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The Battle Of 2020 Continues-- COVID Versus Flu with Ann Mattison, APRN
Ann Mattison, APRN explains the difference between COVID-19 and the flu, and why the flu vaccine is important this year.
Featured Speaker:
Ann Mattison, APRN, MSN, CPNP
I have been a CPNP since 2003. I graduated from the University of Iowa. I have worked in a variety settings including as a hospitalist, in the Sleep Clinic, and in primary care(both at CMH and in private practice). I have worked at the Primary Care Clinic (PCC) at CMH since 2015. I am a primary care provider for > 1000 patients. As part of my role, I also work at the Truman Well Baby Nursery taking care of newborns. I have been involved in the LEAN leadership team since 2017. Immunizations are a passion of mine. I am on the hospital wide immunization committee. I chair the Childhood Vaccine Group for the MidAmerican Immunization Coalition. Transcription:
The Battle Of 2020 Continues-- COVID Versus Flu with Ann Mattison, APRN
Trisha Williams (Host): Hi guys. Welcome to the Advanced Practice Perspectives. I’m Trisha Williams.
Tobie O’Brien (Host): And I’m Tobie O’Brien. This is a podcast created by Advanced Practice Providers for Advanced Practice Providers. We will be highlighting our amazing APPs here at Children’s Mercy and do some education along the way.
Trisha: We are so glad that you’re here to join us today. It’s time to sit back, tune in and let’s get started.
Tobie: We are so excited to have Ann Mattison with us today. Ann is an APRN 3 in the Primary Care Clinic at Children’s Mercy. Ann, please tell us about yourself, your background and your role in the PCC clinic.
Ann Mattison, ARBP, MSN, CPNP (Guest): Thanks for having me today. I have been a Nurse Practitioner for the last 17 years. I have done a variety of things. I started out at Children’s Mercy as a Hospitalist and I did that for several years and then I moved to Private Practice where I did Primary Care and then I’ve been back at Mercy for the last five years doing Primary Care and so I work at the Primary Care Clinic over at 31st and Broadway and I also spend some time in the Truman Newborn Nursery taking care of newborns over there.
Trisha: Oh that’s great. What a great experience that must be collectively altogether, newborns and then Primary Care. That would be great. Ann, I feel like you and I know each other a little bit because we participate in the Advanced Practice Advisory Council at Children’s Mercy. But why don’t for our listeners and for Tobie, tell us some areas of interest that you have in the Primary Care Clinic. We all have our own specific little niche. So, what would you say your niche is?
Ann: I have a passion for immunizations. I have been on the Children’s Mercy Hospital wide immunization committee since I started back at Children’s Mercy about five years ago. I’m also very involved with the mid-America immunization coalition which is a coalition here in the Kansas City metro area that promotes immunizations. And specifically within that group, I chair the Childhood Vaccine Group and so trying to promote vaccines for children. I also am on the Missouri Immunization Coalition. That is a new coalition that’s only been around since last year. And so that’s been fun being a part of getting that started.
Trisha: Oh absolutely. Tell us a little bit more about the hospital wide immunization committee at Children’s Mercy. What does that entail?
Ann: So, the hospital wide immunization committee meets once a month. And we address issues related to immunizations within Children’s Mercy. As a Primary Care Provider, we do immunizations all day, every day. And every encounter a child has at Children’s Mercy in the Primary Care Clinic, we take that as an opportunity to give immunizations. Our goal is for every child who comes into any clinic at Children’s Mercy to be given that same opportunity. So, we’ve been working with different subspecialty clinics to have them give immunizations if they’re seeing that the child is behind on their immunizations. We also are the ones that put together the Friends and Family Flu Clinic which that is a clinic for friends and family of our patients to come and get no cost flu vaccines. Unfortunately, there’s been a shortage of the flu vaccine and so that has been delayed and I just got an email today saying that’s going to be rescheduled for the middle of November.
Typically, that happens the beginning of October and then we have a second one the middle of November.
Trisha: Do we know why there was such a shortage on the flu vaccine this year or is it just something that can potentially happen?
Ann: It is not something that we were expecting. Typically, we know when our flu vaccine is coming, and we don’t schedule those clinics until that happens. They’re thinking that because of COVID-19, there’s been an increased desire to get the flu vaccine which is a great thing and that’s why our shipments were delayed.
Tobie: Well Ann, I think that’s really great about your involvement with the hospital immunization committee and something that you said, I thought was really interesting and helping the subspecialty clinics be able to recognize if children are falling behind. I know that in our ENT clinic, I don’t know that I would be able to pick up on that. Is it potentially our nurses who are getting that training or really would it be me that would be able to try to look into that or what is the goal of your committee in educating the subspecialty clinics or how do you do that?
Ann: It starts just with a communication and discussion about the importance of vaccines. And so I think sometimes we get narrow and we start focusing on just the things that we need to get through that visit. And so having those open conversations about the need for vaccines. And so, we’ve really worked hard with clinics that have children with chronic illnesses like the nephrology clinic and the heme/onc clinic to have them really look at their patients’ immunization records and so that’s helpful. For you, it would be more difficult I think since your and correct me if I’m wrong, your patients don’t tend to be as chronic. They tend to be more of a one time visit. And so then you probably aren’t going to have the vaccine record. But the kids that are followed in the primary care clinic or just that you see frequently, a lot of kids who are followed closely in chronic clinics do not follow up routinely with their primary care provider.
There is a statewide both in Kansas and Missouri immunization registry and so our nurses before every visit check that if we don’t have a complete vaccine record. And so that would be something that the clinic nurses can do. Like I said, it’s a little bit more difficult in your clinic where you’re seeing them maybe once or twice versus a clinic that is following them for years.
Tobie: That makes sense. And I know I would love to talk more about vaccinations because I think it’s interesting and I’m sure you could talk with us considering your role in all of these committees about how to talk to families about vaccinations but not to get sidetracked, I want to get on to the topic of how you talk to your families about the flu shot. That to me, also is challenging for people that are resistant to it. So, what do you think as far as how we try to encourage our families to get the flu shot? Could you give me any advice on how, if they’re resistant to it, what I could tell them in a diplomatic way of course?
Ann: I always start diplomatic and then I don’t always end diplomatic. But I also have the luxury of I have rapport with most of my patients because I’ve seen them for hopefully years or at least since they’ve been born and so we’ve been having multiple discussions about vaccines and so then that makes it easier with the flu vaccine. One thing is giving a strong recommendation rather than saying oh you can get your flu shot today. I just lump it in with the other vaccines they are getting. And there are a lot of studies that show that if you put it in the middle, so instead of saying today, you’re getting your MMR, varicella and flu vaccine, then they’re going to focus on the flu vaccine. Instead, I’m like you’re going to get your MMR, your flu and your varicella vaccine and so then when you lump them together, they don’t necessarily pick out that one is more or less important.
And then I always talk about the pediatric deaths. There are hundreds of kids that die every year from influenza. And as the season goes on, I will even give them the statistic of how many kids have died this year. And then I talk about how even if last year’s flu vaccine wasn’t real effective, it still reduces pediatric related ER visits as well as hospitalizations. So, for example, last year’s vaccine was only about 40 to 60% effective. But it reduced pediatric flu related ER visits by as much as 50% and hospitalizations by 40%. And if neither one of those work, then I go back to the number of kids that died last year and I just say, and I would just hate for you to have that guilt. Which again, probably not very diplomatic but I just want them to know that it is serious and that their child could die from this.
And then I always have them sign a vaccine refusal form like I would for any other vaccine. So, again, showing them that it’s important and I feel like it’s important enough that you need to sign saying that you’re declining it.
Trisha: That for flu vaccine that people are doing that as we normally would for like the required mandated vaccines. I could see into the society of 2020, with masking and social distancing with COVID that a lot of families or maybe some families could say we’re already social distancing, washing our hands and wearing a mask. Why is it necessary to get the flu vaccine when we’re already doing what should be required and maybe the instances of flu is going to go down. I heard you mention earlier that you feel like the flu vaccines have gone up. What’s your take on that and do you think that we’re going to have more resistance because of masks and social distancing, or do you think people are like I don’t want to get the flu because everybody’s going to think I have COVID and so I’m going to get the flu vaccine?
Ann: I think that’s a tough question because I think you’ve got people on both sides of it. We learned from Australia that they had a very mild flu season because of course they’re like six months ahead of us. But they also had nationwide buy in for masking and social distancing and so their COVID cases also weren’t as high as ours and so I think that just goes to show the importance for us to get a flu vaccine because we aren’t doing a real good job of wearing masks and social distancing. And just because you’re wearing a mask, that’s going to protect other people but that’s not protecting yourself. And I am still highly encouraging people to get their flu vaccine. The other thing is, we don’t want to overrun our hospitals and we’ve already had our hospitals be on diversion and so I think that’s something to take into account too that all these hospitalizations from influenza we need to try and prevent so that we have beds for potentially COVID patients or just patients with other illnesses.
Trisha: I think that’s an excellent point in regards to vaccinating ourselves and our children to protect ourselves like we wear masks and social distance for others but getting a vaccine for flu protects us for flu and can protect our children. So, I think that’s a really good valid point to mention to our families. Can you give us your thoughts on how you can tell the difference between COVID versus flu? Can we really tell the difference?
Ann: That is a great question. And I think that’s going to be very difficult this fall and winter. Last year at the beginning of the pandemic, they were saying that if you had influenza, you could not have COVID. But I think that we’re at a very different point with our COVID positivity rates and so I think that you will be able to have both at the same time. It’s very difficult because they do have very similar symptoms. The one thing that I think differentiates them a little bit is flu tends to have more body aches and COVID at least in children, tends to be more mild, common cold symptoms like fever, cough, runny nose, diarrhea. I also feel like we’re going to be doing a lot more flu testing this year. In the past, we’ve only really tested if there was something, we could do about it. So, if they were high risk and needed some sort of an antiviral, then we would test them. But the majority of kids did not get tested because it wasn’t going to change our management.
This year, it’s going to be very different because it’s going to be the difference of a kid being out of school potentially for five to seven days versus ten to fourteen days. And so I think that will make it more challenging this year.
Trisha: I would definitely agree. I could foresee lots of people being home sick or children being home sick for possibly a cold, but we don’t know so we have to be extra cautious. Do you mind talking about the kind of differences of COVID testing versus flu testing and what those two differences are in the testing methods?
Ann: Sure. So, as of right now, they’re both nasal swabs and far up nasal swabs, at least what we’re doing at Children’s Mercy. I know that there are some other COVID testing methods in the works, but we are not currently doing those at Children’s Mercy. With influenza, the turnaround time for the influenza test is usually 30 minutes to an hour versus the COVID test usually takes 24 to 48 hours. And if your child is positive for influenza, we can tell you pretty much that same day. But if they have COVID, you’re not going to know for a day or two. Which is sort of frustrating as a parent but we can also treat sometimes flu and you have to have that in a very rapid window because we can only treat within the first 48 hours maybe 72 hours of onset of symptoms versus COVID is just going to be supportive treatment and supportive care meaning fluids, ibuprofen, Tylenol, staying hydrated and comfortable and so, you don’t have that pressure of the time crunch.
Trisha: It will be interesting to see if the numbers of flu treatment with Tamiflu goes up as well. Like if you’re going to have more parents and patients request to be treated using the Tamiflu versus not historically but prior to COVID. So, that will be interesting to see what those numbers look like.
Ann: It will also be interesting, I think just to see what our numbers look like because so many kids are not in school and I just saw that Kansas City, Missouri I believe, it may have been Kansas City, Kansas, I’m not sure, just put out today that they are delaying even further when they’re going back in-person. They had hope within the next couple of weeks to be in-person and now they’re saying nope. Their COVID positivity rates are too high and so, it will just be interesting to see how that all plays out.
Tobie: Sure. Yeah, I wondered also if we would potentially not see the numbers be quite as high because of the distancing but nonetheless, it’s so important to still be getting the flu vaccine.
Ann: Exactly.
Trisha: Well I want to switch gears here a little bit and you had mentioned that you work at the Truman Hospital in the newborn nursery which I find very fascinating. Newborn babies are the best ever.
Ann: They are the best.
Trisha: They are the best but how would you talk to new mamas at Truman about COVID? So, how would you mentor them about staying away from family members or if they come in contact with somebody who has COVID, do they stay away from their babies? How do you guide parents or new moms in that respect in regards to COVID and bonding with their newborn babies?
Ann: This is ever changing as well. The more we learn about COVID, our recommendations are changing. And we currently talk to the moms because we test all of the moms when they are admitted to know if they are COVID positive or not and if they are COVID positive, we isolate them for ten days. If their COVID test was positive greater than ten days, then they are no longer considered infectious and so we no longer are isolating them.
Trisha: I’m sorry. Isolated means to keep them away from the baby for ten days after delivery?
Ann: No. It just means that we tell them that they need to stay isolated, so they need to stay home. They need to be quarantined would be a better term. And then while they are inpatient, we do isolation measures. And so if it’s within that first ten days of a positive test or onset of symptoms; then we are asking the mom to wash her hands and wear a mask before she picks up the baby. And so we are encouraging breast feeding as long as they are wearing a mask and they wash their hands. And then we ask that the mom keep the baby in a crib at least six feet away from her and so the current American Academy of Pediatrics recommendations are that the baby sleep in a crib in the mom’s room to help prevent SIDS but with that, we’re asking them to keep the baby far away from mom.
The thing that makes it tricky is with the asymptomatic moms that come in that test positive. We’re not testing the dad, so we don’t really know if they’re positive or not and so, I encourage them to still have the dad wear a mask and wash their hands also.
Tobie: Ah, what a bummer time to be a new mom, huh?
Ann: And you can’t have visitors in the hospital so, it’s kind of – it is a bummer.
Trisha: It is a bummer. Brand new baby, great thing, 2020, bummer.
Tobie: I know, all you want to do is snuggle that baby. I bet that would be very difficult to have to wear that mask and you do what you have to do to keep your baby safe. So, I understand, and I think it’s important to follow those guidelines for sure or recommendations. That’s really interesting. How often are you over at Truman?
Ann: I’m there about one to two days every week.
Tobie: Okay so you do their newborn exam?
Ann: Yes.
Tobie: Okay. Great. I bet that’s really fun. Do you enjoy that?
Ann: Oh yes. I love the newborns. It’s very rewarding.
Trisha: I think it’s a great service that Children’s Mercy is able to offer over at Truman and have that collaboration. That is a fantastic service that is offered for the patients and the families.
Ann: And it’s great because a lot of them end up following up at PCC and so it really is a good transition for them.
Trisha: It starts that really good rapport from the beginning.
Ann: Yeah, absolutely.
Tobie: And I’m sure that sets the groundwork too for you to have those good relationships with those families in the PCC clinic and just as you mentioned, as we were talking about immunizations, being able to set a good foundation for talking with families about immunizations. So, I think that’s great. One question I also had is if I wanted to be able to learn a bit more about how I can talk with families about immunizations, how would I or anyone that’s listening who wants to feel better equipped especially when they are challenged somewhat on the recommendations on immunizations. Where would be a good place for us to start?
Ann: There are a few really good resources. I’m going to put a plug in for my module that I just put out. I worked with Nurture Casey and put out an education module for families on childhood vaccines and there is a vaccine hesitancy section in there and so it talks about the importance of vaccines and some reasons why you might be a little bit worried about getting them but why it’s still important. The CDC also has great resources and I think another good resource for more of the lay people is Children’s Hospital of Philadelphia or CHOP. They do a lot with immunizations and they have a lot of really great resources on their website.
Tobie: Oh great. That’s really good to know. Thank you. I’m going to look into both of those. I’m excited to look at your module.
Trisha: Me too. That sounds amazing.
Ann: Yes, I can definitely get you the information if you are interested.
Trisha: Very much so. That sounds amazing. Ann, thank you so much for your time today. We certainly appreciate your expertise and your insight on these topics that we discussed today. it was a great conversation.
Tobie: Yeah, thank you Ann so much.
Ann: You’re welcome. Thanks again for having me.
Tobie: Ann, thank you for joining us and we love to end each episode on a much lighter note. So, we would love to know a fun way you have taken on the challenges of 2020.
Ann: I’ve been thinking about this after listening to your last podcast. And one thing that I think is hilarious and my kids would disagree, but we actually were on vacation on a road trip when all of the COVID stuff started hitting. And so we were literally at the Oklahoma Texas border. We were headed to Dallas Fort Worth area. I had all these great things planned that we were going to do. Well as we got to the border, like everything was closing. We’re listening to the radio and they’re like oh this is closed, this is closed, this is closed. So instead of going to all these really fun places, I took my kids to a cemetery. I was – I just Googled fun things to do in Paris, Texas because that was one of our destination places. And they were talking about this Jesus and Boot Statue and this big buffalo statue. And so I was like how awesome is that. Let’s go check it out. As it turns out, it’s in the middle of a cemetery. So, my kids will always remember 2020, as the year that we took them on vacation to a cemetery.
Trisha: That’s fantastic. Well what are you going to do. It is what it is. Right? Forever in our minds, 2020, the year mom took us to a cemetery. That is fantastic. Thanks again Ann, for joining us and thank you for listening to the Advanced Practice Perspectives podcast. Tune in next time where we’re going to talk with Jane Yearly. She is a physician’s assistant in our own ENT department and we are so excited to talk with her.
The Battle Of 2020 Continues-- COVID Versus Flu with Ann Mattison, APRN
Trisha Williams (Host): Hi guys. Welcome to the Advanced Practice Perspectives. I’m Trisha Williams.
Tobie O’Brien (Host): And I’m Tobie O’Brien. This is a podcast created by Advanced Practice Providers for Advanced Practice Providers. We will be highlighting our amazing APPs here at Children’s Mercy and do some education along the way.
Trisha: We are so glad that you’re here to join us today. It’s time to sit back, tune in and let’s get started.
Tobie: We are so excited to have Ann Mattison with us today. Ann is an APRN 3 in the Primary Care Clinic at Children’s Mercy. Ann, please tell us about yourself, your background and your role in the PCC clinic.
Ann Mattison, ARBP, MSN, CPNP (Guest): Thanks for having me today. I have been a Nurse Practitioner for the last 17 years. I have done a variety of things. I started out at Children’s Mercy as a Hospitalist and I did that for several years and then I moved to Private Practice where I did Primary Care and then I’ve been back at Mercy for the last five years doing Primary Care and so I work at the Primary Care Clinic over at 31st and Broadway and I also spend some time in the Truman Newborn Nursery taking care of newborns over there.
Trisha: Oh that’s great. What a great experience that must be collectively altogether, newborns and then Primary Care. That would be great. Ann, I feel like you and I know each other a little bit because we participate in the Advanced Practice Advisory Council at Children’s Mercy. But why don’t for our listeners and for Tobie, tell us some areas of interest that you have in the Primary Care Clinic. We all have our own specific little niche. So, what would you say your niche is?
Ann: I have a passion for immunizations. I have been on the Children’s Mercy Hospital wide immunization committee since I started back at Children’s Mercy about five years ago. I’m also very involved with the mid-America immunization coalition which is a coalition here in the Kansas City metro area that promotes immunizations. And specifically within that group, I chair the Childhood Vaccine Group and so trying to promote vaccines for children. I also am on the Missouri Immunization Coalition. That is a new coalition that’s only been around since last year. And so that’s been fun being a part of getting that started.
Trisha: Oh absolutely. Tell us a little bit more about the hospital wide immunization committee at Children’s Mercy. What does that entail?
Ann: So, the hospital wide immunization committee meets once a month. And we address issues related to immunizations within Children’s Mercy. As a Primary Care Provider, we do immunizations all day, every day. And every encounter a child has at Children’s Mercy in the Primary Care Clinic, we take that as an opportunity to give immunizations. Our goal is for every child who comes into any clinic at Children’s Mercy to be given that same opportunity. So, we’ve been working with different subspecialty clinics to have them give immunizations if they’re seeing that the child is behind on their immunizations. We also are the ones that put together the Friends and Family Flu Clinic which that is a clinic for friends and family of our patients to come and get no cost flu vaccines. Unfortunately, there’s been a shortage of the flu vaccine and so that has been delayed and I just got an email today saying that’s going to be rescheduled for the middle of November.
Typically, that happens the beginning of October and then we have a second one the middle of November.
Trisha: Do we know why there was such a shortage on the flu vaccine this year or is it just something that can potentially happen?
Ann: It is not something that we were expecting. Typically, we know when our flu vaccine is coming, and we don’t schedule those clinics until that happens. They’re thinking that because of COVID-19, there’s been an increased desire to get the flu vaccine which is a great thing and that’s why our shipments were delayed.
Tobie: Well Ann, I think that’s really great about your involvement with the hospital immunization committee and something that you said, I thought was really interesting and helping the subspecialty clinics be able to recognize if children are falling behind. I know that in our ENT clinic, I don’t know that I would be able to pick up on that. Is it potentially our nurses who are getting that training or really would it be me that would be able to try to look into that or what is the goal of your committee in educating the subspecialty clinics or how do you do that?
Ann: It starts just with a communication and discussion about the importance of vaccines. And so I think sometimes we get narrow and we start focusing on just the things that we need to get through that visit. And so having those open conversations about the need for vaccines. And so, we’ve really worked hard with clinics that have children with chronic illnesses like the nephrology clinic and the heme/onc clinic to have them really look at their patients’ immunization records and so that’s helpful. For you, it would be more difficult I think since your and correct me if I’m wrong, your patients don’t tend to be as chronic. They tend to be more of a one time visit. And so then you probably aren’t going to have the vaccine record. But the kids that are followed in the primary care clinic or just that you see frequently, a lot of kids who are followed closely in chronic clinics do not follow up routinely with their primary care provider.
There is a statewide both in Kansas and Missouri immunization registry and so our nurses before every visit check that if we don’t have a complete vaccine record. And so that would be something that the clinic nurses can do. Like I said, it’s a little bit more difficult in your clinic where you’re seeing them maybe once or twice versus a clinic that is following them for years.
Tobie: That makes sense. And I know I would love to talk more about vaccinations because I think it’s interesting and I’m sure you could talk with us considering your role in all of these committees about how to talk to families about vaccinations but not to get sidetracked, I want to get on to the topic of how you talk to your families about the flu shot. That to me, also is challenging for people that are resistant to it. So, what do you think as far as how we try to encourage our families to get the flu shot? Could you give me any advice on how, if they’re resistant to it, what I could tell them in a diplomatic way of course?
Ann: I always start diplomatic and then I don’t always end diplomatic. But I also have the luxury of I have rapport with most of my patients because I’ve seen them for hopefully years or at least since they’ve been born and so we’ve been having multiple discussions about vaccines and so then that makes it easier with the flu vaccine. One thing is giving a strong recommendation rather than saying oh you can get your flu shot today. I just lump it in with the other vaccines they are getting. And there are a lot of studies that show that if you put it in the middle, so instead of saying today, you’re getting your MMR, varicella and flu vaccine, then they’re going to focus on the flu vaccine. Instead, I’m like you’re going to get your MMR, your flu and your varicella vaccine and so then when you lump them together, they don’t necessarily pick out that one is more or less important.
And then I always talk about the pediatric deaths. There are hundreds of kids that die every year from influenza. And as the season goes on, I will even give them the statistic of how many kids have died this year. And then I talk about how even if last year’s flu vaccine wasn’t real effective, it still reduces pediatric related ER visits as well as hospitalizations. So, for example, last year’s vaccine was only about 40 to 60% effective. But it reduced pediatric flu related ER visits by as much as 50% and hospitalizations by 40%. And if neither one of those work, then I go back to the number of kids that died last year and I just say, and I would just hate for you to have that guilt. Which again, probably not very diplomatic but I just want them to know that it is serious and that their child could die from this.
And then I always have them sign a vaccine refusal form like I would for any other vaccine. So, again, showing them that it’s important and I feel like it’s important enough that you need to sign saying that you’re declining it.
Trisha: That for flu vaccine that people are doing that as we normally would for like the required mandated vaccines. I could see into the society of 2020, with masking and social distancing with COVID that a lot of families or maybe some families could say we’re already social distancing, washing our hands and wearing a mask. Why is it necessary to get the flu vaccine when we’re already doing what should be required and maybe the instances of flu is going to go down. I heard you mention earlier that you feel like the flu vaccines have gone up. What’s your take on that and do you think that we’re going to have more resistance because of masks and social distancing, or do you think people are like I don’t want to get the flu because everybody’s going to think I have COVID and so I’m going to get the flu vaccine?
Ann: I think that’s a tough question because I think you’ve got people on both sides of it. We learned from Australia that they had a very mild flu season because of course they’re like six months ahead of us. But they also had nationwide buy in for masking and social distancing and so their COVID cases also weren’t as high as ours and so I think that just goes to show the importance for us to get a flu vaccine because we aren’t doing a real good job of wearing masks and social distancing. And just because you’re wearing a mask, that’s going to protect other people but that’s not protecting yourself. And I am still highly encouraging people to get their flu vaccine. The other thing is, we don’t want to overrun our hospitals and we’ve already had our hospitals be on diversion and so I think that’s something to take into account too that all these hospitalizations from influenza we need to try and prevent so that we have beds for potentially COVID patients or just patients with other illnesses.
Trisha: I think that’s an excellent point in regards to vaccinating ourselves and our children to protect ourselves like we wear masks and social distance for others but getting a vaccine for flu protects us for flu and can protect our children. So, I think that’s a really good valid point to mention to our families. Can you give us your thoughts on how you can tell the difference between COVID versus flu? Can we really tell the difference?
Ann: That is a great question. And I think that’s going to be very difficult this fall and winter. Last year at the beginning of the pandemic, they were saying that if you had influenza, you could not have COVID. But I think that we’re at a very different point with our COVID positivity rates and so I think that you will be able to have both at the same time. It’s very difficult because they do have very similar symptoms. The one thing that I think differentiates them a little bit is flu tends to have more body aches and COVID at least in children, tends to be more mild, common cold symptoms like fever, cough, runny nose, diarrhea. I also feel like we’re going to be doing a lot more flu testing this year. In the past, we’ve only really tested if there was something, we could do about it. So, if they were high risk and needed some sort of an antiviral, then we would test them. But the majority of kids did not get tested because it wasn’t going to change our management.
This year, it’s going to be very different because it’s going to be the difference of a kid being out of school potentially for five to seven days versus ten to fourteen days. And so I think that will make it more challenging this year.
Trisha: I would definitely agree. I could foresee lots of people being home sick or children being home sick for possibly a cold, but we don’t know so we have to be extra cautious. Do you mind talking about the kind of differences of COVID testing versus flu testing and what those two differences are in the testing methods?
Ann: Sure. So, as of right now, they’re both nasal swabs and far up nasal swabs, at least what we’re doing at Children’s Mercy. I know that there are some other COVID testing methods in the works, but we are not currently doing those at Children’s Mercy. With influenza, the turnaround time for the influenza test is usually 30 minutes to an hour versus the COVID test usually takes 24 to 48 hours. And if your child is positive for influenza, we can tell you pretty much that same day. But if they have COVID, you’re not going to know for a day or two. Which is sort of frustrating as a parent but we can also treat sometimes flu and you have to have that in a very rapid window because we can only treat within the first 48 hours maybe 72 hours of onset of symptoms versus COVID is just going to be supportive treatment and supportive care meaning fluids, ibuprofen, Tylenol, staying hydrated and comfortable and so, you don’t have that pressure of the time crunch.
Trisha: It will be interesting to see if the numbers of flu treatment with Tamiflu goes up as well. Like if you’re going to have more parents and patients request to be treated using the Tamiflu versus not historically but prior to COVID. So, that will be interesting to see what those numbers look like.
Ann: It will also be interesting, I think just to see what our numbers look like because so many kids are not in school and I just saw that Kansas City, Missouri I believe, it may have been Kansas City, Kansas, I’m not sure, just put out today that they are delaying even further when they’re going back in-person. They had hope within the next couple of weeks to be in-person and now they’re saying nope. Their COVID positivity rates are too high and so, it will just be interesting to see how that all plays out.
Tobie: Sure. Yeah, I wondered also if we would potentially not see the numbers be quite as high because of the distancing but nonetheless, it’s so important to still be getting the flu vaccine.
Ann: Exactly.
Trisha: Well I want to switch gears here a little bit and you had mentioned that you work at the Truman Hospital in the newborn nursery which I find very fascinating. Newborn babies are the best ever.
Ann: They are the best.
Trisha: They are the best but how would you talk to new mamas at Truman about COVID? So, how would you mentor them about staying away from family members or if they come in contact with somebody who has COVID, do they stay away from their babies? How do you guide parents or new moms in that respect in regards to COVID and bonding with their newborn babies?
Ann: This is ever changing as well. The more we learn about COVID, our recommendations are changing. And we currently talk to the moms because we test all of the moms when they are admitted to know if they are COVID positive or not and if they are COVID positive, we isolate them for ten days. If their COVID test was positive greater than ten days, then they are no longer considered infectious and so we no longer are isolating them.
Trisha: I’m sorry. Isolated means to keep them away from the baby for ten days after delivery?
Ann: No. It just means that we tell them that they need to stay isolated, so they need to stay home. They need to be quarantined would be a better term. And then while they are inpatient, we do isolation measures. And so if it’s within that first ten days of a positive test or onset of symptoms; then we are asking the mom to wash her hands and wear a mask before she picks up the baby. And so we are encouraging breast feeding as long as they are wearing a mask and they wash their hands. And then we ask that the mom keep the baby in a crib at least six feet away from her and so the current American Academy of Pediatrics recommendations are that the baby sleep in a crib in the mom’s room to help prevent SIDS but with that, we’re asking them to keep the baby far away from mom.
The thing that makes it tricky is with the asymptomatic moms that come in that test positive. We’re not testing the dad, so we don’t really know if they’re positive or not and so, I encourage them to still have the dad wear a mask and wash their hands also.
Tobie: Ah, what a bummer time to be a new mom, huh?
Ann: And you can’t have visitors in the hospital so, it’s kind of – it is a bummer.
Trisha: It is a bummer. Brand new baby, great thing, 2020, bummer.
Tobie: I know, all you want to do is snuggle that baby. I bet that would be very difficult to have to wear that mask and you do what you have to do to keep your baby safe. So, I understand, and I think it’s important to follow those guidelines for sure or recommendations. That’s really interesting. How often are you over at Truman?
Ann: I’m there about one to two days every week.
Tobie: Okay so you do their newborn exam?
Ann: Yes.
Tobie: Okay. Great. I bet that’s really fun. Do you enjoy that?
Ann: Oh yes. I love the newborns. It’s very rewarding.
Trisha: I think it’s a great service that Children’s Mercy is able to offer over at Truman and have that collaboration. That is a fantastic service that is offered for the patients and the families.
Ann: And it’s great because a lot of them end up following up at PCC and so it really is a good transition for them.
Trisha: It starts that really good rapport from the beginning.
Ann: Yeah, absolutely.
Tobie: And I’m sure that sets the groundwork too for you to have those good relationships with those families in the PCC clinic and just as you mentioned, as we were talking about immunizations, being able to set a good foundation for talking with families about immunizations. So, I think that’s great. One question I also had is if I wanted to be able to learn a bit more about how I can talk with families about immunizations, how would I or anyone that’s listening who wants to feel better equipped especially when they are challenged somewhat on the recommendations on immunizations. Where would be a good place for us to start?
Ann: There are a few really good resources. I’m going to put a plug in for my module that I just put out. I worked with Nurture Casey and put out an education module for families on childhood vaccines and there is a vaccine hesitancy section in there and so it talks about the importance of vaccines and some reasons why you might be a little bit worried about getting them but why it’s still important. The CDC also has great resources and I think another good resource for more of the lay people is Children’s Hospital of Philadelphia or CHOP. They do a lot with immunizations and they have a lot of really great resources on their website.
Tobie: Oh great. That’s really good to know. Thank you. I’m going to look into both of those. I’m excited to look at your module.
Trisha: Me too. That sounds amazing.
Ann: Yes, I can definitely get you the information if you are interested.
Trisha: Very much so. That sounds amazing. Ann, thank you so much for your time today. We certainly appreciate your expertise and your insight on these topics that we discussed today. it was a great conversation.
Tobie: Yeah, thank you Ann so much.
Ann: You’re welcome. Thanks again for having me.
Tobie: Ann, thank you for joining us and we love to end each episode on a much lighter note. So, we would love to know a fun way you have taken on the challenges of 2020.
Ann: I’ve been thinking about this after listening to your last podcast. And one thing that I think is hilarious and my kids would disagree, but we actually were on vacation on a road trip when all of the COVID stuff started hitting. And so we were literally at the Oklahoma Texas border. We were headed to Dallas Fort Worth area. I had all these great things planned that we were going to do. Well as we got to the border, like everything was closing. We’re listening to the radio and they’re like oh this is closed, this is closed, this is closed. So instead of going to all these really fun places, I took my kids to a cemetery. I was – I just Googled fun things to do in Paris, Texas because that was one of our destination places. And they were talking about this Jesus and Boot Statue and this big buffalo statue. And so I was like how awesome is that. Let’s go check it out. As it turns out, it’s in the middle of a cemetery. So, my kids will always remember 2020, as the year that we took them on vacation to a cemetery.
Trisha: That’s fantastic. Well what are you going to do. It is what it is. Right? Forever in our minds, 2020, the year mom took us to a cemetery. That is fantastic. Thanks again Ann, for joining us and thank you for listening to the Advanced Practice Perspectives podcast. Tune in next time where we’re going to talk with Jane Yearly. She is a physician’s assistant in our own ENT department and we are so excited to talk with her.