June 5, 2020
Dear Colleagues,
 
Children’s has been very full this week with the increase in surgeries. Thank you to our inpatient teams for early discharges and strong communication; thereby, allowing us to accommodate all these admissions. Children’s ED is also seeing an uptick in volumes. We currently have no children admitted with COVID. 
 
Thank you to the COVID response team (Eve Wu, Jim Hagood, Tim Vece, Zachary Willis and Yasmina Abajas) for an outstanding and up to date presentation about COVID. We have listed below answers to some of your questions from grand rounds. Please attend grand rounds next week, which will be our awards ceremony for the residents and fellows!
UNC COVID Updates
Ambulatory Care
  • Please remember to wear your mask in all clinical spaces including shared workspaces.
  • Please also try to maintain 6 feet apart in the shared workspaces. Thanks for your help with this process
  • We (and the healthcare system) are re-evaluating the visitor policy and should have updates next week. 
Pediatric Specialty Clinic Follow Up Process Work flow and Support Sessions
  • See the attached Optimized Workflow for Scheduling Follow Up Visits Children’s Specialty Clinics.
  • The workflow will also be available on the Pediatrics COVID Resources page.

  • Ryan Haushalter will be hosting the following WebEx sessions for Pediatric Specialty Clinic providers to help anyone with customizing the follow-up activity. 
6/8-6/12 (M,T, W, TH, F) 8:00am – 9:00am
Meeting ID - 160 378 4237
Meeting Password kMSNft35aD9

Click Here  to join.
6/8-6/12 (M,T, W, TH, F) 11:30am - 12:30pm
Meeting ID - 160 441 4315
Meeting Password 8bsPyFMYV25

Click Here  to join.
6/8 & 6/9 (M, T)
 4:00pm – 4:30 pm
Meeting ID - 160 990 1012
Meeting Password
9H3nyNpKSm2

Click Here  to join.
Your COVID-19 Questions & Answers
Questions from Grand Rounds & Response from Children’s COVID-19 Squad

Q: Can Dr. Willis explain testing newborns at 24 and 48 hours if infection doesn't occur until birth? Isn’t a negative test at 24 and 48 hours expected? Is there evidence that newborns infected at birth will be shedding virus at 24 or 48 hours of age?

A: Unfortunately, much is not known about this. My sense is that we are not seeing many infants test positive at that time point, but I don’t think they knew that would be the case when the recommendation was first published. I am hoping that CDC or some other public health entity is looking at frequency of infection
Q: It seems that the remdesivir trials have been only in adults... is it permitted for use at UNC in kids? If yes, are data being collected to ensure peds have the same results as adults?

A: Yes it is permitted for pediatric use. There are two dosage forms, and only one (lyophilized powder) can be used under 40 kg. The lyophilized powder is in shorter supply but is somewhat available. We would be willing to request it for a child of any age down to 3.5 kg. In recent weeks we have had adequate remdesivir supply for patients who meet inclusion and exclusion criteria, but that is not guaranteed. Unfortunately, there are not pediatric clinical trials that I know of, which would be very difficult to power in children. We are contributing to various registries and I think it will be possible eventually to do some comparative effectiveness studies. I think it's reasonable to extrapolate adult findings at least to adolescents for the time being.
Q: It How do you distinguish acute COVID infection from MIS-C?

A: This is a great question as there can be overlapping features between acute COVID-19 infection and MIS-C. Most children with MIS-C do not have acute respiratory symptoms and instead present with more persistent fever, GI symptoms, and other organ involvement. They are also more often testing positive for COVID-19 IgG and negative for COVID-19 by PCR. While some children with acute COVID-19 infection can have elevated markers of myocardial inflammation, the prevalence and degree of elevation seems higher among children with MIS-C.
Event recording is available HERE (password: Xp4dXVdd)
Join Us Saturday for
A Moment of Silent Reflection
We invite you to join our health care professionals across the country in a moment of silent reflection and commitment to improve the health and safety of people of color. We will kneel for our patients, colleagues, family, friends and entire community. 

Please remember to maintain proper social distancing, wear a mask and white coat. 

We encourage you to submit and tag photo from the event - #whitecoatsforblacklives. If you aren’t able to attend Saturday but would like to participate, please send photos to unc_childrens@med.unc.edu f or inclusion on the UNC Children's Wellness Instagram.
 
When: Saturday, June 6th at 1:00pm
Where: Starbucks Patio
I hope that each of you take a moment for silent reflection on Saturday as a commitment to the health and safety of people of color.  
 
Warmly,
919-417-3130 (cell)