Pediatricians in Vermont stretched thin; Delta cases in children are making it worse

Alexzander James Guiett, 13, received his first dose of the Covid-19 vaccine at Spaulding High School in Barre on May 19, 2021. Alexzander said he hoped things would be “relatively back to normal” by the time of his second dose. , if enough people get the chance. Photo by Mike Dougherty/VTDigger

Laura Derendinger cared for measles and cholera patients in war-torn countries, but the scenario that scares her the most is much closer to home.

She has experienced the nightmare several times over the past few years. Her 5-year-old Pascal gets hypoxic (related to insufficient oxygen) every time he catches a cold.

“There’s nothing like being a mom more terrifying than what you go through when you’re in an emergency room and the doctor says, ‘We need to put you on a helicopter to send you to a bigger hospital so we can intubate your child.” said Derendinger, who lives in Middletown.

Derendinger is determined to protect her child — and his three siblings — from Delta, a highly contagious strain of Covid-19 that infects more children than previous versions of the virus.

Health department data shows a dramatic increase in coronavirus infections among children. The infection rate of children aged 9 and under has risen from 8 cases per 10,000 children to 331 since last year, a 41-fold increase. Coronavirus cases for children and adolescents aged 10-19 – many of whom have been vaccinated – have also risen from 14.3 per 10,000 children to 527, a 36-fold increase.

Derendinger has taken drastic measures to protect her children. The family has tried to isolate as much as possible. The children spend most of their time outside. Derendinger and her family, who lived in France at the start of the pandemic, even moved to Vermont specifically so the children could attend a school that offers year-round outdoor education.

Doctors who care for Vermont’s children say they see some of the implications of that parental caution. The state does not yet have a pediatric ICU case from Delta, Health Commissioner Mark Levine said last week. However, outpatient clinics are overrun with children with respiratory infections.

“We are probably at 150% of capacity and we weren’t necessarily well prepared [for that]but we’re making sure it works,” said Elizabeth Hunt, a pediatrician at Timber Lane of the University of Vermont Health Network, a clinic with about 1,000 patients and three locations in Chittenden County.

Testing for the coronavirus in that age group has also increased dramatically. According to state data, about 450 children under 17 were diagnosed with Covid-19 in August, but 4,400 children and adolescents were tested in the week of August 16 alone.

That increase coincides with the usual increase in pediatric visits each summer. Children out of school are more at risk for injuries – from sunburns to falls to car accidents and bicycle injuries. Families are also trying to go back to school and get physical sports during this time, contributing to the increased demand.

However, this year also children with viral respiratory infections — including croup, RSV and rhinovirus — are appearing in clinics in greater numbers than usual, not just because parents are concerned about Delta infections, but because more children than usual are getting respiratory disease this summer, it said. hunt.

Hunting practices in an area of ​​the state with the most primary care providers, according to a 2018 state physician census. The rise in respiratory disease in children outside of populous Burlington, where doctors are not as numerous, some pediatricians are already out of capacity.

‘All hands on deck’

Meredith Pickard – a registered nurse at Northern Express Care, an emergency care clinic serving the cluster of rural counties in the northeast of the country – has also seen an increase in pediatric patients with respiratory symptoms. Data from the Federal Health Resources and Services Agency shows that the clinic is one of the few options for primary care there.

Clinics were already stretched there before the pandemic. The vast majority of GPs do not accept new patients, according to the 2018 physician census.

Express Care is one of the few places outside of a hospital emergency department where patients can be seen quickly. With more children coming to emergency care clinics for respiratory conditions, patients there may have to wait longer to be seen. On an average day, that could mean an extra 10 minutes to half an hour of waiting, although some may have to wait longer, Pickard said.

Responding to the growing need requires an “all hands on deck” approach at a time when medical staff are already battling pandemic-related burnout, she said.

“It could mean bringing in different providers and recruiting front desk staff to help with clinical [staff],” she said. “It’s working on vaping now.”

A backlog of needs

Tracy Tyson’s practice at Northwestern Pediatrics is already past the stage of vaping that Pickard of Northern Express described.

Tyson’s rural clinic, which serves 6,000 patients at six locations in St. Albans City and surrounding areas, has a chronic staff shortage.

In addition to the rise in respiratory illness and conversations about coronavirus vaccines with reluctant parents, the clinic’s six pediatricians are trying to make up for missed wellness visits for patients who were unable or unwilling to attend earlier in the pandemic.

Many patients also need more support with depression, anxiety and suicidal thoughts.

Even with extended hours, double bookings and triage appointments, employees don’t seem to be catching up.

“It’s emotionally, physically and compassionately exhausting,” she said. “I do notice that I want to say ‘yes, I will do more’ and I find that I just can’t. I hit a wall and I can’t take it anymore.”

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