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Pediatricians reflect on how pandemic played out over past year

February 17, 2021

Pediatricians across the country shared stories with the AAP early in the pandemic of how they were innovating, adapting and digging deep to care for their patients, communities and colleagues. AAP News caught up with some of them to find out how their stories unfolded.

The need was great and time was short

Dr. Thuet/Courtesy of Nina Mayer Ritchie

 

 

 

 

 

 

 

 

 

 

 

 

As the Navajo Nation was reeling from coronavirus and supply chains for personal protective equipment (PPE) were disrupted, Christina Thuet, M.D., FAAP, mobilized friends, friends of friends and their connections to collect donated and handmade supplies.

“I had served the Navajo and Hopi tribes in Tuba City, Ariz., for the past four years and wanted to continue supporting my colleagues and the community I had grown to love during this time of crisis,” Dr. Thuet said in an AAP Voices blog post last May.

At first, Dr. Thuet boxed and shipped donated supplies to health care facilities serving the Navajo Nation. A few weeks later, Angel Flight West, a nonprofit air transport service that provides free, nonemergency travel for children and adults with serious medical conditions, volunteered to deliver the supplies.

“We became an emergency short-term bridge for PPE supplies when we partnered with Angel Flight West,” Dr. Thuet said. From this partnership, With Love, From Strangers (WLFS) was born.

WLFS (https://www.withlovefromstrangers.org/) also collected and distributed water and basic relief supplies across the region. It partnered with Northern Arizona Volunteer Medical Corp. to acquire, produce and deliver gowns for Navajo, Hopi, Zuni and Fort Apache reservation health care partners.

“This has been such a rewarding experience. I’m so proud to see our ‘strangers’ coming together to help others during their time of need, people who they will likely never meet,” she wrote in her blog.

To date, 180 supply flights have been logged, serving 11 health care facilities and supporting eight tribal community service units. “The partnership grew into something so much larger than I ever expected, supplying well over $300,000 in supplies — all donated,” Dr. Thuet said.

Nearly a year later, a supply network has been established, and emergency calls for deliveries have nearly stopped. Dr. Thuet said she is ready to “reintroduce” herself into the workforce. On April 1, she’ll begin working at Granger Medical Clinic in Salt Lake City. “I’m very much looking forward to using that part of my brain again.”

Looking back, Dr. Thuet said “nothing can be as crazy as those times. I was getting deliveries (of PPE) sometimes at midnight, then taking them to the airport at 5 or 6 a.m. to get them delivered to a hospital by 8 a.m. for use that day.”

Yet, she is glad she was in the right place at the right time. Dr. Thuet was on sabbatical when the pandemic hit and had canceled travel plans. “I never thought of this as something I would be doing or that I would know where to get face shields or gloves in a pandemic. I got a phone call one day last year asking if I could get body bags. How did I become the person who could find body bags?”

WLFS’ mission will continue on with time-limited projects, Dr. Thuet said. “It was created with a broad stroke so that we can shift our focus to the local homeless population or children in low-income, low-resource communities and provide assistance to them.

“Because of the poverty and geographic isolation prior to COVID-19, the Navajo Nation and other Native American communities can very easily be impacted by something like this. And I think these communities’ needs will exist long after the pandemic ends.”

‘Defining moment’ of career

Dr. O'Connor

Katherine M. O’Connor, M.D., FAAP, found herself in an inconceivable situation last March — caring for adults with COVID-19 as the pandemic bore down on New York City.

“It’s nothing I could have ever imagined in my career as a pediatrician,” Dr. O’Connor said shortly after an adult unit opened at The Children’s Hospital at Montefiore in the Bronx, N.Y., where she works. “It might sound overdramatic at times, but it’s definitely the closest thing that I’ve felt to being in a battle or on the front line of something.”

Dr. O’Connor made it to the other side but not without some battle scars. 

Because personal protective equipment (PPE) was in short supply early in the pandemic, she and other hospital staff tried to minimize the number of times they entered the adult patients’ rooms. Family members weren’t allowed to visit, so difficult conversations were done over the phone. 

“And that part was the haunting part that stayed with us for the months that followed,” said Dr. O’Connor, attending physician and associate division director for pediatric hospital medicine.

Eventually, the doctors decided it was too hard to be so disconnected from their patients, so they would bring them ice water, a cup of tea or some Vaseline for their lips. “These small little things because they were so alone at that time,” she recalled. 

Dr. O’Connor lost several patients with whom she had become close, a rare occurrence for a pediatrician, and said she thinks about them every few days.

When the adult unit closed last May, there was a lull at the hospital and Dr. O’Connor floundered. 

“There were days I would just kind of lay in my bed and not know what I should get up and do, which is not like me at all,” she said. “And so part of it was just giving myself time to process and time to grieve and time to heal. And that's not something that I am used to.”

With support from the hospital and her colleagues, Dr. O’Connor got back on her feet. And in January, she once again was caring for adults as New York faced another surge of COVID patients.  

This time around, the hospital is better prepared and more treatments and PPE are available. Patients aren’t as sick as they were last spring, and the no-visitor policy has been relaxed. 

As she reflected on what she went through last year, she said it was “a defining moment” of her career and an experience that gives her a great sense of pride. 

“It took a different kind of strength and endurance to go through at that time,” Dr. O’Connor said. “But what was very incredible in our hospital is the way everybody came together … the nurses and the doctors and all of the other support staff who are in the hospital. We really came together as a team in a way that my 17 years at the hospital before, I had never felt as deeply. And the beautiful thing is that it has stayed.”

Bearing witness to ‘true devastation’

Dr. Mukerjee/Courtesy of Tulane University School of Medicine

Kimberly A. Mukerjee, M.D., M.P.H., FAAP, is waiting for the day when she can come up for air. 

In the early months of the pandemic, it was too quiet. Most of her patients in New Orleans are undocumented immigrants and were difficult to reach. “Do they know we’re still here, that they can access care?” Dr. Mukerjee asked last March.

Gradually, her patients came back for well-child and sick visits. And when they did, she found the pandemic had magnified their complex needs. 

“It has been true devastation for the patient population I take care of, and bearing witness to that has been just heartbreaking and traumatizing and infuriating all at the same time,” said Dr. Mukerjee, assistant professor of clinical pediatrics and director of Immigrant and Refugee Health, Section of Community Pediatrics and Immigrant Health at Tulane University School of Medicine.

Many of her patients’ families are still unemployed and don’t qualify for government assistance. As a result, they can’t afford to buy food, medicine or even a bar of soap to wash their hands. 

“I have never seen so many hungry children as I've seen over the past 10 months, kids coming to clinic and telling me that they're hungry,” Dr. Mukerjee said.

So she and her team focus on meeting those basic needs — one day at a time, one family at a time.

“Our well visits turned into also handing out food during the visit, handing out clothing that we had from donations, helping families figure out ways to purchase medications,”   she said. 

The community has rallied around them with unsolicited donations, including stimulus checks, that allowed the clinic to put together relief packages for hundreds of families. The packages include food, hygiene items, masks, diapers, hats, gloves, school supplies and gift cards. 

The small wins like giving a family food for the day are what keep Dr. Mukerjee going. 

“I was seeing just this devastation from so many different layers … that if I didn't focus on the small things, the small positives that we were able to do, it was very easy to get lost in that really dark layer upon layer of trauma,” she said.

Dr. Mukerjee acknowledges that she is not the model of self-care. She hasn’t seen her family in over a year and is exhausted. But she sees some light at the end of the tunnel thanks to the vaccines and potential changes in the political landscape. 

Prior to the pandemic, she advocated for her patients on the state and national levels and said that type of advocacy will be vital in the coming year. 

“I think one of the biggest takeaways is we cannot go back to business as usual,” Dr. Mukerjee said. “We cannot go back to a health care system that allows the most marginalized to slip through, especially when we're talking about children.”

‘Marathon doc’ is in it for the long haul

Dr. WeitzmanIn the early weeks of the pandemic last March, developmental-behavioral pediatrician Carol Cohen Weitzman, M.D., FAAP, worried about whether she was doing enough to help her patients with neurodevelopmental disorders.

“I struggle with trying to figure out how to reach all of the families and what messaging they want from me and how to be there for them in ways that are helpful and meaningful,” she said.

A year later, she has come to the realization that she and her colleagues are making a difference. 

“I think the role that we play in my field, in developmental peds, has been really crucial for families this year,” she said. “I think it's been really crucial in helping families helping their kids maintain skills, getting them the supports and services they need, addressing challenging behaviors, thinking about functioning, maintaining functioning, all of those things.”

Dr. Weitzman has seen a number of concerning trends among her patients, including more anxiety and aggressive behaviors. Their ability to adapt to changes in their school situation has been a mixed bag. The hybrid model where students split their time between online and in-person learning has been a godsend for some kids with attention-deficit/hyperactivity disorder, thanks to smaller class sizes, fewer distractions and more hands-on opportunities. 

“And then, a lot of kids have not done so well,” Dr. Weitzman said. “I've had a lot of kids who just can't learn with distance learning.”

In response to those challenges, Dr. Weitzman is prescribing medications more liberally, telling parents, “It's not forever. These are really weird, unusual times we're living through. We’ve got to make sure we manage symptoms.” 

She also has helped some patients with individualized education prrograms return to in-person learning five days a week to stem the loss of skills. And she coaches parents, who are weighed down by stress.

Dr. Weitzman, who started a new job as co-director of the Autism Spectrum Center at Boston Children's Hospital, continues to rely heavily on telehealth for both diagnostic evaluations and follow-up visits. “I've done a ton of autism evaluations using telehealth, and I feel like it's an incredibly good modality.” 

Families also have embraced telehealth, especially those who live far from her. “I don't think anyone's ever going to want to come back to the office,” she joked.

Looking ahead, Dr. Weitzman knows her patients will have a hard time adapting when restrictions ease and routines are reinstated. 

“The road to recovery is not going to be like, oh, now we're done. Boom. Let's go back to normal,” she said. “There's going to be a process for kids to come back and I think a lot of lasting sequelae.” 

Dr. Weitzman remains committed to seeing her patients through. 

“What I do is I go on that journey with families,” she said. “… We're going down that road together. We're trying to help to make sure that child gets to the very best place they can get.

“I'm not a sprinter. I've always been a marathon doc,” she continued. “We're in it for the long haul.”

A year of transitions and heartbreak

Dr. MillerThe transition from fellow to attending physician is significant. But when it involves moving to another state during a pandemic with three kids in tow, it becomes even more daunting. Add to that witnessing the toll COVID-19 is taking on your tiny patients and their families, and that sums up the experience of Emily Miller, M.D., M.S., FAAP.

After Dr. Miller finished her fellowship in Louisville, Ky., last summer, she and her family moved to Ohio, where she started a new job as a neonatologist at Cincinnati Children’s Hospital. 

“I think there's not a single component that's been untouched. Everything from buying and selling a house without really being able to feel like you can safely go into homes or let people come into your home to trying to figure out what part of the city you want to live in,” she said. “Joining a new job, a lot of it is the relationships that you have with your colleagues and your workplace environment… that is just nonexistent.”

Prior to her move, Dr. Miller described in an AAP Voices blog how the coronavirus had “infected the best parts of (her) job.”

“Some mothers aren’t aware that their newborn was delivered; some aren’t even conscious… some families will be separated for an extended time due to quarantine restrictions,” she wrote. “All the people who once shared in the excitement of a new baby — aunts and uncles, grandparents, friends and cousins — are not here. Now, there’s no one.”

COVID-19 has continued to upend families’ first few months with their premature babies, Dr. Miller said.

“We've had families who haven't met their babies for weeks and just look at them on a camera, which is the way we try to bridge the gap for them,” she said. “But there's no bonding. If their baby is very sick, you can imagine how stressful that is for families.”

Dr. Miller has witnessed many other heartbreaking situations during the pandemic.

“We had a mom come in with respiratory failure. She was 32 weeks pregnant and so sick that her baby had to be delivered prematurely,” she said. “That would not have happened otherwise, and unfortunately, the mom did not survive because she was so sick from COVID. This is a family that is completely torn apart by COVID.”

Despite the challenges she’s faced over the past year, Dr. Miller remains grateful and optimistic.

“All of our lives have been affected in some way,” she said. “I always felt lucky and privileged to be in the line of work I'm in, to be meeting families where they are and supporting them in what is usually a very difficult and emotional time in their lives.”

‘We pushed through together’

Dr. MakovskyA year ago, Stapleton Pediatrics in Denver — now called Colorado Kids Pediatrics — designated one of its offices for sick patients, with a walled-off “practice-within-a-practice” for those suspected of having COVID-19. That arrangement left its second location for well care.

But after about two months, the system became impractical because of the distance between the sites. So Noah J. Makovsky, M.D., FAAP, and staff did another rehab: They transformed part of the larger office into an appointment-only urgent care. They put up walls, added fresh paint and hung pictures. HEPA air purifiers were placed in every exam room. A separate entrance and a streamlined traffic flow allows families to wait in their cars.

A year ago, the practice’s challenges also included an inadequate supply of personal protective equipment (PPE), uncertainty about payment for telehealth and concern about the decline in practice volume due to COVID-19. 

“The foundation of primary care in this country could be threatened by this crisis if we can’t make it to the other side,” Dr. Makovsky said last March. 

Most concerns have been alleviated, and practice volume is close to what it was before the pandemic. The practice obtained PPE from Colorado Children’s Hospital, thanks to a clinically integrated network partnership. Telehealth continues to work well, especially for mental health consults. 

The biggest stressor has been figuring out how to bring patients back for routine visits. 

To convince families to resume appointments, the pediatricians and staff sent out video announcements and posted them on social media. The two- to three-minute messages provided COVID updates and showed what the practice was doing to make it a safe environment. 

“The feedback we received from them (families) was really tremendous,” Dr. Makovsky said. “I think it was different than just receiving email or seeing something posted on a website.”

The most unexpected change was having to revamp flu clinics from walk-in clinics to an online scheduling system.

If COVID was not enough of a challenge in 2020, the practice also began a lengthy process to change its name, following an official name change by the neighborhood where the practice is located. 

Stapleton was named for a Denver mayor (1923-1947) who had ties to the Ku Klux Klan. When the Stapleton neighborhood dropped its name in favor of Central Park, the practice followed suit. 

Now, its two locations — Central Park and Pearl Street — are under the umbrella of Colorado Kids Pediatrics. 

Staff cooperation has helped everything work as smoothly as possible, Dr. Makovsky said. A year ago, the office reduced all salaries, a move employees agreed was preferable to losing staff. Two months into the pandemic, as things were looking up, the pay cuts ended. By Thanksgiving, the practice was able to pay back all of the salary that was deferred.

“It was a great feeling,” said Dr. Makovsky, “and it was wonderful for our staff and our pediatric office family to feel like we pushed through together.” 

Bringing care to homeless youths

Dr. Kirkilas

As part of the Homeless Youth Outreach team at Phoenix Children’s Hospital, Gary E. Kirkilas II, D.O., FAAP, used a retrofitted RV to bring health care services and medications to vulnerable children and adolescents. Until the pandemic hit. 

“… each has two exam rooms, a lab and a pharmacy. We could do everything there, including dispensing necessary medication,” Dr. Kirkilas wrote in an AAP Voices blog last May. “But those mobile clinics have been grounded during the pandemic.”

That didn’t stop Dr. Kirkilas and the team from continuing to provide comprehensive care to homeless youths over the past year. 

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