Transcription:
Taking Safety to the Next Level During COVID-19

Tiffany Kaczorowski (Host):  Welcome to Inside Pediatrics, a podcast brought to you by Children’s Hospital of Alabama, in Birmingham. I’m Tiffany Kaczorowski. Today, we’re talking about the changes and shifts that we have had to make at Children’s Hospital of Alabama when it comes to infection prevention since COVID-19 reared its ugly head in March. And I’m joined today by Dr. Cecelia Hutto. She is a Professor of Infectious Diseases at UAB, the University of Alabama at Birmingham and the Medical Director of Infection Prevention and Control here at Children’s. Welcome Dr. Hutto.

Cecelia Hutto, MD (Guest):  Thank you.

Host:  So, I have to say, we are distanced here in our little studio and we both have our masks on. So, if it sounds a little muffled, that’s why. We’re both taking those precautions. And Dr. Hutto, something I wanted to start with is that Children’s realized pretty early on that we needed to develop some sort of a task force. Can you tell us about that?

Dr. Hutto:  That’s correct. And the task force is something that hospitals use across the country when there is a potential evolving emergency, something different that’s going to affect the hospital, the processes in the hospital, the safety of patients, the safety of healthcare workers. And so, when we knew that there was a pandemic, when we first understood that there was a pandemic happening that was likely going to affect our hospital; then what happens, and this happens – we’ve done this before like for Ebola. We had a task force during the Ebola outbreak or Ebola concern. Fortunately, we never had patients here, but we did a lot of preparation and work to get the hospital ready. And we’ve done it – when we understood that this pandemic was likely going to affect our hospital.

So, the task force includes a group of people from various areas of the hospital who are responsible for various issues related to patient care, making sure that our patients who don’t have Coronavirus and those who may have Coronavirus or do, are provided care appropriately, all the patients are safe. And it also is important to provide – to make sure that our healthcare workers are safe. The task force involves as I said, people from throughout the hospital, multiple areas of the hospital, all involved in patient care. And when we know that our processes for providing care are going to change, we need to determine what those changes will be, who will be involved in making those changes. We need to educate healthcare workers about the changes.

We have to make sure that we have the equipment and the supplies that we need. So, our task force included certainly, nursing, nursing leadership is continued, physician leadership, administrators, people from the laboratory is important. We have to know what kind of testing that’s going to be done, what kind of reagents are needed for testing. We have to make sure that we have adequate PPE. We’ve all heard that term a lot. And that has been a major issue for all hospitals doing ongoing assessments or whoever is the central supply and whoever in the hospital is responsible for those is a major part of the task force. People who are responsible for cleaning of the hospital. We have to make sure that they are involved because the cleaning could potentially change, and we also need to make sure that everyone in the hospital is aware of the change in process and educate those people. So educators in the hospital. Nursing educators are extremely important in the task force.

All hospitals have these tasks forces when we have situations like pandemics like the Coronavirus pandemic. It was very active in the beginning. It continues to be active as changes occur. And they have occurred during the course of this pandemic.

Host:  What are some of the things that we instituted here in the very beginning to ensure the safety of our patients and employees and physicians?

Dr. Hutto:  A number of changes have been instituted. Our changes are not something that we just make up. We are using recommendations from national organizations that have dealt with pandemics previous to this. So, our – most of our recommendations for changes that we need to institute in the hospital have come from the CDC. Other hospitals use the same CDC guidelines and if these have changed, we have changed, we’ve changed those processes but initially, what we understood that we needed to do, one of the things that we needed to do was decrease the number of people who did not need to be in the hospital. We needed to decrease the number of people in the hospital. The more people we have, the greater the risk for everyone that if there are individuals with infection, they could spread the infection. So, only essential employees remained on campus. If employees or personnel could work from home; they began working from home and many of those continue to do that at this time.

We also have changed our policy in terms of visitors. In the fall and winter when we have influenza, there’s a visitor policy that we usually put in place to decrease the visitors. We instituted that policy right away. And that policy is continued so that we don’t allow visitors in the hospital. Actually we allow no visitors. The only people who can visit patients are their parents. The parents can come if they are inpatients, the parents can be with the child. But no one other than the parents.

Our outpatient clinic schedules changed tremendously during this time. We began seeing patients that could be seen or having visits by Telehealth as many institutions have. So, the hospital has used Telehealth and continues to do Telehealth for visits at this point in time. We only are seeing patients that need to be seen on an in-person visit and for those visits, only a single parent is allowed to come into the hospital. And this is something else that we do to make sure that the patients – that the hospital is safe for parents. We screen children that have appointments for the clinics, 24 hours before they come in and if they have any symptoms suggestive that could be Coronavirus either in the patient or the parent that’s going to accompany the patient, or if they’ve had any close contact; we reschedule those patients.

So, we are trying to decrease people who – coming into the hospital who may potentially have Coronavirus.

Host:  So, they are receiving a call, you’re saying, 24 hours before their appointment just to screen for any types of issues they may be having symptoms, they might be having.

Dr. Hutto:  Exactly. To decrease – we are screening them again and hospital personnel are screened as they enter the hospital. They are screened based on questions that could suggest they’re having symptoms and they’re also – temperatures are being taken. So hospital personnel are screened, patients coming into the clinic and their parents are screened and then we are making sure that the patients who come to clinic, that we have adequate space in clinic to space out parents and children who are in clinic so that they are distanced from each other. We are requiring masking now. And have required masking both parents and children coming in, all healthcare workers, universal masking is required.

Host:  Why with this particular virus are we masking?

Dr. Hutto:  Masking is really related to how this virus is transmitted. And we know that the virus, like other respiratory viruses, is transmitted person to person. So, through exchange of secretions, and that’s oral secretions, it’s nasal secretions. So, we know that if we are in contact, with another person and we’re talking to that person, even if we can’t see it sometimes, there are very small droplets of sputum fling that we expel into the air and it can be there depending on what the virus – what virus we’re talking about, it can be there for differing amounts of time.

So, for this virus, it is transmitted via something called droplets. And we think it’s – and it’s felt that it’s mostly large droplets which don’t stay in the air a long period of time. That’s another infection that people are familiar with that can be spread through droplet transmission is tuberculosis. Tuberculosis, we know probably a lot more about it because it’s been around a lot longer. But it also is droplet spread but it probably stays in the air a lot longer than this particular Coronavirus. So, if you have a mask on, if we have a mask and we’re talking to someone, if we’re coughing, if we’re sneezing, if we have the potential to exchange or to expel our oral secretions into the air; even if we can’t see them, the mask can prevent that from happening. Depending on the kind of mask you have, you protect – certainly protect the people in front of you and you protect yourself to some extent. Now some masks are better than others at protecting the person wearing them.

But we know that we can protect, and it’s been shown in many ways that we can protect the people who we are in contact with, who we are talking to. Anybody over the age of two should wear a mask. And we’re asking – we are requiring masks, anybody over the age of two who come to the hospital, who work in the hospital to wear a mask.

Host:  Some people are comparing this to the flu and they’re wondering what is the difference between this particular virus and the influenza virus. Can you explain that a little bit? I know flu season is coming up.

Dr. Hutto:  And that’s a good question. Because influenza and this virus are both respiratory viruses. They have a lot of things in common from the standpoint that they are viral infections and they are spread similarly and using masks and if we have patients in the hospital, who have influenza; we wear masks to prevent spread. And we do the same with this. This virus is different, however. One of the ways it is certainly different is that the mortality rate associated with this virus in people who are especially vulnerable, is much higher. We have a lot of experience with influenza epidemics and even pandemics. And those are severe. Fortunately, we’ve not had anything like happened in 1918 but the usual influenza that we’re familiar with, the mortality rate is less than 1%. Significantly. And this one, it’s certainly more than 1%. So, the mortality rate in vulnerable people is higher. The other issues related to this that are different is that it’s a very odd virus in that it can cause secondary morbidities that we’ve not seen with influenza. For example, people can have more severe – people can be left with renal failure for example. We see a lot of renal failure with this virus in older people in particular. We’ve seen that in some children here. We also know that it can makes the vessels and the lining of the vessels and strokes have been seen. It’s not uncommon for strokes to be seen in individuals and in fact, using anticoagulant therapy is something that’s being done particularly in adult hospitals because of the concern for strokes. So, people can have strokes, even young adults had had strokes. You can have pulmonary emboli. That’s not something that we see with influenza.

So, some of the long term complications associated with an infection are very different than from influenza. And the other thing is that we don’t know now, there’s a lot we don’t know about this virus. It’s an unusual respiratory virus but even for people who are not so sick and who recover, we don’t know if there can be any long term complications. We’re still trying to understand even for those individuals. So, it’s not influenza.

Host:  Right. Because of some of those secondary issues you talked about with the lungs, and with kidneys and stroke.

Dr. Hutto:  And potential strokes and pulmonary emboli, thrombi that can be potentially anywhere in the body.

Host:  And those are blockages basically, right?

Dr. Hutto:  Exactly.

Host:  Also, let’s talk about – and we talked a little bit about it with the masking, but why six feet apart? Why are we trying to distance?

Dr. Hutto:  Well good question. And I’m going to tell you what as I understand where this came from, it is the recommendation from the CDC. They do not really provide their data for why the six feet. But we do know that back in the 1930s, when researchers were trying to understand transmission of TB, they learned that TB droplets could be expelled and be in the air up to maybe three feet of distance or about a meter. And actually, the World Health Organization doesn’t recommend six feet, they recommend three feet. And it’s really probably based on research that was done more than a century ago.

More recently, the first SARS epidemic that happened in 2003, and wasn’t as extensive as this one; studies in airplanes were done and reports were that people in airplanes could be – who were sitting more than three feet away from someone who was infected; could be infected by this virus or the virus that is similar to this virus. So, based on that experience, I’m assuming that’s where the CDC’s recommendation came from, the six feet of social distancing. But in all honesty, I don’t know that we actually know for sure how far and I’m sure in some situations that even a greater distance is probably likely that it occurs that it is spread further but we really don’t know.

Host:  Any other myths or anything that you’re hearing out in the news or in the public that you’d like to dispel or just clarify a little bit as an infectious diseases expert?

Dr. Hutto:  I think one of the questions and a lot of discussion you hear about is children. And how – can children become infected with this. And then if they are infected, how infectious they are. And again, I think that’s something that we’re still learning. There are recent data, fairly recent that came out this week, a study from South Korea about this infection in children that really was related to trying to understand this. And what they reported is that children over ten years of age appeared to be those who had coronavirus appeared to be as infectious or as contagious as young adults and older adults. For children under ten, that did not appear to be the case. That did not mean that children under ten years of age couldn’t become infected, but it did not appear that they were as likely to transmit infection. I think that has to be confirmed.

We also don’t know how many children actually become infected. We know that if they do or are infected that they are much less sick, they are much less likely to become seriously ill. They may have a milder infection. That doesn’t mean that some children aren’t particularly ill because we’ve had certainly had some very ill children in the hospital and fortunately most of them have recovered. But we really don’t know about children, how many are actually infected and how well some of these asymptomatic children or even mildly symptomatic can transmit. This is another area that we still don’t understand. But I think we know that children can become infected. We’ve seen them. But it’s just not as common for children to become seriously ill as adults.

Host:  I suspect that this is going to be around for a while. This virus. And although a lot of people, a lot of companies are working on a vaccine and or treatments for symptoms; what are some of the things that you think will – some of the precautions that we’re taking that you think will stick around for a while? What’s the new normal going to look like?

Dr. Hutto:  This virus is widespread in our community and many communities in this county. There’s no doubt that we don’t have just moderate, we have substantial transmission. You can see that on the data that we hear daily from the news. So, I think to be able to decrease transmission and to try to do something about getting this virus, that amount of virus that’s being transmitted down to a level that we can actually have a chance of going back to our normal activities; we are going to need to continue to wear masks. We’re going to have these to become part of our normal. Just as it has in many countries where they’ve actually been able to do something to control this infection. If we can decrease the transmission, the virus can’t continue to be as widespread. But it’s going to take us, all of us to do it.

And then I think distancing ourselves, not putting ourselves in a position that we can acquire the virus if we are around others and that’s difficult, not being in large crowds, not going back to our usual activities but if we do, and if we don’t do something like this; we’re going to continue to have – that’s just the nature of viruses. If they can find a host that they have not infected, and it spreads pretty easily, then it’s going to – if they don’t – if the virus can’t find a host, and if we are protecting ourselves from becoming infected, that’s how we’re going to resolve this pandemic that we’re in and that our country is in.

Host:  Some people have talked about the vaccines that are being worked on and whether something is going to potentially come out this year that would be able to protect us or even in 2021. What do you say to people who might be afraid to be in that first wave of getting the vaccine because it seems like it’s being developed more quickly than vaccines usually are developed.

Dr. Hutto:  No, you are absolutely right. It’s amazing how much progress this country, laboratories throughout the country and the world have made in developing a vaccine. And I think that the safety is a concern and it has to be foremost, not only getting a vaccine out there so that people can actually be protected against it but making sure that all the precautions were taken in developing and testing this vaccine. It’s being done and the different phases that are required before the FDA is going to approve a vaccine, from my understanding that is being required for every company that’s producing a vaccine. The safety and what’s being done to make sure that safety, that they are safe has to be reported so that people can be assured that all the steps were taken.

Host:  Right.

Dr. Hutto:  To make these as safe as possible.

Host:  We do have a resource on the Children’s website that people can go to if they want to see our visitation policy as it stands and any other resources that we have been producing, any guidelines from the CDC et cetera. And that’s at www.childrensal.org/coronavirus. Anything else? Any other thoughts?

Dr. Hutto:  I think I just want to assure people who have children who are sick, and they may not have Coronavirus, but they may have other medical issues, that the hospital is doing everything – our hospital and other hospitals in the community. We are here to provide care to children who are ill. And we know that parents are concerned in this pandemic and in this time about bringing their children to the hospital. But the hospital is doing everything we can to make it safe, a safe environment, to provide care to children so that when we are providing care, whatever it is, that it is safe for the families who come in, for the children who are hospitalized here. We worry that parents are worried about coming into the environment that they will be exposed and then they may wait too late and we hope that doesn’t happen. We hope that parents will talk to their care providers whoever they need to, if they need to get further assurance. But I think the hospital is a safe place for children who need care.

Host:  And we want to make sure that they are not putting off some of the care that they need if they do have other issues unrelated to the Coronavirus, just making sure that they stay on top of those issues.

Dr. Hutto:  That’s exactly right. And don’t wait too late. Call your health provider if you are concerned about something but any physician, any of the nurses, we’re going to work with you to make sure your children are cared for and cared for safely.

Host:  Okay. Thank you so much Dr. Hutto for joining us.

Dr. Hutto:  You’re welcome.

Host:  Thanks for listening to Inside Pediatrics. More podcasts like this one, can be found at www.childrensal.org/insidepediatrics.