Five years later, we reflect on all that has occurred and changed since March 4, 2020. We asked Cook Children’s employees to reflect on their experiences during the COVID-19 lockdown and how they experienced growth, loss, and change.

Cook Children’s Medical Center has completed its new infectious diseases critical care unit (CCU), meeting the need for a clinical facility dedicated to the treatment of patients with contagious illnesses.

The expansion ensures children with highly infectious diseases will be treated in the safest environment possible. The unit’s design and technology allow for the treatment of the sickest patients while also protecting Cook Children’s staff and the community from the spread of illness.

While the need for the unit first appeared on Cook Children’s radar several years ago when Ebola made its way to U.S. shores, the COVID-19 pandemic shined a light on its importance once again.

“COVID-19 overwhelmed us and we had a hospital full of kids with COVID during the Omicron surge,” said Marc Mazade, M.D., medical director of infection control and prevention at Cook Children’s. “But we only saw a modest number of kids with COVID-19 who really needed care in the pediatric intensive care unit (PICU), and most of them graduated out of the PICU pretty quickly in comparison to the much sicker adolescents with severe lung manifestations that we saw with the first two waves of COVID. We have to be prepared to deal with whatever comes and this new unit will help us to do that.”

The overall expansion for the preparedness of current and future pandemics includes the new six-bed infectious diseases CCU and a 24-hour solutions center with dedicated incident command space. In addition, a new 32-bed medical-surgical unit was added to expand Cook Children’s ability to meet the hospitalization needs of the growing communities it serves.

“I work for a system that pursues whatever is needed to improve a child’s health or save a child’s life,” said Mary Suzanne Whitworth, M.D., medical director of infectious diseases at Cook Children’s. “This new infectious diseases CCU is that next great opportunity and we are all thrilled to be a part of it.”

The pandemic showed us all how important it is to feel close to your family members, even if you can't be in the same room. In September 2020, a Cook Children's dad went viral for dancing in the parking lot during his son's cancer treatments. Due to the COVID-19 restrictions at the time, only one parent or caregiver could attend appointments with patients. 

These new infectious disease critical care units will make seeing family much easier with Virtual Connect – think FaceTime but for hospital rooms. Doctors and clinicians will also be able to visit with patients through Virtual Connect.

This will allow all “dancing dads” to connect with their child if they can't physically be at the Cook Children's Medical Center.

Family-Centered Safety

Since the start of the pandemic, much has been learned about how to maintain safety for staff and guests and expertly care for infectious disease patients now and in the future.

These best practices and protocols are standard design in the infectious diseases units, which feature specialized air ventilation systems, dedicated areas to put on and take off personal protective equipment (PPE), and technology that allows clinicians to closely monitor a patient without having to be directly at the bedside and other heightened protection measures to contain disease spread.

“These units will be used in an effort to place potentially contagious patients in one area,” Dr. Whitworth said. “The goal is to have everybody in one unit with every employee in that specific unit dedicated to being experts in proper PPE donning and doffing, patient and visitor flow and all of the aspects of interrupting the spread of an infectious disease.”

Maintaining a family-centered and supported environment also influenced the design of the new infectious diseases CCU. The decision to limit visitors to Cook Children’s Medical Center during the pandemic was a difficult one for everyone. While Cook Children’s patients have always been allowed at least one family member at their bedside during the outbreak, the spread of the virus demanded that administrators take steps to protect employees and vulnerable patients by restricting the visitation of others within the family unit.

“Segregating families is not who we are as an organization,” said Stan Davis, chief operating officer at Cook Children’s Medical Center. “We promote that when a child is sick and in our hospital, they need family at their bedside to help with treatment and healing. This unit allows our staff to feel comfortable that they’re in the right environment and have the right precautions to be comfortable treating patients, and it allows our community to understand that in addition to having the best nurses, therapists and support folks in the world, we have the right environment to keep families together.”

Each of the new infectious diseases CCU rooms will have a private bathroom, an accommodation not available in the previous critical care space used for contagious patients. This allows parents to stay in the room with their child as long as they would like and reduces the in and out traffic of a parent who may have the same illness as the child due to exposure. Dedicated entrances and exits to these units for staff and visitors will help protect the general hospital environment.

“It’s our responsibility to re-too in order to deal with situations and illnesses such as the re-emergence of SARS which resulted in lots of health care worker deaths in Canada, for COVID-19 variants already circulating, for Middle East respiratory syndrome (MERS), for avian flu, for new and old world hemorrhagic fever viruses, or for bioterrorism-related infections like anthrax,” Dr. Mazade said. “We’re excited to have the facility to do that better than ever.”

To open up space for the infectious diseases CCU, the Cook Children’s simulation lab was relocated. The simulation lab is an educational space where staff practice using new technologies, innovations and research. Last year, Cook Children’s was the first freestanding children’s hospital in the world to receive full accreditation through the Society for Simulation in Healthcare. The relocated lab allows for the future expansion and growth of this program.

System-Wide Solutions

The design of the new 24-hour solutions center was inspired by lessons learned about system-wide coordination and cooperation throughout the pandemic. Members of all 14 of Cook Children’s Health Care System’s entities worked together in the medical center’s incident command center to coordinate a consistent response to COVID-19 across the entire organization. This consolidation and cooperation allowed Cook Children’s to be nimble, flexible and quick to the ever-changing environment.

The new solutions center will operate year-round under the same premise of consolidation, coordination and consistency. It will be a one-stop shop for staff and guests of any one of Cook Children’s entities to report or request assistance with a facility or operations issue.

“The solutions center will be a single touch point for staff, patients and families, in terms of who they contact for assistance with an operations issue at one of our facilities,” Davis said. “The consolidation that will occur is that there will be a joint information system—a communication hub, if you will—that everyone in the system uses, and the issue will be triaged and assigned from there. It’s similar to what you see with a technology help desk.”

Inside the solutions center is a dedicated incident command center equipped with meeting space that accommodates proper social distancing protocols and communication technology that supports real-time global health updates for rapid, informed decision-making. This is a much-needed upgrade from the classroom that doubled as an incident command center during the height of the pandemic.

“We’ve learned with COVID-19 that hospitals can become overwhelmed rapidly,” Dr. Mazade said. “Planning for staff shortages, getting supplies, developing protocols, and getting our teams the most up-to-date information ASAP while combating misinformation is vital to everyone in the organization, to our community partners, and to our community. We need an up-to-date, world-class incident command station built for that.”

Cook Children’s Health Foundation’s Protecting your Tomorrows campaign helped make the expansion and improvements possible. Thanks to the generosity of donors, Cook Children’s is more equipped than ever before to care for children during a pandemic or outbreak of any infectious disease. For more ways to support our patients, staff and families, visit cookchildrenspromise.org. If you’d like to join the Protecting Your Tomorrows fundraising effort, contact Cook Children’s Health Foundation at 682-885-4105.

Distribution of the Pfizer-BioNTech and Moderna COVID vaccines for the youngest age group will begin this week. The CDC's Advisory Committee on Immunization Practices’ (ACIP) recommended that all children 6 months through 5 years of age should receive a COVID-19 vaccine.

This expands eligibility for vaccination to nearly 20 million additional children and means that all children ages 6 months and older are now eligible for vaccination, the CDC said.  

Parents may be wondering if they should get their children vaccinated. Vaccines are the best way to prevent serious illness in people of all ages, including children.

The COVID positivity rate has slowly increased at Cook Children's.  

The rolling seven-day average positivity rate:

• June 20: 10.6%
• June 5: 8.4%
• May 5: 3.5%

Based on available data, our health care providers and pediatricians at Cook Children’s strongly recommend that parents get children vaccinated as soon as they are eligible.

Moderna's vaccine, for children 6 months through 5 years old, is two shots spaced one month apart.

The Pfizer-BioNTech vaccine, for children 6 months through 4 years old, is three shots over the course of 11 weeks.

The vaccines are being distributed and will be available at thousands of pediatric practices, pharmacies, Federally Qualified Health Centers, local health departments, clinics and other locations, the CDC said.

Cook Children’s is currently working on its plan to distribute vaccines to pediatrician offices and will announce details regarding scheduling soon.

Laura Romano, D.O., a hospitalist at Cook Children’s Medical Center, has two children, an almost 4-year-old daughter and a 20-month-old son.

“My son was exposed and tested positive when he was 10 months old. We were very fortunate because I had received my COVID vaccine when he was 8 weeks old so he had plenty of antibodies and protection from me and my immune system,” Dr. Romano said. “We escaped his illness with two days of congestion and one day of fussiness. I, unfortunately, know that not all families have been as lucky.”

“These are some of our most vulnerable patients, and being able to provide them protection against COVID will be a huge relief to so many parents, including me!” Dr. Romano said. Here are her answers to some frequently asked questions:

Why should my child get the COVID vaccine?

It is extremely important to get everyone who is eligible vaccinated.

Vaccinating against COVID is what will continue to allow everyone to return to a more normal life. 

People who are fully vaccinated are significantly less likely to spread COVID-19 because of their smaller viral load, which means a lower risk of transmission to others. That’s one of the main reasons why I’m so excited to get my children vaccinated against COVID. My father is a type-1 diabetic with rheumatoid arthritis who is immunocompromised due to his medications, and I always worry about accidentally spreading COVID to him.

Additionally, someone who is vaccinated against COVID, even if they are exposed and test positive for COVID, is at a significantly decreased risk for complications such as ICU admissions, the need for life support and death.

Here at Cook Children’s between Dec. 19, 2021 and Jan. 15, 2022, there were more than 14,800 children who tested positive for COVID at their pediatrician’s office, a Cook Children’s Urgent Care, or at the medical center. Out of 321 patients who required hospitalization, only 18 were vaccinated against COVID. Out of the 37 patients admitted to the PICU with COVID, only two were fully vaccinated. This data strongly suggests that the vaccine is effective at preventing hospitalizations and at preventing ICU admissions.

COVID vaccines also help prevent MIS-C, multisystem inflammatory syndrome in children. MIS-C is a potentially very serious complication that we see four to six weeks after a COVID infection or exposure. Out of a large cohort of 21 million vaccinated young adults, only 21 children developed MIS-C after COVID vaccination. This tells us that not only can a COVID vaccine prevent severe illness from an acute infection, but it can also prevent some of the more serious complications following COVID exposure.

COVID vaccinations also prevent long-haul symptoms such as daily headaches and persistent fatigue. Although not common, we do see COVID long-haul symptoms in a pediatric population. Patients who are fully vaccinated against COVID are 50% less likely to develop long-haul symptoms.

COVID vaccines do not affect a woman’s fertility. The American College of OB/GYN, the Society of Reproductive Endocrinology, and the Society for Maternal Fetal Medicine have recommended COVID vaccination for all women whether they are pregnant, or trying to become pregnant, or breastfeeding.

On a more practical aspect, a fully vaccinated person will also have different quarantine requirements after exposure or testing positive for COVID. As someone who lived through a 10-day quarantine, I would not recommend or want to repeat it. A fully vaccinated person can have shorter quarantine periods.

How do we know it’s safe for children 5 and under? 

Despite the name “Operation Warp Speed,” the process to investigate and certify the vaccine did not cut any corners. Throughout the vaccine development process, researchers had to follow the same procedures and regulations as if they were developing a new medicine for headaches or blood pressure.

In addition, both the Pfizer and Moderna studies have increased their sample sizes throughout the process to make sure that side effects or reactions are not being missed. Participants in the study were closely monitored.

Should parents get their children vaccinated, even if their child recently had COVID?

Children should be vaccinated even if they already had COVID. Some studies have suggested a second or a third infection can be associated with more severe disease. More severe disease could mean hospitalization, ICU admission and even death.

Some infectious disease experts recommend waiting three months after COVID infection before being vaccinated so that the vaccine has the maximum effect.

Why should my child be vaccinated if they have already had COVID?

I hear a lot of parents, neighbors and friends say that they tested positive for COVID and only had mild flu-like symptoms. However, this is not always the case. While I’m happy that your first case was mild, please know that your second infection may not be the same.

What if I live in an area with a low number of cases? 

If you live in an area with a low number of cases, please still get your vaccine. With the global nature of our world, you will have plenty of opportunities to come into contact with people who come from areas with high number of cases.

COVID vaccines can also be extremely important if you want to travel. Some countries or cruises require you and your child to be fully vaccinated before travel.

Do I have to vaccinate my baby on schedule if I am breastfeeding him/her?

After a breastfeeding mother is vaccinated against COVID-19, antibodies pass through her breast milk to her baby. Various studies have found that the 87 – 95% of babies were given immunity through their mother’s breast milk against COVID-19. If it’s been more than six months since the mother received her COVID vaccine or booster, she should consider vaccinating her baby at this time.

How soon after the vaccine will my child build immunity?

Immunity will begin after the first shot! Immunity and protection have been demonstrated in Pfizer recipients within 12 – 14 days after the first dose, but this will be very short-lived. Immunity will be more permanent two weeks after the second dose.

Are the side effects of the vaccine different for children?

The main side effects are very similar to adults. There will most likely be injection site tenderness and some muscle aches. There can be redness and swelling along the injection site. Most people report fatigue and malaise that should be resolved within 48 hours.

A very concerning side effect that we saw in young men was myocarditis. However, only saw four cases in every 1 million vaccines in children 5 – 11 years old.

How do I know if my child is eligible for the vaccine?

Children over 6 months old are now eligible for the vaccine!

There are only a few very strict contraindications to receiving the COVID vaccine. The two absolute contraindications are having a severe allergic or anaphylactic reaction to a prior COVID vaccine or a known allergy to a component in the COVID vaccine.

If you have any questions about children with known clotting disorders, heart problems, or prior neurologic processes such as Guillain-Barre Syndrome, please talk to your primary care provider. The CDC recommends that these patients can receive a COVID vaccine with proper precautions.

RELATED: 

How to Help Young Children Cope with Vaccine Anxiety (checkupnewsroom.com)

7 Reasons Why This Doctor Mom’s Kids Will Be First in Line for the COVID Vaccine (checkupnewsroom.com)

With more adults across the country getting a COVID-19 vaccine, we can finally see the light at the end of the tunnel. It is vital to keep in mind that children 16 and younger cannot yet get vaccinated, and we all must do our part to protect them.

In an interview on Monday with Lauren Zakalik from WFAA, Justin Smith, M.D., a pediatrician at Cook Children’s Pediatrics Trophy Club, warns, “the risk outweighs the benefit of large gatherings for Easter because all children are not yet vaccinated.”

Dr. Smith says he understands parents are eager to let their children spend time with their fully-vaccinated grandparents and family members; however, it’s essential to take extreme caution this weekend and for the near future. 

“Anyone at a gathering who isn’t vaccinated could potentially bring the disease to the gathering,” Dr. Smith warns. “It is necessary to still follow the guidelines in place and not gather with several households until everyone can get vaccinated.”

Another critical point to remember is not only could spending time with other households potentially be a space to spread COVID-19, taking your children to large Easter egg hunts and other Easter festivities could also prove to be problematic.

“Social distancing can be challenging and it's likely there will be a lot of people unmasked,” Dr. Smith said.

As a physician and a father of three, Dr. Smith says large gatherings of any kind this Easter are not something he would be comfortable with his children or his patients doing.

“We are closer to the end of this than we’ve ever been, and I think we can make decisions for a short-term now that could potentially get us to the end,” Dr. Smith said. “I’m nervous about really trying to get back to normal right now when it feels like we’re so close, because I’m afraid it could set us back.”

While Texas has opened up vaccines to everyone 16 and older, it is not clear when younger children will begin to receive vaccinations. “Just like we’ve been doing for a year, we are advising adults to use caution and choose activities that are done in the safest way possible,” Dr. Smith explains.

Get to know Justin Smith, M.D.

Physician names in order of appearance: 

1. Dr. Diane Arnaout
2. Dr. Alice Phillips
3. Dr. Suzanne Whitworth
4. Dr. Laurie Gray
5. Dr. Bradley Mercer
6. Dr. Daphne Shaw
7. Dr. Kim Mangham
8. Dr. Eriel Hayes
9. Dr. Angela Hippeli
10. Dr. Diane Arnaout
11. Dr. Bianka Soria-Olmos
12. Dr. Samson Cantu
13. Dr. Ramon Kinloch
14. Dr. Kim Mangham
15. Dr. Alice Phillips
16. Dr. Suzanne Whitworth
17. Dr. Michelle Bailey
18. Dr. Laurie Gray
19. Dr. Ramon Kinloch
20. Dr. Angela Hippeli
21. Dr. Bianka Soria-Olmos
22. Dr. Daphne Shaw
23. Dr. Jason Terk
24. Dr. Bradley Mercer
25. Dr. Kim Mangham