Well Visits, Fishtown Opening, MIS-C & Mental Health Matters!

The statistics are alarming …. not just the numbers that headline the news nightly, but also the impact that COVID-19 has had on primary preventative care. Since mid-March childhood vaccinations have plummeted, leaving many children vulnerable. Last week the CDC reported that the largest national vaccinating program, Vaccines for Children, ordered 2.5 million fewer doses of non-influenza vaccines and 250,000 fewer doses of measles vaccine compared to the same period last year. Because the time during which vaccines are given is also often the time when children have growth, development, and general health monitored, the American Academy of Pediatrics is sounding an alarm: Well-Visits are Important!

Well Visit Scheduling

As we have reported in previous newsletters, our focus up until now has been the youngest children in our practice, specifically those 18 months and younger. We will now start scheduling children for the 2-year, 4-year, 5-year, and 11-year well visits, as well as teens requiring physicals for college. We expect to be able to resume well visits for all ages in the very near future. Our highest priority at Center City Pediatrics remains ensuring the safety of our patients and staff as we meet the challenges of being a medical home during this pandemic. We will continue to be proactive in our policies.

• All our staff have been required to wear medical face masks at all times since April 1st. With the PA governor’s order on April 19th, all visitors, and patients 2 years of age and older are now also required to wear face coverings when entering our offices.
• We have a strict illness policy for our employees, and all of our staff undergo daily temperature and symptoms checks at the start of shifts.
• Minimizing crowding has been and will continue to be a priority! To this end, we hope to return to our full office hours, including evenings, as soon as possible.
• In an effort to keep families out of our waiting room, we are modifying our normal schedules to ensure a staggered flow of arrivals. Please help us by being on time for your appointment. Late arrivals may need to be rescheduled. Please contact the office by phone if you will be late for your appointment. Likewise, we may not be able to check you in early, depending on room availability.
• We are excited to announce the opening of our new Fishtown location this summer. Adding this exam room capacity allows us to bring you back as soon as you step in the office, reducing time spent in the waiting area.
• The Fishtown office will follow the Bala Cynwyd location’s model of having no “sick visits”. Only well visits will be scheduled at these locations.
• The bulk of sick visits will continue to be managed via Telehealth.
• The Center City office will see “sick visits” only in a separate designated area, cordoned off from the other rooms. The multipurpose room remains set up as a separate waiting room for sick patients, even though we have thus far been able to immediately isolate all sick patients in the designated exam rooms as soon as they arrive.
• All examination rooms undergo routine disinfection with an EPA-approved product between patients.

In order to keep our offices as safe as possible, we ask that all families review our COVID-19 office policies prior to coming to the office.

COVID-19 Philadelphia Area Updates

Philadelphia County is entering its 10th week of red phase measures as part of Pennsylvania’s public health response to COVID-19, with 19,950 cases and 1,040 total deaths as of May 18th. While this period has felt endless, there are signs of light at the end of the tunnel. In contrast to one month ago when the rate of new cases per day continued to increase, Philadelphia has gone through a plateau phase and now a downward trend in the numbers of new cases each day. We flattened the curve together this past March and April, at a time when our local hospitals were already near maximum capacity due to a severe flu season, and we avoided the hospital capacity crisis that affected other countries hit hard by the virus earlier on. As healthcare providers in this city of Brotherly Love, we thank all our families who stayed home these past 2 months. You are what makes us #PhillyStrong. Please, continue to practice social distancing measures, wear a cloth mask when outside of the home where other people are present, and continue to practice all the other important preventive measures that reduce your household’s risk of exposure and community spread.

A study by Drexel researchers found that compared with imposing no safeguards, the first 45 days of shutdown was estimated to have avoided about 57,000 hospitalizations and 6,200 deaths. Those tens of thousands of Philadelphians that avoided being hospitalized or dying due to COVID-19 will never know that they were spared. It is almost impossible to know when a preventive intervention “worked” and protected you personally. The same could be said for vaccines: few will know when they personally were protected from getting sick with meningitis, tetanus, or whooping cough, because most will never know that very moment when they were exposed but infection was avoided.

Unfortunately, this is only the end of the beginning of this pandemic. As rates of new cases continue to decrease and Philadelphia moves towards a gradual reopening, we will need to learn how to live with a “new normal” that balances activities of life with safer practices that prevent a surge of new cases. We will continue to send updates as we learn more with you about this unprecedented time in our lives.

New Inflammatory Syndrome in Children

In the past several weeks, the news media has publicized a new syndrome in children that may be linked to recent infection with COVID-19. Children with this syndrome, called Multisystem Inflammatory Syndrome in Children (MIS-C) by the Centers for Disease Control & Prevention, have presented with several days of high fevers, abdominal pain with diarrhea, and other symptoms that may include widespread rash, reddening of the eyes, and inflammation of the lips and tongue. While being likened to another childhood inflammatory syndrome with unclear cause, Kawasaki Disease, it has clear differences. Kawasaki disease tends to more commonly affect children under 5 years of age. The MIS-C cases reported in Italy, the U.K., France, and New York State more commonly involve school age children. Children with MIS-C also have higher rates of heart inflammation not commonly seen with Kawasaki Disease, appear to be significantly sicker with multiple organ systems involved, and require therapies not often used for Kawasaki Disease. Children with MIS-C have been noted to be previously healthy, without pre-existing conditions. The majority of them have tested positive for COVID-19 by serology test or nasal swab. The vast majority of children are recovering from this condition, although to date, 1 child in the U.K. and 3 children in New York State have died. While we still are learning about this syndrome, experts are suspecting that MIS-C is not directly caused by COVID-19, but by an abnormal immune response to the virus.

Many parents have been asking, “I thought children didn’t get that sick from COVID-19. Why is this happening?” Numerous studies of COVID-19 in countries with high rates of infection continue to show that children make up < 2% of all confirmed cases of COVID-19. Those who are infected with COVID-19 most often have no symptoms or mild symptoms, with a significantly lower proportion needing to be hospitalized than adults. Death continues to be rare. However, some may hear “low risk” and misunderstand this to mean “no risk” for significant illness. Even children and young adults are at some level of risk of complications due to COVID-19, which is why everyone – not just those with high risk factors – should exercise caution.

As COVID-19 case counts continue to rise, we will likely see more cases of MIS-C. Parents should once again be reassured to know that this condition is uncommon. We do want parents, however, to be aware of potential signs of MIS-C, as early identification is important. If your child is experiencing persistent fever > 24 hours with abdominal pain or diarrhea, and has a widespread rash, reddening of the eyes without drainage, and/or changes to the tongue or lips, please contact our office.

Mental Health Matters

Parents and caregivers are dealing with many sources of pressure right now, from work-related stress and health concerns to childcare and parenting challenges, all while managing worries in their children and themselves. We’ve put together resources for families to help them access mental health on-line support materials and experts remotely. Remember, you’re not alone.

• While our on-site workshops have been temporarily suspended, several of our facilitators are conducting virtual classes and support groups – many of them at no charge. Check out our class calendar for details and registration links.
• Specifically, in the weeks ahead you’ll find we have virtual workshops to help with sleep issues affecting school aged children, for parents of younger children to play your way to a happier quarantine, and for caregivers of all ages to help manage COVID-19 anxiety. Register online to reserve your space.
• The CDC’s COVID-19: Stress & Coping page contains information and advice on identifying signs of mental health distress in children and adults, accessing community resources including the National Domestic Violence Hotline, and provides planning and preparation advice.
• The Child Mind Institute provides phone consultations, remote evaluations, Facebook Live video chats, and comprehensive on-line resources directed towards helping parents and children, including those with special needs, cope with the COVID-19 crisis.
• The American Academy of Pediatrics parent education platform, healthychildren.org, has put together some helpful tips on positive parenting and how to manage those times when parenting feels overwhelming.
• On April 2nd, Pennsylvania launched a statewide Support & Referral Helpline – (855) 284-2494. This service is available 24/7 to counsel PA residents struggling with anxiety and other challenging emotions, and to help refer them to community-based resources.