What It's Like To Be A Primary Care Pediatrician In A Pandemic
Though news of a novel and deadly coronavirus began to trickle in late in December, it was not until the past few weeks that life as we know it in America began to feel truly and completely upside down. There are many newly popular phrases — “social distancing” and “flatten the curve,” anyone? — that most of us would be glad never to hear again, when all is said and done. But as a pediatrician, I can attest that two words being used right now — “unprecedented” and “uncharted” — are extremely accurate.
As a general pediatrician at a large academic medical center in the Midwest, my patients range in age from newborn to young adults. So far, what we know about how COVID-19 affects pediatric patients is largely reassuring. One study that examined over two thousand children in China who were diagnosed with the SARS-CoV-2, the virus that causes COVID-19, found that over 94% of these children were asymptomatic or had only mild or moderate symptoms.
However, that still leaves six out of every one hundred children with severe or “critical” symptoms, and the authors of this particular study found that younger infants and children were more likely to develop severe or critical symptoms than older children and adolescents. And as with any rare diagnosis or tragedy, when it befalls your own child or loved one, the fact that it was unlikely to happen in the first place provides little comfort. In other words, statistics don’t matter when you’ve won the bad news lottery.
So what is it like being a primary care pediatrician right now, as cases of COVID-19 surge across the country and the world? In addition to teaming up with my husband to try to homeschool our four daughters while we continue to work, there are a few primary issues on my mind.
First, my colleagues and I are scrambling to learn as much as we possibly can about this new virus, such as how it spreads; how symptoms manifest in children (we know that children are not simply “little adults”); and how we can most safely and effectively treat our patients from a medical perspective. With the new information being released on a daily, even hourly, basis, it’s like drinking from a firehose. We are working with colleagues and administrations to develop and keep up with continuously evolving testing protocols, and building the protocols and processes to provide testing and treatment as safely as possible.
Second, we must continue to provide essential medical care. While there are some conditions — like warts or acne or check-ups for healthy school-aged children who are not due for vaccines — for which visits can be safely postponed, much of what we routinely manage as primary care pediatricians cannot be delayed. Newborns need to be closely monitored for feeding, weight, and jaundice, and infants and young toddlers receive critical vaccines on a fairly strict schedule. And children continue to break bones, have asthma flares, and develop all the same medical conditions that they did before the pandemic.
So we are working hard to maintain access to important care, and radically restructuring what that looks like, including increasing access to video visits and telephone visits when possible. We are also working hard to keep kids out of the hospital when they don’t absolutely need to be there, which means pushing our limits in terms of what we can safely oversee and manage while kids remain at home.
Third, we are continuing to provide the most compassionate, holistic care and support that we can for families during a time of great challenges and disruption. Schools are closed, and parents are losing their jobs or falling ill. Because of this, many children are at greater risk of experiencing hunger or abuse, and now — more than ever — we must partner with families, schools, and communities to keep children safe, secure, and fed.
Finally, we are planning for the future, which frankly looks pretty scary to us right now, and as doctors, it takes a lot to scare us. All around the country, hospitals, medical practices, and health departments are implementing emergency pandemic plans that we all hoped we would never have to use. This means different things in different places at different times. For many health care workers, this will mean stepping outside our usual roles, which are often very specialized and siloed. As a primarily outpatient doctor, for me this will likely mean being redeployed to an inpatient role, caring for patients in the hospital; while this is well within my scope of training, as a mother, it’s hard not to feel a swell of anxiety imagining a front line role that is even more front line than the one I currently hold.
It’s hard, too, not to wonder how this will change us all. How will our children be shaped by the experience of living through this pandemic? Will there be parents who are resistant to a coronavirus vaccine when it is developed? In pediatrics, we think a lot about the balance between protecting children’s best interests and respecting parents’ decision-making authority; about the interplay between individual health and community health; and about the impact of social factors on the long-term trajectory of children’s lives.
At a time of great fear and grief, though, we are also seeing people and communities coming together as never before, outpourings of generosity and kindness, and deep caring for the wellbeing of our neighbors. As someone who has the privilege of witnessing the beauty and resilience of children on a daily basis, it is my hope that the most lasting lesson for our children from this international crisis will be that together, we can create a world that is kinder, and better, and safer for us all.
Information about COVID-19 is rapidly changing, and Scary Mommy is committed to providing the most recent data in our coverage. With news being updated so frequently, some of the information in this story may have changed after publication. For this reason, we are encouraging readers to use online resources from local public health departments, the Centers for Disease Control, and the World Health Organization to remain as informed as possible.
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