A Message from the Physician-in-Chief - COVID-19 Update

Physician-in-Chief's Message

April 29, 2020

Dear Colleagues,

Today’s newsletter has many important updates as noted below. We currently have 36 patients hospitalized for COVID at UNC medical center. Based on recent modeling, we are seeing an uptick here in the Triangle partly due to the nursing home outbreaks and the outbreaks in the meat processing centers.

There are no COVID positive children currently hospitalized at UNC. Our NICU continues to be very busy. We have moved 14 neonates to the 7th floor to adhere to physical distancing rules.

I am so grateful for the flexibility and collegiality during these times of uncertainty!

UNC COVID Updates

Inpatient Care

COVID-Pediatric Pagers now searchable in WebXchange under On-Call Schedule. See screen shots below.

Ambulatory Care

Please be on the lookout for information on scheduling and using all 3 video platforms... AmWell, Doximity and Webex teams.
As we begin to consider a timeline for increasing face-to-face visits in Raleigh, please begin to think about what a "new normal" will look like for your division.
How many providers and ancillary staff (fellows, dieticians, pharmacists, SW... people who are usually part of your clinic team) would you need to start seeing more face-to-face visits?
Would you consider changing templates to have a block of face-to-face visits and a block of video visits?
Children's Specialty clinic in the hospital in Chapel Hill is currently under the control of the Healthcare system for COVID Response. While we are uncertain when the clinic may be able to re-open we are discussing and planning for different scenarios, we realize we will need availability for some patients to be seen in Chapel Hill and are thinking through that process.

General Updates

All UNC FP clinicians were asked to update their contact information. Please follow THIS LINK to confirm correct contact information if not already completed.

All UNC FP clinicians were asked to attest to viewing the N95 User seal check educational model. With the introduction of different N95 models into circulation, it is critical all understand how to perform a N95 User Seal check. Please follow THIS LINK to complete the education if not already completed

Your COVID-19 Questions & Answers

Response from Tom Belhorn

Q: I read the WHO has warned that there is no evidence that COVID-19 infection causes immunity. I thought there was some immunity after SARS. Is the immune response different? Can I get COVID-19 again?

A: The WHO desired to make a statement warning people that much is unknown about the immune response against COVID-19 after natural infection. There is no evidence that shows a lack of an immune response, but it is more a lack of evidence of how long and how protective the immune response will be after infection. Endemic coronaviruses yield antibodies that last a period of a few years (though variable). Both SARS and MERS infection yielded neutralizing antibody. Most people infected with either virus were still antibody-positive after a year. The response to MERS seemed to wane quickly after that (antibody did not persist much longer than 12 months) but SARS antibody did persist for multiple years (at least a few years). It is important to remember that in natural infection the T cell immunity is also important and T memory cells persist. Decisions on vaccine development will need to take this into account. There is early promising data from COVID vaccine development and of course reports of efficacy of convalescent serum. So we have hope of some immunity- but we are not sure how long immunity will last.

Children with COVID-19 Presenting with Toxic Shock Syndrome & incomplete Kawasaki disease - from Eve Wu

There have been reports of children with COVID-19 presenting with features of toxic shock syndrome and/or incomplete Kawasaki disease. Many of these children have laboratory evidence of severe COVID-19 infection with a hyperinflammatory response or “cytokine storm.” These presentations have been observed in children who test COVID-19 positive as well as negative, and it is unclear whether COVID-19 is associated with Kawasaki disease and/or toxic shock syndrome. Abdominal symptoms and carditis have been other reported manifestations. Children may not necessarily have respiratory symptoms. Children with COVID-19 should be monitored for signs of Kawasaki disease and/or toxic shock syndrome, and clinicians should consider the diagnosis of COVID-19 in children presenting with symptoms consistent with Kawasaki disease or toxic shock syndrome.

New Dashboard - COVID-19 Activity Across the UNC Health System

Marketing & ISD developed a dashboard map everyone, including those outside the system, can find here: www.unchealthcare.org/coronavirus/dashboard/

Pediatric Grand Rounds Returns! Tomorrow 8a - WebEx ONLY

April 30th is Fellows Grand Rounds

Brendan Kleiboer, MD, Hematology-Oncology &

Krysten North, MD, Neonatal-Perinatal Medicine

JOIN WEBEX MEETING

Meeting number (access code): 733 697 457

Host key: 942362

Meeting password: xKFV55pD

PLEASE MUTE YOUR MICROPHONE

This will be our first of many Webex Grand Rounds for the remainder of the academic year. We expect there to be upwards of 150 participants each week. For those who are new to joining via Webex, here are some courtesy guidelines:

When logging in for the first time, you will be asked to identify yourself and give an e-mail address. Please list your work e-mail and both your first and last name
Please mute yourself (cell phone or computer) when you join
For questions of the speaker, please send a chat to Rob Hartman and Marianne Muhlebach (one of them will be host for the meeting from ~ 8:15am onward)
Questions will be addressed by the host at the end of the session as time allows
Attendance will also be taken by eeds. Make sure to complete the evaluation to receive MOC2 credit

Medicine Grand Rounds on COVID-19 Tomorrow at Noon

Click Here for WebEx Details

Despite pandemic, Wonder Connection continues to bring science, smiles to kids at NC Children's Hospital

We're so glad WRAL highlighted the ongoing efforts support kids in the Children's Hospital during this difficult time.

From WRAL's Go Ask Mom:

Usually, Katie Stoudemire and the staff and volunteers of the Wonder Connection are working one-on-one with kids at NC Children's Hospital, bringing them a fun and educational science activity to help take their mind off the reason why they're there.

But, since mid-March, when the COVID-19 pandemic limited visitors to the Chapel Hill hospital, Stoudemire and her team haven't been able to make slime or dig into fake owl pellets with the children.