Physician-in-Chief's Message
May 13, 2020
Dear Colleagues,
 
Our inpatient COVID positive patients have decreased this week. This evening there are 25 COVID positive adults at UNC medical center. The current modeling is definitely showing a flattening curve; however, this will be a marathon, not a sprint. I am also sharing an editorial from Science written by Myron Cohen - clink on the attached.
I would like thank all of you as we have ramped up surgeries this week. The screening process has overall gone very well. Furthermore, our outpatient clinic volume continues to increase. Thank you for your continued flexibility during these times of ambiguity.
UNC COVID Updates
Inpatient Care
Ambulatory Care
  • The traditional (preCOVID) way we mark follow-up doesn't work in our current situation.  
  • Please make sure you are following this process to communicate follow-up appointment requests.
  • Use these instructions to schedule a follow-up appointment by using check out notes. Check out the attached screen shots for guidance.
  • This allows the scheduler to quickly see when the provider has completed the visit and the patient can be contacted to schedule follow-up appointments.
OR Testing Clarifications
  • Outpatients presently on the OR schedule as Priority now have 2 options for COVID-19 testing: The 5 day process as outlined in the attachment, or the can now go the RDC 48 hours or less. Sara Lisinski has sent a list of the Priority patients in the COR scheduled for this week, who can get the test at the RDC.
  • Please use the 5 day scheduling plan for COVID-19 testing from now moving forward
  • Remember for inpatients, the batch test (not the rapid test) can be used for asymptomatic preop/pre-procedure patients. The turnover is on average 12-14 hours
  • Please do not admit a patient or send them to the ER solely for COVID-19 testing. We do not have the capacity in the Children’s Hospital
  • For Interventional radiology general anesthetic procedures, the same rules apply for COVID-19 testing
  • For sedation (MRI etc) our Pediatric sedation service will be ordering the COVID-19 test for those patients
  • This is remains a work in progress, so please share any issues with Dr. Hayes-Jordan
Visitation Rules for the Children's Hospital
  • Please review the visitation rules attached or in PolicyStat.
  • The rules are unchanged but a reminder is always helpful since there are so many family situations to manage.
  • The goal is to allow a parent at the bedside at all times but one parent staying (not in and out) is preferred. This is not always possible and in the NCCC parents cannot stay the night.
Your COVID-19 Questions & Answers
Response from Tom Belhorn

Q: I have heard a COVID-positive mother can still breastfeed her newborn infant. But if a COVID-positive mother is being treated with medications for the virus, can she still provide breast milk? Would it harm the infant?
 
A: One mother of one of our most recent COVID-exposed infants was being treated with Remdesivir. Two other agents that have been discussed for treatment in adults are Kaletra (Lopinavir / Ritonavir) and Hydroxychloroquine. Breast feeding is not a contraindication for any of these three medications. Treatment algorithms will likely change as more data is accumulated on efficacy of these agents for COVID treatment, and safety for the infant should be checked with newer agents. And remember to always check the complete medication list for the mothers to make sure no other medication would be a contraindication for transmission via breast milk to her newborn.
Resident Education Help Request
One of the adaptations our residency has made during COVID has been the creation of a GroupMe text stream, where residents are provided with 2-3 daily questions to answer, followed by an explanation. Content has been created primarily by Eric Zwemer, Associate Program Director . Dr. Zwemer is asking for faculty assistance in two areas:
  • EBM Literature: Please send me 1-2 new or older important articles/references in your field that you think residents should know about. The best articles are ones that argue for a specific practice (e.g. early removal of the stylet improves success rate in infant LPs) or teach a specific clinical pearl (e.g. adolescents in cardiac failure often present with abdominal symptoms). 
  • Trivia: As a more lighthearted option, we have included trivia about our residents in our daily questions (see excellent examples here)  Unfortunately, we are running out of residents! If you’re up for it, please send me a trivia fact about you, along with a picture if able. In a recent survey, 100% of our residents requested trivia about their attendings!
  • Please send any content suggestions to eric_zwemer@med.unc.edu
Perry Participating in COVID-19 NC DHHS Webinar Series
  • Dr. Martha Perry has been invited to participate in the NC DHHS COVID-19 Healthcare Professional Webinar Series as a subject matter expert during this week's session on Thursday, May 14 at 5:30 PM. 
  • Community Care of North Carolina (CCNC) and NC AHEC are working together with NC DHHS to help North Carolina’s healthcare providers address the challenge of the COVID-19 pandemic through this weekly webinar series. 
  • Dr. Perry has been invited to participate as a subject matter expert - engaging in a panel discussion around pediatric well child care during COVID and the new Medicaid guidance on well child care and telehealth. 
The UnMask Project
Dr. Yael Shiloh-Malawsky, Assistant Professor Child Neurology reached out to share the UnmaskUNC program with us! Click the link below to email the program.
Finally, I would like to highlight the SOM Hooding Ceremony . Our own, Kenya McNeal-Trice was recognized by this graduating class and Marty McCaffrey commissioned the military officers. You will also see a few well known physicians speaking to the class.
Please watch this beautiful "Hero to Me" video written and performed by Abby Schiller in honor of UNC Health workers .
Thank you for all that you are doing for the children and families cared for at UNC Children's.

Gratefully,
919-417-3130 (cell)