Physician-in-Chief's Message
April 1, 2020
Dear Colleagues,

Thank you for your continued flexibility as plans change daily. Today, screening started throughout Children’s and facemasks are available for all. The screening is going well; thank you to Melanie Dawes and Jennifer McElroy.
UNC COVID Updates
General Updates
  • North Carolina has had terrific progress in the model for predicted healthcare utilization due to COVID over the past 2 days. Keep up the physical spacing and stay at home orders!
  • The UNC system has about 20 adult patients hospitalized with COVID. We have still not had a child COVID positive as an inpatient.
Inpatient Care
  • New guidance from our Pediatric Infectious Disease group. All patients who are having a respiratory viral panel or flu swab done should also have a COVID swab ordered.
  • The COVID team has worked with ID and others to adjust the placement process for patients being tested for COVID. The majority of patients being tested for COVID will remain on regular primary teams with appropriate precautions until test results are back. A small group of children who are deemed “high likelihood” for COVID infection will be cared for on a special primary COVID team.
Kudos to the PICU staff for making their screening area fun!
Virtual Care
  • All providers have now been cleared for video visits through Epic. Please watch the LMS module UNCHISDVCARE and then you are ready to use them. The clinics leadership are working on refined flow to offer this to families.
  • Raleigh Specialty Clinics: For service leaders, we need you to work with Ceila and Will to set up templates and in-person v. virtual visits in a way that works for your specialty.
  • Franklin Street Primary Care Clinic: Video and phone visits will continue in the designated exam rooms. In-person visits are limited to acute medical issues, newborn weight/bilirubin checks and immunizations. Pediatric patients with respiratory issues who need evaluation are being referred to the Pediatric RDC.
  • We know this transition is stressful and there are still lots of questions and the processes are changing frequently. Thank you for your patience and please continue to reach out to all of us with concerns and suggestions.
Ambulatory Care
  • Chapel Hill Children's Specialty clinic: volumes continues to decrease and will shift physical location to space in the Peds Orthopedic clinic at the ACC. 

  • There will be wellness checks every day for all providers and staff working in the clinics and masks will also be distributed at that time. 

  • If you are feeling sick, don’t come to work and call Occupational Health at 984-215-5668!
Time to make the Donuts, Ceila?
Emergency & Urgent Care
  • Emergency Department volumes for children are down markedly.
  • Planning is under way for potential surge capacity at UNC Emergency Medicine if there is an influx of children with COVID.
  • Urgent Care is rapidly progressing in offering video visits
Surgical Services
  • Continuing to operate at Level 4 with only prioritized and emergent cases. Inpatient surgical volume dramatically decreased.
  • Congratulations to ENT who quickly stood up some video visit care.
Your COVID-19 Questions & Answers
Response from Tom Belhorn

Q : Someone in my practice saw that kits for COVID-19 serology were available for purchase. Can these be used to confirm COVID-19 infection, especially if the other diagnostic testing takes a long time?

A: There are some diagnostic kits for COVID-19 serology (IgM, IgG, and / or IgA) becoming available. It is important these kits are validated for sensitivity and specificity (the latter to make sure there is no cross-reactivity with endemic “benign” coronaviruses). One will need to be careful how to interpret serology for this virus. Early studies show, to no surprise, that the virus can be detected in NP swab days before an IgM is positive. Studies need to be done with the various products to determine the exact time antibody can be detected in the course of infection. The greatest benefit of serologic tests will be to gaining accurate information about seroprevalence (and trying to determine how many individuals are / were asymptomatic). It is possible that serology, specifically a positive specific COVID-19 IgM, may be used in the future as one means of diagnosis, but further studies need to be completed to inform such decisions.
As requested, if you're looking for a link or detail you might have missed in an earlier newsletter, you can now find all past Physician-in-Chief - COVID-19 Updates on the Pediatrics COVID-19 Resources page - arranged by date.
Coping and Wellness - F rom The Schwartz Center

  • This is a recorded webinar presented on March 24 by Patricia Watson, PhD, of the National Center for PTSD. Dr. Watson discusses ways that healthcare workers can manage stress - theirs and others’ - as we face the ever-changing circumstances of the COVID-19 pandemic.

  • Join Schwartz Center Chief Medical Officer Beth Lown, MD, for a conversation with Patricia Watson, PhD, of the National Center for PTSD, and Richard Westphal, PhD, RN, of the UVA School of Nursing, about what healthcare leaders can do to support their teams during the COVID-19 crisis. April 7, 2020, 1-2p EDT. REGISTER HERE!
Don’t forget to attend our webinar on Thursday at 11:30 am entitled "The Impact of COVID-19 in Children (Session 2)." Both Tom Belhorn and Zach Willis will be giving updates. We will leave plenty of time for questions.

Finally, thank you to all who are participating in patient visits through phone calls and video visits. Telehealth is really increasing!

Gratefully,
919-417-3130 (cell)