Physician-in-Chief's Message
March 25, 2020
Dear Colleagues,
 
Thank you for working hard to increase phone call and video visits! Our families are very appreciative. See the video below.
UNC COVID Updates
Telehealth and Virtual Care
Please listen to Elizabeth Walters’ daughter! She loved her video visit with Dr. Amy Liu. I do think video visits are wonderful opportunities to care for our outpatients.
Inpatient Care
  • No positive patients. All patients to date has been ruled out.
  • No issues to be reported.
Ambulatory Care
  • Division Chiefs – Please send your division’s Raleigh provider clinic schedules and your templates to be BAS team uncmcccs@unchealth.unc.edu (am –in person and pm – phone visits or however you division would like.)
  • Our goal is to have everyone over in Raleigh in 2 weeks - by April 10. Thank you to those divisions that have already sent your new schedules and templates.
  •  All patients, New and Return, can be phone or virtual visit. If, as you are talking on the phone to a patient, you feel the patient would be better served by an in-person visit, then the visit can be flipped to face-to-face visit. We are working on a standardized process for scheduling these visits.    
  • Chapel Hill specialty clinic is working on a plan for add-on essential/emergent patients at Chapel Hill.
Emergency Department and Urgent Care
PATHWAY UPDATES (CLARIFICATION ON RPP and COVID ORDERING)
  • Ordering RPP and COVID test separately is effectively the same thing as ordering an RPP with Reflex COVID. Reflex is actually a misnomer here. For the RPP with reflex COVID they are running them in PARALLEL because of concerns for co-infection that a lot of you were concerned about early in this process. Nurse only needs one swab! The pathway encourages RPP with reflex COVID because it is one order. 
  • You CAN add on COVID PCR up to 72 hours after RPP is sent 
  • Quicks lists will be updated with reflex orders by the end of TOMORROW 3/25.
 
PPE (**N95 Respirators used in rule-out or confirmed COVID-19 patients rooms are single use and should not be reused, even if covered with a surgical mask or face shield.**)
  • All staff entering the room of a known or suspected COVID-19 patient should follow Special Airborne/Contact precautions (respirator, eye protection, gown and glove). 
  • See Ben’s update for recycling info.
 
MDI vs Nebs (ACTIVE CONVERSATION BUT GENERAL APPROACH—BRONCHIOLITICS AND ASTHMA EXACERBATIONS GO INTO RESPIRATORY ROOM IN PED WITH DOOR CLOSED. IF HFNC OR NEB REQUIRED DUE TO SEVERITY OF SX THEN HEPA FILTER MUST BE IN ROOM AND EVERYONE MUST WEAR FULL PPE UNTIL NEG COVID TEST.)
  • Intubated COVID-19 patients suspected or confirmed: discussion with clinical team and RT to determine use of MDI versus nebulizer
  • Non-intubated COVID-19 patients suspected or confirmed: MDI only 
  • All other non-COVID-10 patients, including those confirmed negative: nebulizer only (to conserve MDI stock
Your COVID-19 Questions & Answers
Response from Tom Belhorn
Q: Older infants or toddlers still come in to the office with high fever, some may have nasal congestion, no other obvious source of fever. Can I attribute this to COVID? Should we still do evaluations?
 
A: This question is coming up frequently. There is a spectrum of COVID-19 disease in young children from asymptomatic to the more classic lower respiratory disease +/- fever and everything in between. I would be hesitant to automatically attribute high fever to COVID (even if they have a positive test result). As our youngest patients are more likely to have bacterial infections (e.g. otitis media, bacterial pneumonia, UTI), sometimes alone or sometimes as a sequelae of viral infection, we do need to evaluate them for this. We still need to make sure they are clinically stable and decide if they need other diagnostic tests (e.g. urine) or empiric antibiotics if this looks like a bacterial process (otitis). Also we need to make sure we give the usual information to the family about the importance of follow-up (call at least or visit) if symptoms do not resolve in a timely manner and certainly if they become more ill.

Response from Amy Ursano
Q: Domestic violence can increase during times of stress such as this pandemic. What resources are available?

A: Here are a few resources:
  1. Beacon Program (of course) - www.med.unc.edu/beacon/get-help/
  2. Recent NYT article - www.nytimes.com/2020/03/23/opinion/covid-domestic-violence.html
  3. Safety Planning COVID 19 - sanctuaryforfamilies.org/wp-content/uploads/2020/03/Safety-Plan-Flyer.pdf
How Everyone Can Help
UNC Health is urging people to follow the Centers for Disease Control and Prevention's guidance for social distancing and staying home as much as possible. Many people are still looking for ways they can help. Please share this link with others interested in being of service to local hospitals and the community.
Peds Specific Updates to Ophthalmology Consults during COVID-19
Updated consult guidelines are below - changes to these guidelines were to address unique pediatric situations of non-accidental trauma and Retinopathy of Prematurity.
A Big Thank You to UNC Health
From UNC Lacrosse Coach Breschi on behalf of our UNC family: "We are so blessed & grateful to have amazing health care providers ⁦ @UNC_Health_Care. Thank you for all you are doing for the state of North Carolina and beyond #Family". Click on the photo to hear him share his gratitude and support.
Please send questions regarding COVID-19! We will include this as part of the daily email.
Thank you for your dedication and care to patients and families!
 
Gratefully,

Stephanie
Cell: 919-417-3130