Post-pandemic pediatrics

In the April 2020 issue of Contemporary Pediatrics, I wrote a short message “Your Voice” entitled “COVID-19: Thoughts while circling the wagons.” At that point my practice was closed, like most medical practices in the country, and I was only doing virtual visits from home. We placed 1 brave, young and healthy colleague in the office, along with a nurse and a secretary to evaluate and treat patients who needed to be seen in the office. Our practice was cautious, following advice from the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP), and saw children (without COVID-19 symptoms) with injuries, rashes, or worsening chronic problems. We only saw good young babies who needed vaccines and handed out baby scales so that babies with feeding difficulties could be tracked through virtual visits. We continued to do this for 2 months until we all returned to the office. During the lockdown, many pediatricians took advantage of the help provided through the CARES Act to keep their offices afloat, and quickly learned new skills to provide virtual home visits. We’ve all implemented new workflows to use parking spaces as waiting rooms, reuse personal protective equipment (PPE) that were suddenly in short supply – and tried to avoid staff leave when revenues suddenly dropped.

Now, more than a year later, we see that millions of adults in the United States have been vaccinated, and children 12 and older are also being vaccinated. At the time of writing, the CDC recommended that if you are fully vaccinated:

“You can resume activities without wearing a mask or staying 6 feet apart, except where required by federal, state, local, tribal, or territorial laws, rules and regulations, including local business and workplace guidance”

It looks like we’re nearing the end of a movie where science has overcome an evil plague, the clouds part and the sun shines through.

It has been a year and a half since we will remember for a long time. We’ve learned so much about COVID-19, public health, and how resilient families, teachers, and caregivers can be.

Here are some of the things we learned along the way:

We were very lucky that researchers started developing vaccines based on messenger RNA and Adenovirus vector technologies after outbreaks of SARS in 2003 and MERS in 2012. These were quickly adapted to target SARS-CoV-2. A COVID-19 vaccine was developed and released for emergency use in less than a year! Indeed, the FDA can and has changed their arduous drug and vaccine approval process when faced with a crisis. They should certainly be able to change their pre-pandemic rules and regulations to safely expedite new medical diagnostics and therapies. In the early days of the pandemic, many pediatricians learned how to do virtual visits, but now we are back in our office. , fewer pediatricians do this. Virtual visits are a huge convenience for patients and will help restore confidence in the medical home. They should be a regular part of pediatric practice. We need to make sure that insurance will continue to pay for office visits proportionately. Many children were unable to learn effectively through distance learning, and many will need significant help to make up for a ‘lost’ year. Our mental health system – which was inadequate in the pre-pandemic – was almost non-existent during the pandemic and many pediatric caregivers took up the challenge of treating children with depression and anxiety. We need to find new ways to provide mental health care to children and their families. One way is to expand the workforce by motivating interested individuals to become healthcare providers by paying for their education and training. Even now, children’s practices are now seeing fewer patients than pre-pandemic. The result: revenues are down (by at least 25% according to my estimate). The reason, with social aloofness and the use of PPE, less children get the routine illnesses like flu, streptococci, respiratory syncytial virus (RSV) etc., which we often see in the office. Once more Americans are vaccinated and children return to school, we will likely return to “pediatric practice as usual,” but it may take some time for this to happen.

Most importantly, the COVID-19 has exposed glaring flaws in our healthcare system. It no longer makes sense for insurance companies to dictate policies for our patients through their control over the health care wallets. There must be a more efficient way to approve drugs, diagnostic tests and other services for our patients. The FDA must accelerate the introduction of vaccines, medical devices and drugs. The CDC must be apolitical in making its recommendations. These must be evidence-based and crystal clear.

The way forward may be a bit precarious, but as COVID-19 variants emerge we will have to routinely vaccinate children and families, probably on an annual basis, and we will likely be able to prescribe new antivirals that will effectively treat SARS. CoV-2. Hopefully, pediatricians, public health officials and politicians have learned lessons from the 2020/2021 COVID-19 pandemic. Time will tell.

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