As the COVID-19 pandemic enters its third year, people’s weariness is palpable. Yet, pediatricians keep showing up day after day for their patients, their colleagues and their communities. Six pediatricians reflect on what keeps them going, the lessons they’ve learned along the way and their hopes for the future.
Baptism by fire
There’s no doubt transitioning from fellow to faculty member is challenging. But making the move as an infectious diseases specialist in the midst of a pandemic was downright terrifying, said Alexandra Brugler Yonts, M.D., FAAP.
“All of a sudden, I was answering the COVID pager all the time and answering questions that really no one had answers to,” said Dr. Yonts, an attending physician in the Division of Infectious Diseases at Children’s National in Washington, D.C., and an assistant professor of pediatrics at George Washington University School of Medicine and Health Sciences.
Dr. Yonts completed her pediatric infectious diseases fellowship in June 2020 as part of the combined Children's National/Food and Drug Administration (FDA) program and worked in the FDA’s Center for Biologics Evaluation and Research. She then took a position as an attending physician at Children's National.
“I think everyone struggles with imposter syndrome and learning the ropes and dealing with being the ultimate decision maker and learning how to manage these things on your own. And add in the layer of having to read the news every single day to see what is new about COVID, what's the new discovery, what's the newest projection was really, really, really hard,” she said.
Yet, the pandemic also opened up career opportunities.
Dr. Yonts is director of the hospital’s post-COVID program for patients with ongoing symptoms and is co-investigator of a Pfizer-BioNTech vaccine trial.
Since the post-COVID program opened in May 2021, 34 children have been evaluated, and nearly 20 more have been scheduled through late March.
While she’s unsure how long the program will be needed, Dr. Yonts said it can serve as a model for treating pediatric patients with lingering symptoms after other infections.
“I think the multidisciplinary clinic model for nonspecific post-viral fatigue and things like that will be a huge area for growth in the future,” she said.
Among the lessons she’s learned over the past two years are the importance of talking to families about the risks and benefits of a treatment and the value of multidisciplinary collaboration.
“My experience at the FDA kind of made me the point person for concerns about vaccine-related myocarditis at our institution,” she said. “I still get questions constantly about that.”
That, in turn, led to collaboration with cardiologists and other divisions.
“In a perfect world and going forward, I will really try to push for more multidisciplinary evaluation or at least more frequent multidisciplinary conversations about patients because I think all the pediatric subspecialists and the generalists and the nurses and pharmacists bring very different but important perspectives,” she said.
Dr. Yonts also has learned how beneficial it can be to take time for herself, whether it’s eating dinner with her husband or watching TV for an hour after dinner. And she encourages others to do the same.
“I know it's hard because most of us in pediatrics and in medicine feel really guilty about letting someone else down,” she said. “But really doing it has made a huge difference in my quality of life. And it's helped me actually think more about my own well-being and push me to do other things like work on my anxiety, see my doctor, all these kind of good personal health things.”
Lifting each other up
Benson S. Hsu, M.D., M.B.A., FAAP, has seen the best and the worst of people come out over the past two years.
He has been disheartened by the way his public health colleagues have been treated and how they have been limited in what they could do to fight the pandemic.
Yet, he’s also seen his pediatric critical care colleagues rise to myriad challenges. Early in the pandemic, they cared for adult patients. They’ve navigated shortages of supplies and resources. And during the omicron surge, they have picked up extra shifts to cover for those who’ve gotten COVID.
“I've never been more proud of my critical care colleagues — nursing staff, ancillary staff, our chief, respiratory therapists, physicians — in the way that they've stood up, in the way that they responded to the call, in the way that they care for their communities, despite overwhelming odds,” said Dr. Hsu, a pediatric critical care physician at Sanford Children's Hospital in Sioux Falls, S.D.
Since Sanford is a smaller hospital, the staff has been able to develop close relationships.
“We watch out for each other. We lift each other up when others are down,” he said.
Dr. Hsu felt that support firsthand when he recently lost a patient to COVID-19. “I had every single partner reach out to me within 24 hours to make sure that everything was OK.”
Still, he wonders how long they can go on, especially the frontline staff. He also worries about how the pandemic will impact the workforce.
“When COVID hit the adult population more than pediatrics, a lot of my nurses went over to the adult world. So I'll be honest that they lifted way more than I have, and the burnout that I see on their faces is something that's very worrisome to me,” he said. “How do we keep their energy going? How do we keep them aligned to the mission in light of everything that they're facing? It's been hard.”
As for himself, he finds support from members of the AAP Section on Critical Care.
“I think the AAP and my role in the Section on Critical Care has been very beneficial — to know that others are going through the same thing, to learn from others, to lean on others, to talk it out with providers within my group and across the U.S. when bad things happen. And to know that I'm not alone,” said Dr. Hsu, who chairs the section’s executive committee.
Time with his family also helps him decompress. His wife is an adult infectious disease doctor, but they try not to talk about work when they’re together.
“I think everybody has to find their own outlet. And for me, it's family and the community,” he said.
As he looks ahead, Dr. Hsu said he hopes the pandemic will put a focus on the importance of public health and how to devote resources to keep people healthy.
“The goal isn't to just fix patients after they get sick,” he said, “but to prevent them from getting sick, and I'm saying that as an ICU doc. I would like to see less patients.”
Glimmers of hope
Looking back, Dale W. Guthrie, M.D., FAAP, recalls times of gloom, especially early in the pandemic. But lately, he’s seeing more signs of hope.
Dr. Guthrie said the start of the pandemic was the most difficult period for the staff at Gilbert Pediatrics in Arizona as they focused on avoiding infection, acquiring personal protective equipment and applying for the government loan to keep everyone on board as they watched business drop 40%.
Another taxing time came when the pediatricians and nurses realized they had to start seeing more patients in person again for screenings and other preventive care. The office utilized telehealth, but it wasn’t the same.
“You can’t put a stethoscope on a kid’s chest over the internet,” said Dr. Guthrie, who co-founded the practice 33 years ago with Randy H. Leavitt, M.D., FAAP. “It was a really hard thing emotionally, psychologically, to not be able to do what a pediatrician is supposed to do to take care of patients.”
The practice initially decided to see well patients in the mornings and sick patients in the afternoons. Some of the pediatricians were hesitant to open up again, “but now we’re pretty comfortable. We’ve got the vaccine and … the whole office is immunized, so we feel better…” Dr. Guthrie said, noting that an electronic medical record callback system has been beneficial.
One recent encounter provided a reason for encouragement. A mother showed up in the office with her six kids, though only two of them had appointments.
“She brings them in and says, ‘Now today you’re seeing these two, but I want all of these kids to get a flu vaccine,’” Dr. Guthrie recalled.
Because he knew the family generally rejected flu vaccines, he agreed to the request.
Dr. Guthrie sees other signs that things are looking up. While not back to pre-pandemic income, the practice’s bottom line is improving. And more kids are getting their routine immunizations and well checks.
“We don’t have to be as scared now because we have (COVID) vaccines that seem to be holding strong,” Dr. Guthrie said. “And for me that’s the hopeful part.”
Filling a need for reliable information
As the world was just learning about COVID-19 in January 2020, Arthur Lavin, M.D., FAAP, was visiting his son in Hong Kong.
“By the end of January, it was all over China and we felt it coming down into southern China and threatening Hong Kong,” Dr. Lavin said. “We flew to come back to the United States, only to find out we would have been much better off if we stayed in Hong Kong.”
Dr. Lavin praised areas of Southeast Asia, including Hong Kong, Taiwan and South Korea, for early “identify and isolate” strategies meant to limit the spread of the virus in the region.
Back home, however, Dr. Lavin feels more could have been done to help U.S. residents and families deal with the virus. As a general pediatrician at Akron Children’s Hospital in Ohio, he has seen the impacts of COVID-19.
“I saw families really suffering, striving to find some way to keep themselves and their children from dying from this potentially fatal disease,” Dr. Lavin said. “You get a lot of people who may turn to me and to other pediatricians and say, ‘What do I do?’ I knew there was a better path.”
A month after returning home, Dr. Lavin started a blog that he updated almost daily with information about COVID-19. At its peak, the blog had more than 100,000 visitors, he said.
“Families were desperate for guidance, and I felt one of the most important things I could do was create a reliable source of information,” Dr. Lavin said. “There was so much misinformation coming out, and this, sadly, became such a politicized topic.”
In addition to providing as much information as he could, Dr. Lavin’s practice stayed open throughout the pandemic.
“Like all providers, we saw heartbreaking stories of parents dying, grandparents dying and we probably diagnosed over 300 children with COVID during the pandemic, some as young as 3 weeks of age,” Dr. Lavin said. “Fortunately, most of them are quite well.”
In addition to COVID-19’s physical toll, he has seen the mental anguish the virus has caused.
Dr. Lavin said many patients who previously were diagnosed with anxiety, depressive disorders, attention-deficit/hyperactivity disorder or autism spectrum disorder have fared worse during the pandemic, particularly with COVID-related shutdowns.
“It’s just been a terrible exacerbation of already existing conditions,” said Dr. Lavin, chair of the AAP Committee on Psychosocial Aspects of Child and Family Health.
As the pandemic enters its third year, parents continue to seek his advice. Dr. Lavin said he and his peers are more than willing to answer families’ questions.
“If a doctor is not interested in helping people during the greatest medical crisis of our lifetime, then you’re in the wrong profession,” he said.
“I have been asked the same questions many, many times,” he continued. “Even though it’s the same questions, each family is different. Each person is different. Each need is a little different. I get to be in a position to be helping somebody through a real crisis. That’s not just satisfying, it’s deeply meaningful. I feel very honored that I’m put in a position of trust by families.”
Caring about the community
Teamwork, flexibility and AAP connections are helping the staff at The Pediatric Center in Columbia, Md., meet the challenges posed by the pandemic. But days like Dec. 27, 2021, tested their mettle.
The practice, operating with a reduced staff due to the holidays, received 100 calls an hour. When they couldn’t keep up, a front desk person took messages and handed them to a nurse or pediatrician to handle.
It was insane, recalled Monique Soileau-Burke, M.D., FAAP, who responded to 50 triage calls that day.
They managed to see 150 patients and administered 104 COVID polymerase chain reaction tests.
Dr. Soileau-Burke, a partner in the privately owned practice, said the staff has learned to pivot to provide the best possible care for patients. The office even has vaccinated and tested parents when these services were scarce in the state.
Everyone has risen to the challenge, combining their individual strengths.
“I think it’s all taught us an incredible amount of flexibility. …And I hope that will be something we continue to take with us after the pandemic is gone.”
Her roles as vice president of the AAP Maryland Chapter and a member of the state health department’s pediatric workgroup have been helpful for the practice, which includes five pediatric partners, three more pediatricians and four nurse practitioners.
Up to 75 chapter members meet almost every month to share information on topics like testing, telemedicine and vaccination of children.
Expanding use of social media has been beneficial, as well. The office created a video to communicate new procedures and protocols while encouraging everyone to return in person.
When personal protective equipment was difficult to acquire, the practice put out a call asking families of patients and staff members — wherever they were in the country — if they could help procure supplies. Parents working as painters and contractors brought in N95 masks.
“It was one of the reasons we were able to stay open,” Dr. Soileau-Burke said.
She is uplifted by the generosity of the public, including young patients.
“One of the most beautiful things that I see in my patients is them learning to care about their community,” Dr. Soileau-Burke said. “We talk so much about vaccinating and wearing your mask — all the hard things that have come out of this and the mental health crisis we’re seeing in our kids. I think they’re learning about community and … the greater good. Sometimes it’s difficult … but doing the right thing for other people is the right way to go.”
Two years into the pandemic, Arwa K. Nasir, M.B.B.S., M.Sc., M.P.H., FAAP, is preparing for yet another challenge, this one affecting her youngest patients.
Due to concerns about exposure to the SARS-CoV-2 virus, some parents skipped well-child appointments — visits Dr. Nasir said are critical to screen young children for developmental issues.
“What I noticed in the past couple years is we are seeing some children who were between 1 to 3 years old where the medical care had been interrupted by the COVID pandemic,” said Dr. Nasir, professor in the Division of General Pediatrics at University of Nebraska Medical Center. “… Because of that, some kids who had emerging developmental delays which we usually catch during that period got missed because they hadn’t seen a doctor for that year.”
As a result, children who were diagnosed with delays later must now play catch-up.
“Although we are not delivering COVID-19 vaccines, we are delivering this very, very critical screening for developmental delay,” said Dr. Nasir, a member of the AAP Section on Developmental and Behavioral Pediatrics. “The interventions are much more effective when those kids are still small, so a delay in those diagnoses is usually not very good.”
Dr. Nasir said the first three years of life are “a window of opportunity” when interventions for speech, fine motor, gross motor or physical issues can lead to better outcomes for children.
“If you get those basic skills early on, kids can move on, but if you don’t get the basic skills, it’s really difficult to teach them later on,” Dr. Nasir said. “When you’re so behind, all those subsequent skills don’t get built. Really, it compounds the situation.”
Dr. Nasir said she and her team remain committed to ensuring patients and families can access the resources they need.
“We feel what we do makes a difference in people’s lives and families’ lives,” she said. “We just do one patient at a time, but if I can pick up just one of those kids and make sure they get the services they want and support that family, that is a huge achievement. The belief in the importance of this work is what keeps us coming back.”