Coronavirus in Context: How a Pediatric Hospital Prepares for Potential COVID-19 Influx

Hello. I'm Dr. John Whyte, Chief Medical Officer at WebMD, and welcome to Coronavirus in Context. Today, we're going to talk about coronavirus in the pediatric population, especially as it relates to our pediatric hospitals, our children's hospitals. My guest today is Dr. Anthony Sandler. He is the Surgeon in Chief at Children's National Hospital in Washington, DC. Thanks for joining me, Dr. Sandler.

Thank you for inviting me, John.

What are we seeing in the pediatric population in terms of coronavirus? We've been hearing they're not affected as much as adults. Is -- Is that true? What are you seeing in the hospital?

ANTHONY SANDLER: So our experience so far has actually been quite favorable for children. Um, we have had a couple of children who have presented here that have had coronaviral infections, but none of them have been admitted to date, which is very different to the adult and especially aged population.

Why do you think this might be different for kids? Do they have some type of natural immunity to coronavirus?

There are lots of theories, and none are really proven. Children just may be less susceptible because of a difference in receptors to which the coronavirus can bind. But no one is really sure at this point, and we're happy that, at least thus far, children have primarily been spared.

We've been talking about surge capacity. Um, and is it different in a pediatric hospital than for an adult hospital? What is Children's National Hospital doing to ensure, uh, surge capacity?

So you know, one of the things that we have done in preparation for all of this is really limiting elective cases. Now, there's multiple reasons for that, and elective surgery is surgery that is neither urgent nor emergent. It's a kind of a lump and bump that needs to be fixed. So that bellybutton hernia, or the circumcision -- just something simple, really. And the reason we've limited that is because of the resources that are around that.

We think there will be a surge, and -- in from several perspectives. If we ran all our elective cases, then there would be tons of patients and families in waiting rooms, and that would, increase exposure of potential infected patients or family members.

And so what we call social distancing -- this at least allows less people together in a certain area. At the same time, we do think that there will be a surge, and we also want to be open that if adult hospitals that care for kids cannot manage those children, they would send them and regionalize them to places like Children's National, where I work. That way, we would open beds at adult hospitals so that we can take care of children.

I assume ventilators are different for kids. Are we having a different shortage in the pediatric population?

Um, well, hopefully, we won't get the same surge. And if we don't get the same surge in the pediatric population, then ventilators will be fine. But, you know, we're still taking care of sick children.

Sure.

-- and we're taking care of them like we always do. And so that could be a significant stress on the hospital environment if we do get a sudden surge of patients.

Are you limiting visitors? Are parents still able to come see their kids? Are there limitations in terms of --

Yes. We're trying to limit two people to each patient, but that may change, and we may start limiting to just one parent with a child.

Now, elective for parents and kids sometimes means different things that it may mean for you or me as a physician. What's been [INAUDIBLE] parents and their kids when they thought they were going to have a surgery, and now it's -- might be unclear when that's going to be done.

I didn't catch everything you said John. I apologize. But I think from the perspective of an elective surge -- surgery that's necessary, but it's not necessary in the next month or two months. The child's lived with it their whole lives, and the child will do well until we get the opportunity to repair whatever needs to be repaired. There is an elective type surgery which we are calling for the moment semi-urgent, and that's for a child who may have an inguinal hernia, but it's completely asymptomatic.

OK.

Now, those inguinal hernias, for example, can become symptomatic, and when they have -- start having pain or discomfort or difficulties around it, then those sort of move from a purely elective case to one that becomes semi-urgent and should be done so as to prevent the child from presenting --

Yeah.

-- in the emergency room and just putting a bigger stress on the health care system.

What I was asking is, how are the kids and parents responding to being told their procedure is being rescheduled?

They're responding very well. Of course, you know, everyone's unsure, and everyone's a little concerned right now. I imagine people feel that if they don't have to be in a hospital where there's potential coronavirus, you don't want to hang out there. And so I think people that -- the parents have responded very well and are very understanding, and I think everyone realizes we're all in this together, and so everyone's trying to be a good citizen and help however they can.

Sure. How well are the pediatric hospitals prepared for any potential surge in cases?

So we're very well prepared, and by cutting out elective cases, by cutting down elective, uh, clinic visits, which are purely elective, we've cut down the number of patients in the hospital, which has created more opportunities for taking care of more patients.

Having said that, the Personal Protective Equipment, which is PPE is somewhat limited, and we are somewhat concerned about that because we could run out of the Personal Protective Equipment, which is essential for hospital caregivers so that they themselves don't get ill.

We are prepared right now. We're stocked right now. Everything is safe, but one hopes that this will not get out of control, as we go into the next couple of weeks.

Do parents need to do anything differently right now? They're concerned about a [INAUDIBLE] might be having. Um, do they not come to the hospital? Do they call their doctor first? What should they be doing in terms of coming to the hospital, visiting the hospital?

Yes, you know, if it's not really essential that they be in the hospital, it's probably a safer environment to not be in the hospital. Be at home. Be amongst those who you know and those who aren't sick. The concept of -- of families getting hold of us is -- is still the same as they've ever done. We're available by telephone. We're trying to do some telemedicine, trying to communicate. So we really still are actively engaged in health care, albeit maybe less so on a personal visit at times.

How are the kids doing with telehealth? Are they embracing it? They're probably used to it more than you and I.

Yeah, that's exactly what I was going to say. They probably are -- they're seemingly a lot more comfortable with it than we would be. Uh, they spend a lot of screen time. And now, if there ever was a reason to do screen time, it's now. You know, the American Association of Pediatrics have suggested that parents limit the child's screen time, but I think everyone is allowing it more frequently during this period.

Thank you, Dr. Sandler, for spending some screen time with us today.

Thank you.

And thank all of you for watching Coronavirus in Context. I'm Dr. John Whyte, Chief Medical Officer at WebMD. Thanks for watching.