COVID-19 was the overarching theme of the AAP Board of Directors first-ever virtual meeting on May 15. The board heard heartrending accounts from members on the significant impacts the pandemic has had on their lives, their patients and their practices. It also voted to move forward with the Child Health Improvement through Longitudinal Data (CHILD) registry, which is expected to help guide the care of children in future outbreaks.
“American life has changed forever,” said AAP President Sara “Sally” H. Goza, M.D., FAAP. “Board meetings are always important, but today’s is especially so, as we discuss our response to the coronavirus pandemic and our continued work on equity, supporting pediatricians, and protecting children from disease, violence and losing their access to care.”
Update from the front lines
Kimberly A. Mukerjee, M.D., M.P.H., FAAP, was one of three pediatricians who shared the challenges they are facing during the pandemic.
“The words exhausting, heartbreaking, infuriating, draining have all been things that come to mind,” said Dr. Mukerjee, medical director at the New Orleans Children’s Health Project.
Before the pandemic, high rates of child poverty and food insecurity plagued New Orleans, she said. Conditions have gotten worse for immigrant families. New Orleans became a hot spot for COVID-19 disease shortly after Mardi Gras. When schools shut down, her patients fell off the radar.
“We cannot wait anymore for these families to come to us,” she said. “I’m fearful that children are going to die in their homes.”
She could not reach families with telehealth despite many efforts. Many share one device, do not have an email address or struggle with Wi-Fi connectivity. Most of the immigrant families in New Orleans do not qualify for Medicaid or nutrition assistance.
Dr. Mukerjee said guidance from the AAP has helped her advocate for their needs, including health care, food and household supplies like soap and masks.
In rural Colorado, Jennifer Sanderford, M.D., FAAP, fears the sudden decrease in patient visits at her solo practice could trigger an infectious disease outbreak. Immunization coverage for the population hovers around 75%, and the area had a varicella outbreak two years ago when an unimmunized child from Belgium visited the nearby ski resort.
Already operating on a thin margin, Dr. Sanderford saw her patient volume drop to 25% after families heard a social media story from a doctor who brought the first COVID-19 case to the town.
“We saw no patients really for almost five weeks,” she said. “The way that affects our revenue stream means that by June we would have no way to pay our rent.” She had to take out a Paycheck Protection Program loan.
Dr. Sanderford also has taken to social media to let parents know it’s safe to visit their pediatrician.
“We’ve very much appreciated the AAP’s statement to get young kids in. We’ve used that on social media,” she said. “In the last couple weeks, we’ve managed to get a fair number of people coming in for their well visits.”
A 51-year-old urgent care pediatrician with mild asthma, Meera Siddharth, M.D., FAAP, tested positive for COVID-19 on March 30. She was asymptomatic for the first 2.5 weeks, then it hit her. Dr. Siddharth was quarantined at home for a month.
“A few days into my illness, I found out that a college friend of mine had died, and he was completely healthy. He was a marathon runner,” she said. “It really scared me because there’s no reason why someone like him who is so healthy could not survive this and I … should survive. It hits people differently.”
CHILD registry
The board voted to move forward with the CHILD registry and the vendor recommended by the AAP incubator group, a team of experts who have been advising on the project. ArborMetrix Inc., of Ann Arbor, Mich., was selected from the six vendors that submitted proposals. The AAP’s next steps are to select staff and lay the groundwork for the work ahead.
The registry could help pediatricians by providing data on poorly understood conditions and long-term impacts on children, relationships between conditions and co-morbidities, and payment.
“COVID just shows how timely this is,” said Christoph U. Lehmann, M.D., FAAP, a member of the incubator group. “Not only do we want to understand what’s happening to kids with endothelial leakage and Kawasaki-like syndrome, but we also want to understand what (the pandemic) does to the business of health care.”
AAP CEO/Executive Vice President Mark Del Monte, J.D., said the AAP has thoroughly evaluated potential economic risks, particularly in the face of an economic downturn.
“It’s a bold and innovative idea,” Del Monte said. “The timing is right, and the CHILD registry is part of our mission. The pediatricians on the incubator group have done exhaustive due diligence. The board is grateful to Judy Dolins who has led this project to a unanimous vote of the board.” Ms. Dolins, M.P.H., is AAP chief implementation officer, senior vice president, Community and Chapter Affairs and Quality Improvement.
Budget approved
The board approved a balanced budget of $131,239,000 for fiscal year 2020-’21. In submitting the zero-margin proposed budget, Del Monte noted that it was developed to be flexible and will be revisited quarterly, given the impact of COVID-19 on the economy.
