COVID Panel Discussion Moderator Sadia Ansari MD Education and - PowerPoint PPT Presentation

COVID Panel Discussion Moderator Sadia Ansari MD Education and Research Lead Physician Children’s Wisconsin Urgent Care

Medical Director, Children’s Mercy Blue Valley Clinical Assistant Professor Children’s Mercy Hospital Aim imy Patel MD, , FAAP

Medical Director Children’s Wisconsin Board of Directors Society for Pediatric Urgent Care Amy Rebecca Romashko MD, FAAP

Medical Director Seattle Children’s Hospital Chair AAP Provisional Section on Urgent Care Medicine Board of Directors Society for Pediatric Urgent Care John (Jay) Santos MD, MBA, FAAP

Medical Director Cook Children’s Urgent Care Services Kara A Starnes DO, FAAP

Vice President of Medical Education PM Pediatrics Eric Weinberg MD

Objectives 1. Analyze similarities and differences in urgent cares across the nation for following: • Operational changes • Patient volumes • Personal Protective Equipment (PPE) • Testing capabilities 2. Review timeline of school closures in various states and government mandated stay at home orders. 3. Understand clinical course, management and treatment of COVID-19 + pediatric patients in urgent care.

Urgent Care Locations

Time-line : Effects of COVID When it all started? Seattle Children’s : Children’s Wisconsin : January 20 th : February 5th: First US Case (Adult) First COVID-19 + (adult) February 26 th : March 9 th : First local transmission Second Confirmed Case Kansas City Mercy March 7 th : First case in Metro Area Cook Children’s PM Pediatrics: March 14 th : First local transmission March 11 th : First confirmed case Late February/Early March

School Closures 3/12 3/15 Washington Kansas State State 3/13 Texas, 3/16 Wisconsin New York State State

Government Regulations: Safer at Home orders New York Wisconsin Texas 3/22 3/25 4/2 Washington Kansas 3/23 3/30

3/12 Washington 3/15 Kansas State State SCHOOL CLOSURES 3/13 Texas, 3/16 New Wisconsin State York State New York Wisconsin Texas 3/22 3/25 4/2 SAFER AT HOME ORDERS Washington Kansas 3/24 3/30

Patient Volumes Seattle Children’s: Cook Children’s: Children’s Mercy: Compared to 2019: Compared to 2019: Compared to 2019: March: 29% down March: 36% down March: 31% down April: 76% down April: 62% down April: 80% down May: 63% down May: 58% down May: 71% down June: 44% down June: 22% down June 53% down PM Pediatrics: Children’s Wisconsin: Compared to 2019: Compared to 2019: March: 28% March: 28% down April: 80% April: 74% down May: 72% May: 64% down June: 53% June: 49% down

Compared to 2019: Decreased Percentage of Patient Volumes in Urgent Care 0% March April May June -10% -20% -30% -40% -50% -60% -70% -80% -90% Children's Mercy Children's Wisconsin Seattle Children's PM Pediatrics Cook Children's

Operational Children’s Wisconsin Children’s Mercy Seattle Children’s Cook Children’s PM Pediatrics Changes Urgent Care Site Yes, temporarily 3/7 sites, No No No Yes, temporarily shifted Closures 2 have reopened 5/50 sites into testing centers Hours of clinics No Yes No No Yes from 12 hours to 10 changed hours Tele-medicine Started Sept 2019, 10-fold Started May 2020 Still in planning phase Already had it active, Launched PMP Anywhere increase in March, 2020 increased volume App Increased Upper Age Yes - 26 Yes - 22 No No Screening of adults Limit? Which age? offered Drive-Through/Out- No No Outpatient screen Yes, began in June Yes 1-2 offices in each door Testing started in May region Front Desk/Access Plastic Tarp Barriers on Plastic screens Screen prior to Front Door screeners – pts Plexi-glass introduced Reps 3/12 introduced entering building, waits in car if +screen Plexi-glass bariers Encouraging families Utilizing tele-medicine No No +screen calls front desk Offices are open but tele- to stay home via from car, offered medicine option if you Patient Portal Telemedicine encounter want to stay home first

Personal Protective Equipment Children’s Wisconsin Children’s Mercy Seattle Children’s Cook Children’s PM Pediatrics PPE shortages Yes – early on Yes Yes Yes Yes early on Initial PPE Surgical masks, N-95s PAPRs CAPRs. N-95s Surgical Masks, Surgical Masks, N- reserved for reserved for code Gown, Gloves, Eye 95s Reserved for aerosolizing situations Protection. N-95s aerosolizing procedures reserved for aerosol procedures generating procedures for + screens Later on PPE Switched to N-95 for CAPRs for Surgical Masks, Same as above all providers with symptomatic pts and Gown, Gloves, Eye direct patient aerosolizing Protection. N-95s contact at peak procedures, surgical reserved for aerosol (April), recently masks and goggles generating added CAPRs for for asymptomatic pts procedures for + those who failed fit screen. Mask and testing eye protection for all patient encounters

COVID Testing (PCR & Antibody Testing) Children’s Children’s Mercy Seattle Children’s Cook Children’s PM Pediatrics Wisconsin PCR Testing Yes Yes Yes Yes Yes Limited Testing 1 week of testing Discontinued MP swabs and We have had Yes initially March 20 th and then March viral testing media extremely limited 17 th limited to Started Again June supplies ran out testing until June, only admitted still limiting to patients symptomatic pts Antibody testing No Yes, started May No Yes 7 th Current Exact Sciences In house testing In-house for PCR -Drive through Labcorp PCR/Antibody testing in May and antibody testing - NP Swab Quest Testing 2020/ for PCR Northwell In House testing -In-house ID Now Pilot in-house PCR as of 7/20 testing Texas

Tele-Medicine Children’s Wisconsin Seattle Children’s Children’s Mercy PM Pediatrics Cook Children’s

Morbidity and Mortality Children’s Children’s Mercy Seattle Children’s Cook Children’s PM Pediatrics Wisconsin Urgent Care 5.3% 1.5% for UC (1.2% 8% current, Patients Positivity 14 Urgent care for hospital) peaked at 20% Rate cases early in pandemic Severity of illness Asymptomatic Mild illness Asymptomatic Mild illness Mild illness (known exposure) (known exposure) to mild to mild Multi-system 1 case: requiring None sent from 9 confirmed cases 6 cases, all 9 cases: many Inflammatory ICU level care urgent care but in system required PICU requiring ICU level syndrome in System has seen system has seen 1 None via UC care, none care Children (MIS-C) 11 suspected MIS- case originated from UC C cases

Urgent Care and Institutional Data Children’s Children’s Mercy Seattle Children’s Cook Children’s PM Pediatrics Wisconsin Urgent Care 4-5% positive rate 1 UC staff member 3-4% positive rate in No positive staff 3% positive, of Community/Prima tested positive workforce members as a result which 75% occurred Staff/Provider ry Care of work exposure. in Westchester area Specific Data during the 1 st wave No UC providers Several staff were known to have positive but before universal tested positive quarantined prior to masking exposing staff Institutional Data 317 Pts tested: 6,553 0.5% positive rate in Pts tested: 9,233 staff/providers Positive: 159 (2 pre-procedure pts (includes pre-op and tested admitted) symptomatic 268 negative Pending: 56 Employees patients) 49 positive screened: Positive: 617 No known work Employees screened: approximately 1,800 % positive: 6.7% exposures in 1,715 positives Employees tested: 1,113 Confirmed +ve: 71 (48 back) Pending: 28

Children’s Mercy 3 w M with fever and jaundice Jaundice since birth but did not require bili lights per mother Discharged home on dol #2 Follow up at 2 weeks with PCP was un-concerning Mom noted worsening jaundice in past 5 days with scleral icterus Fever x 1 day pta of 100.9 axillary – mom gave ibuprofen No fevers on day of presentation Alert and active per mother Breastfeeding 20 minutes q3-4 hours and cluster feeds at night

Continued HPI 6-10 wet diapers per day 6-7 stools per day Denies vomiting, diarrhea, cough or URI symptoms No ill contacts Birth History: 39 weeks BW 7 pounds 10 oz Prenatal testing negative per mother