Frontline Stories: Doctors Share Impact of Pandemic on Non-COVID-19 Pediatric Patients
Let’s imagine a scenario that no parent wants to think about.
Let’s say your child starts acting weird over the past few weeks. She seems tired. She’s sleeping more, and laying around all the time.
She starts to drink more water. It sure does seem like a lot of water – way more than on a hot day outside. She’s starting to pee more often. She’s waking up at night to refill her cup over and over.
She’s starting to lose weight. She’s complaining her vision is blurry. She started to vomit yesterday, and cries today that her stomach hurts. She’s acting exhausted.
You take her to the pediatrician, who checks her blood sugar. The number is so high, the monitor cannot read it. It only says “over 500”.
You rush her to the ER, where you get the diagnosis: diabetic ketoacidosis. Your child is a new diabetic, and you had no idea until this moment. DKA is life-threatening and requires ICU care, the ER physician says.
“The problem is…we don’t have any PICU beds available currently. The unit is completely full.”
In the spirit of our ongoing efforts to be real and transparent with you about the status of children with COVID in Tarrant and surrounding counties, allow me to share with you what my colleagues have shared with me. I asked them, “Are the high numbers of COVID patients in our hospital affecting your other patients?”
The following quotes are nearly word-for-word (though I took to liberty to make a few large medical terms more understandable, and keep patient details anonymous):
Dr. Scott Perry, Neurology: “I’ve got plenty. Several surgeries canceled. Surgeries that could potentially stop seizures in children where their condition is life-threatening. Several workups canceled while we wait for more room. Trying to manage people at home throughout the night so they don’t need the emergency room. I am so exhausted from this, from dealing with the pandemic and the risk of losing highly trained people as a result. The list goes on…”
Dr. Samson Cantu, Gastroenterology: “From the GI standpoint, we have had to second guess our decision to proceed with planning for gastrostomy tube (feeding tube) placement in our failure-to-thrive patients. All new feeding tube placements require hospital admission for 48 to 72 hours. Given the scarcity of inpatient beds, we are very limited in having a scheduled admission, despite a feeding tube being a true life-line for several patients.”
Dr. Charles Saadeh, ENT: “With airway surgery, we have to take into account worst-case-scenario hospital resources that necessitate PICU bed availability. I have had two patients so far that have had a delay in care. Cook has been so very diligent about accommodating patients that need to go when they are delayed, but it’s definitely a case-by-case discussion with each family. We wouldn’t be offering supraglottoplasty (a complicated surgery that allows children with airways disorders to breathe easier) if things weren’t relatively urgent to begin with, so this is certainly a difficult position for us.”
Dr. Teena Thomas, Endocrinology: “More than once last week, when I received a transport call for a new onset, I was not always sure that I would be able to admit a new onset in DKA to the PICU because of the lack of bed availability. On my last day of call, we had to divert a very young new onset to another hospital… I have never not been able to admit a new onset here. I checked on the child the next day and the hospital they went to did not actually have PICU availability either (they had to some shuffling to get the kid to the PICU). Last week, my diabetic patients also had to spend a lot more time in the ER because of lack of bed availability in the PICU or the endocrine floor.”
Dr. Michelle Marcincuk, ENT: “I had an entire day of surgeries cancel because there were no beds to admit the patients to post-op. These were kids with trachs, airway obstruction, swallowing dysfunction. I had a child with a mass on the face that needs a biopsy. Had a little one with a draining fistula on the neck. All had to be postponed. Two kids were hoping to get their trachs out. But had to cancel.”
(Imagine the day finally comes when your child gets the breathing tube taken out of their neck…and your day is yet again postponed, and sometimes for a YEAR. Keep reading.)
MM: “Since the hospital has been full, I can’t say whether we will get to do their surgery the next time they are scheduled. It’s just a complete guess as to whether or not there will be a bed available for them on the day we reschedule. And since we don’t decannulate (breathing tube taken out) kids in the winter, if we don’t get them done soon, they may miss their window of opportunity to get decannulated this year and may have to wait a whole year more for their next chance. That’s a whole additional year with a trach due to COVID. None of my patients have COVID. But their health is being affected by the COVID surge.
The health of these kids is suffering because of this pandemic. Even though they themselves don’t have it. And their parents have done everything possible to keep them healthy. The parents have taken days off work preparing for this surgery. When the surgery is cancelled, they have to take even more days off for the new surgery date, putting their jobs at risk due to absences. And some patients drive 5-6 hours here for surgery, only to arrive and be told that they can’t have the surgery and have to drive back home because the hospital is full. Then you think of the wasted time the surgeon experiences when this happens. Basically, it’s a day that they can’t see patients because of the last minute, unexpected cancellations. We have a huge list of kids waiting to be seen in clinic, but most of the time these cases are cancelled last minute and it’s too late for new patients to be booked into clinic. So both the surgery patients and the new patient for clinic who are waiting for appointments are affected.”
Dr. John Honeycutt, Neurosurgery: “It is frustrating from several different levels. However, we are ONLY delaying non urgent or elective surgeries. Cases for brain tumors or other surgeries where delay could cause harm we are still full steam. But it is very frustrating to families that have planned, taken off work, mentally prepared and then have to delay. It’s extremely hard for them. Nobody’s outright angry or screaming, all seem to understand, which is so cool. We see all this in media about people screaming and yelling about selfish things, but they miss the vast majority of people that are just trying to get by in life and care for their community and others. They are frustrated, but make the sacrifice for the better of others. That is missed and it is refreshing to see that personally.
As a team, we are so used to being full steam, so for us to transition to a lull is a bit of a challenge (easier for younger docs, harder for me). But we understand too. We see the ICU, ER and hospitalists and nursing staff overworked and stressed. Sad to see.
Finally, our service line has not had our neuro PICU for a year and a half since it is now the COVID unit, and last week we lost our neurosciences floor to be the second COVID floor unit. So we are scrambling hard, being extra sure our patients get what they need since they are now scattered throughout the hospital. Exhausting for our team.
We are fine, just adapting to the new norm which I pray is short lived.
Dr Karthik Srinivasan, Pediatric Hospitalist: “As pediatric hospitalists, we care for children who require hospitalization. I recently took care of a cute infant who was not admitted for COVID and improved within a day. I was excited to discharge him home, as was his mother. We had a pleasant conversation, and the mother was very thankful. She seemed to trust Cook Children’s and all our staff. As I was leaving, I mentioned that her son was too young for the vaccine but wanted to know if family members had received it. “No. No. We’re not going to talk about that” was what I got, and the tone and mood took a 180. There was an awkward silence. The family was out the door within the next 20 minutes.
As of about two months ago, we were fortunate to have ZERO COVID positive patients admitted to our service. Now, we are up to about 40% of our service as a whole. About 75% of these children are admitted directly because of COVID, not just incidentally being positive. This is very different than in months past.
Clearly, the delta variant has been a game changer that is much more easily transmitted. We recently set our service’s all-time record for the number of hospitalized children we are taking care of, which can be directly attributed to COVID. We started last year utilizing one floor as the typical “COVID unit.” This grew to two floors, and most recently we have started filling up a third floor, anticipating even more as I write this.
We are seeing children in all age groups being admitted due to COVID. Although we are noting that obesity is a risk factor, we are admitting some children without any apparent predisposing factors. More recently, about 3-4% of older teenagers who are testing positive in the Cook Children’s system are being hospitalized. Beyond infancy, our highest rate of hospitalization and many of our sicker patients are older teenagers, the vast majority who are vaccine eligible but have not received the vaccine.
On a typical call shift, it is not unusual to be called on at least a couple of children who are admitted for COVID and are appearing sicker. And it is a process to see them. For staff member safety and our own protection, there is extensive protective equipment required to see them, and this needs to be worn anew upon entering and completely removed upon exiting the room. Additionally, for some of these sicker children, multiple specialists may be involved in their care, leading to several phone calls. This is all while the Emergency Department anxiously is paging for several additional patients needing to be admitted. Admittedly, in these times, it can be near impossible to return their calls in a timely manner.
As we are stretched thin, the medical care we provide may not be as efficient as you are accustomed to. We need your patience, understanding we are all in this together. If your child gets sick and needs to be hospitalized, we are here for you and your child. But the best weapons we have against this is preventing the illness in the first place. Go back to the basics that have been preached by Cook Children’s physicians for quite some time now. Mask up, socially distance, and get your vaccine if eligible. Even if your child cannot get the vaccine, have family members and friends get it if eligible. Please trust us on this as you do with the care of your child. To be clear, virtually all the physicians at Cook Children’s were vaccinated well before the word mandate was even thrown around. We preach what virtually every major physician organization has advocated for and what we have practiced ourselves. Do it for yourself. Do it for your child. Do it for your neighbors. Do it for us.
We strive to keep our “Promise” to you and your children, but we need your help.
Dr. Christine Ellis, Pediatric Hospitalist: “Page comes through as I barely walk through the doors of the hospital that another one of my patients is in respiratory distress. Seconds later, I hear the “Med Alert” overhead- of course, it’s my patient I was just paged about from the COVID unit. I skip making my morning coffee and checkout from the evening physician and run upstairs to the COVID unit.
I throw down my bag, quickly place on my PPE and walk into the crowded room to see my teenage patient breathing over 60 breaths a minute and oxygen saturations decreasing despite maximum support on a non-rebreather face mask. PICU team arrives shortly and my patient is whisked away to our pediatric ICU for higher level of care. I try to comfort the mother quickly as they start to roll to the elevator for transfer.
I take off my n95 mask, make my coffee and get the rest of my checkout from last night’s physician that stayed late to talk to me. I finally slump into my chair to start rounding on all my other children for the day and all the emotions flood over me.
SADNESS for the patient and family as they go through this difficult time with a very sick patient.
FEAR for my patient’s respiratory status as I am afraid that he is on a long road that will require possible Bi-Pap or even intubation.
FRUSTRATION sinks in as this patient, like many of my other patients, was eligible for the COVID-19 vaccine and is not currently vaccinated. This child likely would not have these severe complications if he was vaccinated. They were completely healthy except for obesity (which significantly increases chances for complications as well). All of this could of been prevented.
As the day goes on, I go between our now two full non-ICU COVID units and see patient after patient similar to my first child of the day. Some children too young for the vaccine but when I talk to their parents, no one in the house is vaccinated either. I continue to march room to room. EXHAUSTION hits me. My face hurts from my n95 mask but I sign up as the COVID physician the next day.
As I drive home to my family I try to find HOPE. Hope that tomorrow will be a better day. Hope that tomorrow another sweet child does not go to the ICU for a now preventable disease. Hope that our community continues to step up and get vaccinated and wear their masks appropriately. Hope that vaccines are available for our younger children soon so my patients and my own children at home can be more protected.
❤️ Dr. Ellis
Dr. Laura Romano, Pediatric Hospitalist: “Our hospitals are full. Our ICUs are full. Due to the surge from the delta variant, we do not have any beds. This means that patients at outside hospitals or clinics who need specialized care cannot be transferred to our facilities. This means that there are children who have to wait longer for necessary and sometimes life-saving treatment.
I've seen a lot of people say that wearing a mask or getting vaccinated is a "personal choice" or "my body my choice." Your choice to not wear a mask and to not get vaccinated is putting our children and our patients in jeopardy. The time for personal responsibility is over. It has already failed our children and that failing has led to unprecedented COVID spread in a few weeks since schools have returned without mask mandates and without vaccine mandates. This spread will continue unchecked and we won’t have the beds or the space to help our patients. It's simple math at this time.
I've seen people posting that health care professionals need prayers because we are tired and overwhelmed. Yes, we are exhausted. We are tired. We are running on empty and are experiencing burn out that we have never felt before. Yes, we appreciate your thoughts and prayers. But what we need more is for YOU to get vaccinated.
The time for talk is over. You need to get vaccinated. You have to get vaccinated. It is the only way to end this.
If you don't care about your own health and wellbeing, please care about your children's health. Please care about my patients' health. Please care about your nieces and nephews. Please care about your neighbor's children. They need your help. We desperately need your help.
And if that's too much to ask, if it's too much to ask you to care about a child, then wear a mask. It's literally the least that you can at this point.
The time for talk is over. We need action. We need it now. I know how some of you will react to seeing this: another COVID post. Some of you will say that this is a joke and a political hoax. Some of you will say that this is baseless fear mongering by the mainstream media to make you afraid of what will amount to a slight cold or a flu. Please know that none of those statements are true.
This is virus that spreads easily. This is a virus that is now causing severe and life threatening disease in children. Please, please, please listen to medical professionals who are quite literally begging you to get vaccinated.
If you don’t want the vaccine for yourself, please get it for your kids, your nieces and nephews, your friends’ kids, or even for the children in your neighborhood since a lot of us don’t have the option to vaccinate our kids against a deadly and fatal virus.
If you have any questions about the vaccine, please reach out to me or your family doctor. We would love to talk to you about it! You have entrusted your children to us throughout the entire lives. We need you to put your trust and faith in us again. Please get your vaccine.
And if getting vaccinated is too much to consider, then please just wear a mask. Please. Children are literally dying from this and we have the ability to stop it.
"Se sabe que la variante delta es altamente transmisible, desafortunadamente ha causado que los casos de COVID pediátricos aumenten significativamente recientemente. Esto, a su vez, ha provocado un aumento de las hospitalizaciones por COVID en nuestro propio hospital.Ha habido varias partes diferentes del hospital que se han convertido en unidades dedicadas al tratamiento de niños con COVID-19.Esto significa que a medida que más niños requieren atención para su enfermedad COVID-19, hay menos camas disponibles y personal para cuidar a otros niños que pueden requerir pasar la noche en el hospital por una condición médica no relacionada con COVID-19. El aumento actual está provocando retrasos en los procedimientos que no son de emergencia o electivos, dado que algunos de esos niños requieren habitualmente de hospitalización, seguimiento posoperatorio o recuperación.
Como pediatras y especialistas en pediatría estamos acostumbrados a atender a TODOS los niños de inmediato en el momento en que necesitan intervenciones o tratamiento, lamentablemente nos estamos dando cuenta de que esto puede no ser posible y no podemos evitar sentir una avalancha de emociones: frustración, tristeza, temor. Nosotros también somos humanos y lo que nuestros ojos ven todos los días crea una montaña rusa de sentimientos que tememos que nadie más pueda entender.Sin embargo, tenemos la esperanza de que si compartimos solo un pequeño vistazo de lo que nuestros ojos ven y presencian todos los días, esa bondad y abnegación ganarán y que nuestra comunidad hará lo correcto.Le pedimos a usted (nuestra comunidad) en este momento que considere que sus decisiones y acciones de la vida diaria pueden afectar y afectarán la trayectoria de esta situación.Le pedimos que nos ayude haciendo lo siguiente: vacunen a TODOS los adultos y adolescentes elegibles en su hogar contra el COVID-19 y se use cubreboca cuando estén fuera de su hogar. Estas simples acciones de bondad no solo lo protegen a usted y a sus seres queridos, sino que también pueden comenzar a aplanar la curva de infección de COVID que necesitamos en este momento para ayudarnos a cumplir nuestra promesa a todos los niños del norte de Texas y nuestra comunidad."
The actions we all take in our daily lives will make a difference for these hardworking doctors, our amazing and exhausted hospital staff, and most importantly, the kids.
Don’t send your kids to school sick. If in doubt, get a test. Move the parties, get-togethers, and playdates outdoors – fall is coming, and it’ll be beautiful out.
With winter approaching, I worry about our already-strained hospital system. COVID is already putting us under pressure – and the flu will bring new challenges for us all. Please get your family vaccinated against the flu now. Kids need to be in masks in school – last year’s nonexistent flu season can attest to how well they work.
We are counting on our community to do what’s right. Please help us help your kids
I ask you to put yourself in the place of the parents of one of these children, who desperately need urgent or critical care, and who may not be able to get it because of the number of patients in our hospital.
There are 41 patients currently in Cook Children’s with COVID. 63 beds and four units that are using vital resources of staff, oxygen, ventilation, life support.
Cook Children’s will always strive to accommodate all of our community’s needs. But I beg to you ask yourself: what can I do to help?
- Send your child to school in a mask. Ask them to keep it on at all times unless outside or eating.
- All children in school over age 2 should be masking indoors. School districts should strive for universal masking right now.
- Quarantine all children who come in contact with a COVID+ child if unmasked and for longer than 15 minutes indoors.
- Get your kiddo the COVID vaccine if they’re over age 12. It’s safe and it’s effective.
- Please keep your sick children home from school.
- Postpone indoor gatherings for now- it’s not going to be forever. Just for now.
- Move the party outside.
- Open windows when you have people over.
- Limit the number of people who can attend sporting or theatrical events at schools so there can be spacing between families.
- Mask up and put at least six feet of distance between you and other people in meetings.
This won’t last forever, but Cook Children’s needs your help to be able to always have a bed available for your child should you ever need one.
As the medical director of our Infectious Diseases department, Dr. Mary “Susi” Whitworth has told us, “we never want to get to the point where we cannot prevent a preventable death.”