. Amongst other big time jobs, she leads NC's WIC program. 
  • Lauren Robinson Abebe, MD MPH - UNC Med-Peds Residency Class of 2012 co-authored this piece in NEJM this week about health system COVID-19 preparedness
  • Betsey Tilson, MD MPH (@betseytilson) - UNC SOM Class of 2000 is a pediatrician and the State Health Director and Chief Medical Officer at NC DHHS. That means she's very involved in most of what's happening at the state level right now. 
  • Susan Mims, MD MPH (@susanrmims)- UNC SOM and UNC Peds residency alum is current President of the North Carolina Pediatrics Society and talked this week about balancing COVID-19 patient privacy with the public's need to know. 
  • David Hill, MD (@davhill)- UNC SOM and UNC Med Peds residency alum and Chair of the AAP's Council on Communication and Media. Naturally he's always in the news, including an AAP #AskAPediatrician this week about parenting during COVID-19.
A short shout-out from the UNC Football Offensive Lines Coach, John Lilly, & family.

They are grateful to the truckers who keep everything moving, the store clerks who help keep us fed, and the healthcare community for their commitment to fight the virus.

Go Tar Heels!
I hope each of you do something for yourself this weekend! 
 
Gratefully…
919-417-3130 (cell)