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COVID-19 (Coronavirus) FAQ for Physicians & Providers

Updated March 30, 2020

COVID-19 Update

The COVID-19 pandemic is rapidly changing and raises many questions. The Children's Mercy Infectious Diseases team has created a COVID-19 online resource, including answers to frequently asked questions from community physicians and providers. We are regularly updating this page with key information as we receive it.

In addition to information here, we have created a COVID-19 hotline for families, community physicians and providers.

CHILDREN'S MERCY COVID-19 HOTLINE
(816) 302-8800

The hotline provides options for parents to ask questions regarding their child's health, and for community physicians and providers with questions regarding specific patients to connect to a specialist.

If you have a general question about COVID-19 that has not been answered in our FAQ, please email us at physicianservices@cmh.edu. We are working with our Infectious Diseases team to provide answers and will return your email within one business day.

Live Virtual Event

Thank you to everyone who joined us for our Live Virtual Event for Community Physicians and Providers on March 31, 2020!

Our Infectious Diseases and Emergency Medicine specialists covered a variety of COVID-19 FAQs and addressed live questions submitted from participants.

For questions not addressed during the Live Virtual Event, we will continue to add our responses below.

Join us for our next Live Virtual Event!
Date: Tuesday, April 7, 2020
Time: Noon-1:00 p.m.

Additional details coming soon.

COVID-19 Testing Results

As of 4 p.m. on March 31, 2020

Patients tested: 266
Patients confirmed positive: 3 (0 inpatient)

Employees tested: 255
Employees confirmed positive: 3

If lacking PPE supplies, should providers and nursing staff be wearing face masks with all patients and re-use them? When should N95 masks, face shields, goggles, gowns, etc. be used?


Gowns, goggles, gloves, and regular masks are recommended when caring for patients with suspected or confirmed COVID-19. N95s are only required for aerosol generating procedures. However, if you have N95s available, you can use them in place of a surgical mask.

We realize that many offices do not have the quantity of PPE to support this. One possible solution is to provide clinical staff with two masks per day, one for the morning and one for the afternoon. Additional masks could be provided only if masks become soiled or moist. When gloves and mask are worn, the risk of infection transmission to the health care provider is low.

How should I manage a suspect or confirmed COVID-19 patient?


If patients are calling ahead and have what you consider to be mild symptoms that do not need medical attention, ask that they stay home and self-quarantine.

If patients need to be seen in your office, recommend using alternate entrances for sick patients, waiting in their car until you can room them, and then place them in a room with the door shut. If you have masks and the child will keep it on, use it. For the most recent CDC recommendations regarding PPE, visit the CDC website.

Do not allow sick patients to wait in lobbies or waiting rooms. Patients with cough or shortness of breath with or without fever (not due to another cause such as allergies or asthma) should be immediately placed in an exam room with the door shut. If no aerosol generating procedures are performed (e.g. nebulized treatment), the room can be cleaned per routine upon patient discharge.

What isolation procedures should we use if we don't have negative pressure rooms?


Negative pressure rooms are ONLY needed for aerosol generating procedures. This would typically be a nebulizer in the community practice setting. Try to use MDIs where available instead. Consider asking patients with MDIs to bring them to their visit.

How is Children’s Mercy managing its PPEs?


We are constantly evaluating our PPE supply to ensure appropriate use in caring for our patients. Children’s Mercy currently has enough supplies but are not able to share with community physicians and providers at this time. However, we continue to look for solutions that could help provide valuable PPE supplies to the community.

Should I wear mask and gloves when examining a child or infant to protect them from anything that I myself may have been exposed to inadvertently?


Providers who are healthy should use good hand hygiene and do not need to wear gloves or other PPE for situations in which they would not normally wear it. If providers are seeing a patient with respiratory symptoms consistent with COVID-19, they should wear contact, droplet PPE with eye shield.

Our current policy at Children's Mercy is that health care workers who have been exposed do not have to wear PPE but they are only able to care for patients who are not immunocompromised. Community physicians and provider should do monitor for temperature, signs and symptoms of COVID-19.

Can I work after an exposure during care of a COVID-19 patient when I did not wear PPE?


If exposed but asymptomatic, you should self-monitor twice daily (once prior to starting work) for temperature and respiratory symptoms for 14 days after the exposure event. If symptoms develop within 14 days, you should follow CDC guidelines for COVID-19 testing.

Is Children’s Mercy accepting donations for cloth PPE masks or other PPE?


We have received many generous offers for donations from community members who are working to procure additional PPE for our CM locations. This generosity is much appreciated and a testament to how the KC community comes together in times of need. We are evaluating each offer that comes in through our logistics team to ensure that these donations meet regulatory standards for use in hospitals. As an organization, we must continue to use PPE that meets national regulatory standards.

What recommendations are there for donated PPE?


N95 respirators should be approved by the National Institute for Occupational Safety and Health (NIOSH) and surgical masks should be of medical grade.

Are procedures to test for flu, strep or bronchiolitis considered aerosolizing procedures?


No. We don't even consider a nasopharyngeal swab for COVID-19 testing and flu testing to be an aerosol-generating procedure. A mid-terminate swab, which is typically done in clinics and what we’re currently doing at Children’s Mercy, will suffice.

If clinics don't have the ability to separate well from sick patients, what should we do?


Clinics have done various things, including separating patient visits by time if they are not able to separate by location within the clinic. It also depends on a clinic's physical layout and patient flow.

For example, some clinics are seeing well visits only in the morning followed by non-respiratory sick visits. Others are seeing all respiratory visits in the afternoon.

Some practices have implemented having patients stay in their car until they are ready for the patient to come in and register. The patient then goes back to their car and stays there until a room is ready. If the patient has respiratory symptoms, a mask can be put on them if available, and an alternate entrance could be considered instead of the routine entrance.

What is your guidance on proper N95 mask prolonged use, storage, reuse and disposal?


In a non-COVID-19 world, after you saw a patient, you would dispose of a surgical mask each and every time. Now, we are facing PPE shortages and must conserve as much as possible. Some clinics, even hospitals, are so short on surgical masks, they can no longer follow the previously recommended guidelines. In those cases some health care providers are leaving surgical masks on through their shift and only replacing it if it gets wet or soiled. Some institutions have given health care workers two surgical masks per day - one to wear in the morning and one for the afternoon. For those working longer shifts, up to 12 hours, they may receive three or four masks. But it's important to keep a surplus in case masks get wet or moist.

Some N95 mask manufacturers have an extended use protocol that allows health care workers to leave the mask on from patient to patient for a certain time period. Workers would still need to ensure proper changing of gown and gloves and hand hygiene between patients. For N95 masks that are not labeled for extended use by the manufacturer, CDC guidelines allow N-95 masks to be worn on and off up to five times before you need to discard it.

At Children’s Mercy, our policy is that when the N95 is off, we put it in a paper bag so that any contamination is contained within the bag. Good hand hygiene is required before and after handling the bag.

There are no recommendations for putting chemical disinfectants on N95s prior to reuse. However, doing this would make the mask wet and decrease its integrity.

Should physicians, providers and all staff who interact with patients wear PPE for all patients, even well-child visits/hours? Or only with sick visits where COVID-19 exposure is suspected?


If you are a healthcare provider who is sick, you should not be at work.

As long as those present in the visit, including the child, the parent or whoever brought them to the visit, are asymptomatic, health care workers do not need to wear PPE to care for patients. If the parent has respiratory systems, PPE should be worn by the health care provider.

Health care providers caring for sick patients should wear appropriate PPE.

Should N95 masks be worn to obtain strep and flu tests?


If you believe secretions from the patient (cough) could land on your face, we recommend health care workers wear PPE.

What are recommendations on using cloth masks if we run out of PPE? Is there any data showing they are less effective?


Companies are offering free supplies to those who would like to make masks for health care workers. There is evidence showing cloth masks are effective. They do not have the sort of thread count needed to prevent the entry of viruses and bacteria and wearing a cloth mask as opposed to a surgical mask increases your risk of getting infection by up to 13 times. Cloth masks should be considered the last resort. Read more here.

Can we use cloth masks over top of N95 masks for health care workers who are trying to conserve their masks? Are cloth masks better than nothing?


Homemade masks appear to allow in almost 100% of respiratory droplets, based on the study published in BMJ Open. While we don’t have data on putting a cloth mask over an N95, it does not seem like this would be helpful to keep the N95 functioning longer, and could possibly be harmful if the cloth mask gets wet and the N95 get wets due to laying on top of the cloth mask.

It is hard to say if cloth masks are better than nothing. In general, people wearing masks touch their face more than they already do (23 times and hour) and thus could increase their risk if they are not using good hand hygiene practices before and after every patient or wiping down equipment that is being used (e.g., otoscopes, tablet computers). 

Is suctioning for babies with bronchiolitis considered an aerosol generating procedure?


Nasal suction is not considered aerosol generating, but deep suction is.

Should clinics consider telehealth for check-ups and then if a follow-up exam is needed have patients seen on the well side? For virtual visits, how should we capture weight and blood pressure?


Seeing patients on site for visits that require vaccines is still important. However, many visits like ADHD follow up or other follow up issues could be seen via telehealth. The only way to get a weight would be from a patient’s home scale. You will likely need to forgo obtaining blood pressure unless the patient has a home cuff and knows how to use it. 

Our clinic requires use of an elevator to get there. Should we stop seeing all patients with respiratory symptoms?


COVID-19 is not airborne. We recommend routinely cleaning the elevator buttons to minimize transmission risk from someone who is coughing into their hand and then touches the buttons.

Should healthcare providers be concerned about exposing our families to COVID-19, especially if their family members are immunocompromised?


If you are performing good hand hygiene and infection prevention measures in your office, your risk to transmit at home is low. It is also a good idea to take off your work clothes when you get home before interacting with your family.

Does PPE need to be worn when caring for patients with upper respiratory infection without a fever? If a clinic doesn't have enough PPE masks or gowns, can they still see sick patients? What is a good substitute?

It is okay to see any patient with respiratory symptoms if your practice feels comfortable doing so. Gloves and a mask, along with good hand hygiene, and cleaning rooms and equipment are the most important. If you don’t have those, an eye shield that covers your face is a reasonable alternative.

Should PPE be worn when cleaning clinic rooms where a suspected COVID-19 patient was seen? If not, how long should we wait to clean?


Unless an aerosol generating procedure occurred in the room (e.g. nebulizer treatment), you can clean immediately after the patient leaves. Wear gloves to clean the room and equipment. If an aerosol generating procedure was performed, shut down the room for 1 hour prior to cleaning.

Should we use paper instead of a laptop to document visits with suspected COVID-19 patients?


Using paper is a good idea, as paper is not considered a good fomite of transmission. Or you could wipe down your laptop after every visit.

Is it preferred for offices to first rule out flu, strep, rhinovirus/enterovirus prior to COVID-19 testing?


It is reasonable to test for influenza in a patient who has influenza-like illness, as it is still circulating in our community. Similarly, testing for Group A streptococcus should be performed when the provider is concerned about streptococcal pharyngitis. Co-infection rates are not yet well defined for COVID-19, but co-infection has been reported.

What kind of screening/questions should we be asking patients?


Since we know that COVID-19 is circulating in our community, we are suggesting that you ask patients if they have any of the following symptoms:

  • Cough
    OR
  • Shortness of breath
    OR
  • Fever

If yes to any of these questions, then they should be masked (if able) and immediately placed in a room with the door shut. The provider should wear gown, glove and mask if they have it, but recognize that the risk of transmission is very low with masks, gloves, good hand hygiene and cleaning the room and instruments after the visit.

How can I test for COVID-19?


Testing should be performed at the discretion of the provider. Testing can be performed by nasopharyngeal (NP) swabs in your office. However, patients with mild symptoms do not need to be tested. Provide instructions on supportive care and home quarantine.

Though the CDC website says a nasopharyngeal swab, a mid-turbinate swab, the type used for influenza testing, is also appropriate. You can also use a flocked nasal swab.

Specimens can be sent to your reference laboratories.

Should we refer patients to CM for CT to diagnose COVID-19?


According to the American College of Radiology, The Centers for Disease Control (CDC) does not currently recommend CXR or CT to diagnose COVID-19. Viral testing remains the only specific method of diagnosis. Although there will be temptation to perform thoracic imaging, the diagnosis of COVID-19 is only accurate from a positive viral test, not imaging findings. In addition, the imaging findings overlap greatly with a variety of other pulmonary diseases, including influenza and RSV to name a few and are not to be used to diagnose COVID-19.

ACR recommends:

  • CT should not be used to screen for or as a first-line test to diagnose COVID-19.
  • CT should be used sparingly and reserved for hospitalized, symptomatic patients with specific clinical indications for CT. Appropriate infection control procedures should be followed before scanning subsequent patients.
  • Facilities may consider deploying portable radiography units in ambulatory care facilities for use when CXRs are considered medically necessary. The surfaces of these machines can be easily cleaned, avoiding the need to bring patients into radiography rooms.

What are the testing criteria Children’s Mercy is using for COVID-19?


In the outpatient setting, we are currently testing patients who have cough or shortness of breath with or without fever AND considered high risk as listed below:

  • Immunocompromised
  • Homeless
  • Living in a group home, residential treatment center or other congregant facility

Given ongoing community-wide spread of infection, we are no longer testing based on travel or other epidemiologic links. In patients with symptoms compatible with COVID-19 and none of the above risk factors, and mild disease that does not require hospital admission, we are not testing.

What does Children’s Mercy define as immunocompromised?


Immunocompromised is defined as primary immune deficiency, cancer, hematopoietic cell transplant, solid organ transplant, other immunosuppressive drugs (including chronic corticosteroids), single ventricle heart patients at any stage, hemodialysis, and advanced HIV. WHY: There may be an alteration in care for the patient with any of the above conditions. NOTE: Neonates and infants without any of the above conditions are NOT considered immune compromised.

Can community providers order COVID-19 testing through Children’s Mercy?


No. If you have a patient that needs testing, you can perform the test and send it directly to your reference lab of choice.

Is a Children’s Mercy physician order required to obtain the COVID-19 test?


No. Testing in your practice does not require any involvement or order form Children’s Mercy. It can be performed by any provider and sent directly to a reference lab.

Why are your testing criteria so strict?


We are doing all we can to limit the spread of possible infection. Adhering to our current testing criteria also helps us be careful and cognizant of our testing and PPE supplies.

Are the COVID-19 testing kits the same as viral media tests used for viral culture? If we were to test clinic staff who have a fever, or some other clinical situation where a test was indicated, do we need to use an NP swab?


Testing can be performed by nasopharyngeal (NP) swabs in your office. These are the same swabs that are used for influenza testing. Though the CDC website says a nasopharyngeal swab, a mid-turbinate swab, is also appropriate. The swab needs to be placed in viral transport media and then sent to the testing facility that you are using. You can use the same swabs for healthcare workers that you use for your patients. Specimens can be sent to your reference laboratories.

What is the protocol for Children’s Mercy employees who are ill with confirmed COVID-19? How many days are they out?


We are testing employees who have new onset cough or shortness of breath, with or without fever. We are requiring employees to remain at home for 7 days or 72 hours following fever resolution (without fever reducers) and asymptomatic, whichever is longer.

What is the current false negative rate for COVID-19 testing?


We don’t have data on the false negative rate. The commercial lab Children’s Mercy is using has not published its sensitivity and specificity for the test. They report it to be quite good.

How can we get a handle on the nature of COVID-19 in our community if we are not testing individuals? Doesn’t it seem like it’s time to start doing more testing so we can understand the spread throughout the community?


Supplies needed to perform testing and testing capacity remain limited at this time, both in the KC area and nationally. Therefore, testing is being prioritized for the most ill patients and those are at highest risk for development of severe disease. As testing supplies and testing capabilities increase, we will continue to re-evaluate which patients are being tested.

Is there any scientific correlation between acquiring COVID-19 and blood type?


Blood groups have long been associated with susceptibility to various infections. The current report has not yet been peer reviewed by the scientific community, so the data are not clear. At this time, we do not know that any patient is more or less at risk for COVID-19 based on their blood type.

Who is considered high-risk for acquiring COVID-19 as a healthcare provider? How can they best protect themselves when caring for patients (whether the patient's exposure to COVID-19 is known or not)?


People who are most at risk are the elderly and those with underlying chronic medical conditions. They have the highest risk of severe infection. The best way to protect yourself is to wash your hands before and after every patient. Wear the PPE you have access to for all respiratory patients and clean the room and equipment well after each patient.

Why are we seeing so much community spread if the transmission rate is less than 1% with prolonged contact within 6 feet of others?


With a population of 2 million people in the Kansas City area, there are still going to be COVID-19 cases even if the transmission rate is low. That’s why the stay-at-home order is so important. We will decrease the spread by people staying at home and away from each other.

What are the risks of COVID-19 transmission between pregnant mothers and their newborns?


There is no data on COVID-19 presence in amniotic fluid or breast milk. There have been two reported cases of infants being COVID-19-postitive shortly after birth, but it is unclear how that transmission happened.

CDC guidelines are available about pregnant patients with COVID-19 and the labor and delivery process, including handling the baby after birth.

When seeing newborns in your practice, we recommend separating them from the sick population.

What is the guidance on ibuprofen and acetaminophen use in children with suspected COVID-19 to reduce fever?


In line with most major medical societies, we are using ibuprofen and acetaminophen as fever reducers. The World Health Organization temporarily recommended no ibuprofen usage with COVID-19 but then changed its stance 24 hours later since there is such limited information and no data to support it.

What is the guidance on treatment of COVID-19 with hydroxychloroquine and/or azithromycin? Are any data available on this?


There is very scant data that isn’t great, and there have been reports of prolonged QTc with the combination and with hydroxychloroquine alone. We need to carefully consider this before using it.

Does maintenance treatment with ACE inhibitors for hypertension play a role in worsening COVID-19 symptoms?


There is a concern that the use of ACE inhibitors in general can result in a worsening COVID-19 course of illness. This is due to the data coming from the adult populations. However, even in the adult world, the medical society for hypertension reported a statement that there is not enough data to change patients medication at this time and they should remain on an ACE.

Should we consider antibiotics for a patient suspected of having pneumonia and considered PUI with findings of bilateral consolidation on the X-ray?


While we are learning more about co-infections with COVID-19, and these certainly occur, unless a patient has a lobar consolidation, we would not recommend immediately starting antibiotics. Many viruses cause pneumonia, and this is much more common than bacterial pneumonia.

Does the first case of COVID-19 in a family tend to be lighter than subsequent ones?


We are not aware of any data on this topic. However, most infections tend to be mild to begin with.

What other viruses are we seeing right now other than the flu?


We are seeing regular coronaviruses, rhinovirus, a little parainfluenza and some human metapneumovirus.

If a patient has a cough and a fever, plus known COVID-19 exposure, what do we tell them to do? 


Patients with known exposure and compatible symptoms should be assumed to have COVID-19. Children with mild disease symptoms do not require testing and can be managed at home with supportive care and home quarantine. PPE should still be worn in caring for those children, as well as proper room cleaning and thorough hand hygiene.

What should I do if I have a patient who has severe symptoms of COVID-19?


Use the same parameters that you would normally use to refer a patient for care. These may include need for oxygen or IV fluids. Please call the hotline at (816) 302-8800 to refer your patient for admission or consultation prior to their arrival.

When do I refer a patient with suspected COVID-19 to Children’s Mercy?


Children who are dehydrated or are having difficulty breathing can be referred to Children’s Mercy. If you need to speak with a physician because your patient has severe enough symptoms that warrant them to be seen in the ED or Urgent Care, call the hotline at (816) 302-8800 for admission or consultation prior to their arrival.

What are the treatments for children with COVID-19?


There is no current evidence from randomized controlled trials to recommend any specific anti-COVID-19 treatment for patients with suspected or confirmed COVID-19 infection.

Currently, supportive care alone is being recommended for children not requiring hospitalization.

Prophylaxis is not recommended for COVID-19.

If a child requires hospitalization due to COVID-19, Infectious Diseases physicians will be involved to consider treatment options.

What should we do when sending a patient to Children’s Mercy Radiology?


Do not send patients with suspected COVID-19 to radiology for a diagnostic CT or CXR. Viral testing remains the only specific method of diagnosis for COVID-19. Call Children’s Mercy Radiology at (816) 234-3270 in advance of sending a sick patient for radiology testing and provide the office’s/provider’s contact information.

 

What is the typical clinical course for COVID-19 infected children who end up having symptoms severe enough to require hospitalization? Do they tend to deteriorate quickly? What percentage of children admitted for complications of COVID-19 end up requiring ICU care? Can I refer patients to Children’s Mercy just for the purposes of conserving local resources?

In studies from China, less than 1% of children end up in the ICU. In one study, only 2% were hypoxemic. Fever and respiratory symptoms are generally milder than in adults. Admitting a child with COVID-19 would be reasonable at your local hospital as few children progress to need ICU care. However, we recognize that regional hospitals, who primarily see adults, may become at capacity with ill adults. Children’s Mercy is happy to have a child transferred to us, in order to conserve local resources. If this is needed, please call 1 (800) GO-MERCY.

How long should patients stay in home isolation?


The decision to discontinue home isolation should be made in the context of local circumstances. Options now include both 1) a time-since-illness-onset and time-since-recovery (non-test-based) strategy, and 2) a test-based strategy.

Time-since-illness-onset and time-since-recovery strategy (non-test-based strategy)*
Persons with COVID-19 who have symptoms (including physicians and providers) and were directed to care for themselves at home may discontinue home isolation under the following conditions:

  • At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and,
  • At least 7 days have passed since symptoms first appeared.

*This recommendation will prevent most, but may not prevent all, instances of secondary spread.  The risk of transmission after recovery, is likely very substantially less than that during illness.

CDC recommendations can be found here.

What can we tell parents who have remained home to care for children who were quarantined for COVID-19 about returning to work?


If the parent/caregiver is still asymptomatic at the time that the child is better, according to the CDC guidelines, they can come out of isolation to return to work. The risk of infection for the caregiver is low at that point, as most people have symptoms within five days of exposure.

What is Children’s Mercy communicating to its employees about working if they have a COVID-19 positive family member at home?


If the family member is asymptomatic, they can return to work according to the CDC and KDHE guidelines. The employee will continue to monitor for any symptoms and should not come to work sick.

Can you explain the criteria for when a physician can return to work if they tested positive for COVID-19?


The CDC states the following:

Return to Work Criteria for HCP with Confirmed or Suspected COVID-10
Use one of the below strategies to determine when HCP may return to work in healthcare settings

Test-based strategy
Exclude from work until:

• Resolution of fever without the use of fever-reducing medications, and
• Improvement in respiratory symptoms (e.g., cough, shortness of breath), and
• Negative results of an FDA Emergency Use Authorized molecular assay for COVID-19 from at least two consecutive nasopharyngeal swab specimens collected ≥24 hours apart (total of two negative specimens).

See Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens for 2019 Novel Coronavirus (2019-nCoV).

Non-test-based strategy
Exclude from work until:

• At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and,
• At least 7 days have passed since symptoms first appeared

If HCP were never tested for COVID-19 but have an alternate diagnosis (e.g., tested positive for influenza), criteria for return to work should be based on that diagnosis.

There are reports of afebrile adults with COVID-19. Does that change return to work guidelines for health care workers?


No. The return to work is afebrile and near resolution of symptoms for 72 hours or after 7 days, whichever is longer.

How long should kids stay out of daycare?


For a child with symptoms concerning for COVID-19 or illness consistent with COVID-19, the non-testing based method recommendation from the CDC states they should stay out of daycare for a minimum of 7 days with the caveat that they also need to be fever-free for 72 hours and have near-symptom resolution, including cough and shortness of breath.

What are the risks to children who continue to attend daycare?


The risk of attending daycare is the same as it always has been. There is risk of exposure to many viruses, both respiratory and GI, in daycare.

What are the current visitor restrictions?


Children’s Mercy has implemented full visitor restrictions to keep patients safe:

• No visitors, including sibling visitors.
• Parents/guardians are not considered visitor
• Parents/guardians must be free of respiratory symptoms and fever to be in the hospital.

You can view the full COVID-19 visitor restrictions for Children's Mercy here.

Can parents get tested at Children's Mercy?


Children's Mercy is unable to provide COVID-19 testing to parents.

Are Children's Mercy Primary Care Clinics changing any procedures or cancelling appointments at this time? Are PCCs continuing with normal visits and well-child checks?


Our Primary Care Clinics are continuing to see children who need immunizations and doing well-child checks. Sick and well visits are being seen on different floors of the PCC.

We are continuing to see any newborns under 30 days and giving the option for 2-month, 4-month, 6-month, 12-month and 15-month well-child visits to come in, or come in for shots only. We are not scheduling any other new appointments. We are contacting patients who already have well-child appointments scheduled to see if we can reschedule after April 30 or converting to telemedicine/phone calls when possible.

We would not recommend delaying live viral vaccines. Children should continue to attend their well visits to keep up with their vaccinations.

Is Children's Mercy Home Care still providing home services?


Children’s Mercy Home Care is continuing all service lines as normal, while beginning to incorporate telehealth visits when appropriate. Given the current situation related to COVID-19, some families have declined outside guests into their homes. We are happy to be able to offer telehealth visits to support the medical progression of the patient while keeping the patient and family’s safety top priority.

There are some visits that won’t include a telehealth option, such as admission visits, infusions and lab draws. Our staff have proper PPE and will continue to service these patients in their home.

Children’s Mercy Home Care service lines include:

  • Nursing
  • Physical therapy
  • Occupation therapy
  • Speech therapy
  • Social Work
  • Pharmacy
  • DME
  • Respiratory therapy

Are Children’s Mercy specialty clinics considering virtual visits?


Children’s Mercy is starting virtual visits. We’ve eliminated non-essential visits to protect our patients and keep them at home as much as possible. We will be ramping up virtual visits for specialty clinics over the next several weeks.

In order to help keep patients as safe as possible, we are working to reschedule some of our specialty clinic visits and elective surgeries. If a patient’s appointment needs to be changed, our team will be reaching out to families directly. We appreciate your understanding as we work to keep patients and staff safe and prevent the spread of COVID-19.

Clinic Scheduling


We continue to accept referrals from community physicians and providers through our web referral form

Once a referral is received, Children’s Mercy will call the family to notify them we have the request from their PCP. Once COVID-19 scheduling restrictions are lifted, then Children’s Mercy will call the family back to schedule the patient in the specialty clinic.  

To keep patients and our own providers safe, we are limiting in-person specialty clinic visits at this time to reduce COVID-19 exposure risk.  

If an urgent referral or consultation is needed, call 1 (800) GO MERCY / (800) 466-3729 to speak with one of our on-call pediatric subspecialists who will triage your request and help facilitate scheduling as soon as possible. We are committed to helping community providers connect with subspecialists to ensure patients receive the care they need. 

Locations

Primary Care Clinics at Broadway and Children’s Mercy West

Children’s Mercy primary care clinics are postponing appointments or converting to telemedicine/phone calls when possible. We are continuing to see any newborns under 30 days and giving the option for 2 month, 4 month, 6 month, 12 month and 15 month well-child visits to come in or come in for shots only. We are not scheduling any other new appointments. We are contacting patients who already have well-child appointments scheduled to see if we can reschedule after April 30.

Children's Mercy locations that are temporarily closed:

  • Children’s Mercy specialty clinics at Olathe Health System
  • Children's Mercy speciality clinics at University of Kansas Health System 
  • Children's Mercy Hospital Kansas inpatient unit
    • Children’s Mercy Hospital Kansas continues to operate the Emergency Department, Radiology, Laboratory, Pharmacy as well as limited outpatient clinics and surgeries. 

Surgery


In keeping with American College of Surgeons recommendations, we are cancelling all elective surgeries at this time. Families are being contacted regarding cancellations and we will follow up directly with them when we are able to reschedule.

Should we continue to schedule well checks, ADHD and other follow-ups?


Many practices have moved to separation of sick and well visits by splitting them morning and afternoon, or by using different entrances and waiting rooms, and in one case using different clinic floors for sick and well. Children still need to get their vaccines and have well visits. We need to consider that this is likely to be going on for some time and thus we still need to provide necessary care. If there are visits that can be postponed or rescheduled, then it is a good idea to do so.

Why are you closing inpatient care at Children’s Mercy Kansas?


After careful consideration, we’ve decided to centralize all inpatient care to Children’s Mercy Adele Hall Campus. This includes any confirmed COVID-19 patients who require hospitalization. We are temporarily closing the Children’s Mercy Hospital Kansas inpatient unit as of 7 p.m. (Friday, March 20). This will help conserve PPE supplies and make the best use of staffing resources. This plan is consistent with what other children’s hospitals and adult hospital systems are doing across the nation.

Children’s Mercy Hospital Kansas will continue to operate the Emergency Department, Radiology, Laboratory, Pharmacy as well as limited outpatient clinics, radiology and surgeries. Below is the current plan for specific clinic operations. We will continue to communicate with you as we have updates:

  • Epilepsy – All elective patients are canceled through April. Urgent cases will be seen at Adele Hall.
  • Sleep Lab – The Sleep lab is closed through March 31.
  • Eating Disorders – Clinical leaders are working with Hospitalists, Children’s Mercy Adele Hall Campus and Children’s Mercy Hospital Kansas Emergency Departments to develop protocol for patients. Urgent patients will be referred to Children’s Mercy Adele Hall Campus for admissions as needed.

We appreciate your flexibility and will continue to notify you of any upcoming changes.

Are there any other Children’s Mercy locations that are closed?


Based on CDC and national guidelines we have closed our Olathe and University of Kansas Health System locations during the COVID-19 crisis. Doing so will allow us to conserve supplies, hospital beds and health care providers to care for those affected.

Is it appropriate for asthmatic patients to continue inhaled steroids for those who currently take twice daily in Green Zone?


Yes, patients should continue all their typical asthma related treatments.

What about starting inhaled steroids in Yellow Zone?


If a patient is having an asthma exacerbation, we would recommend they follow their typical asthma action plan for the Yellow Zone.

Is it appropriate to perform albuterol nebulizer or should all reactive airway patients perform Albuterol inhaler only?


If the patient has asthma and the symptoms are not concerning for COVID-19 (typical asthma symptoms), albuterol nebulizers are fine.

How are you managing asthmatic patients during COVID-19 pandemic?


Children’s Mercy is handling asthma patients in the Emergency Department in the following way:

  • If a child has isolated wheezing and they are not thought to have a viral URI, they are not being tested.

  • If a child has asthma and their viral URI has kicked off an asthma exacerbation, and they get admitted to the hospital, then they do warrant testing.

  • If a child with URI symptoms and asthma comes to the ER and they are not admitted to the hospital, they are not being tested.

Regarding albuterol administration, we have changed some of our practices due to the concern around aerosolization. As much as we can, children with viral symptoms, where COVID-19 is suspected as a possibility, we are trying to limit albuterol use to metered dose inhalers (MDI). Children who have an asthma exacerbation and NO viral URI symptoms are now receiving albuterol nebulizers in an attempt to conserve the MDIs for the COVID-19 suspected patients.

In children requiring treatment continuous nebulizer, you can do puffs of albuterol, four or eight puffs (depending on age and weight) every 20 minutes, and the amount of albuterol they receive is the same as an hour of continuous nebulizer.

Children with suspected COVID-19 that are receiving treatment with nebulizers use a special filter on their nebs. Our health care providers wear an N95 instead of the surgical mask, in addition to all other required PPE. We also wear the N95 for an hour after the aerosolization procedure due to the air exchange in the room.

Is it ok to use inhaled steroids with asthma patients, even if they have COVID-19 symptoms?


It is still okay to treat asthma the way it needs to be treated with inhaled steroids. You’re also still okay to use a 3-to-5-day burst for asthma, croup, or anything else you would use short-course steroids to treat.

What is the difference between aerosolization with NEBs and a patient coughing?


With nebs, you have a continual aerosolization for the 10-15 minutes it takes to treat. A cough disperses relatively large respiratory droplets and aerosol treatments disperse tiny droplets that hang in the air for a while. Their mass is smaller, and they are suspended in air for a longer period of time, whereas larger droplets drop within 6 feet.

Do you expect to see an increase in child abuse cases due to stress on families? Are you preparing for extra screening procedures? What about trauma injuries and even anxiety?


With more kids out of school and staying at home, we may unfortunately see an increase in child abuse cases. We encourage community physicians and providers to watch for the signs and conduct thorough skin exams. We may be the only people in the community to see these children because teachers and school faculty are not able to look out for their well-being right now.

Our Emergency Department is also expecting an uptick in trauma. With warmer weather and kids going outside to play, we may see an increase in broken bones, lacerations, abrasions and head traumas. We may see more trauma cases than COVID-19 cases.

We also expect more questions around fear and anxiety. Children may be anxious about parents, grandparents and relatives getting sick. Children's Mercy has resources available on our website.

Is it safe to travel?


The CDC is your best resource for information travel safety based on assessment of potential health risks involved in travelling to certain areas.

Are community providers able to sign up for shifts to work at Children’s Mercy?


We are currently staffed for the situation, but in preparation for future needs, we would like to know if you or other members of your practice are willing to see patients in one of our ambulatory or urgent care sites. Please email Dr. Laura Fitzmaurice if interested at lfitzmaurice@cmh.edu.

Do you have any tips for how to present proof that we are physicians or providers in case we are pulled over by law enforcement for being “out of home?”


Children’s Mercy employees are being encouraged to show their employee badge. We recommend that physicians utilize their wallet size proof of physician licensure. For other staff, they could present clinic identification (e.g., badge) or other verification of licensure.

Do you expect pediatric practices to see an uptick in regular appointments in the coming weeks?


By continuing to practice social distancing and adherence to the stay-at-home order, we will hopefully see a decrease in spread of disease. That may mean an uptick in regular appointments at pediatric practices.

Our patient volume at Children's Mercy, including at our Emergency Department, is low. We do not expect our hospital visits to increase dramatically like those expected at adult hospitals.

Webinars from the American Academy of Pediatrics:

Our Pediatric Ethics Podcast series features Children's Mercy specialists and other pediactric experts from across the globe covering topics that are changing pediatric ethics.

The Kansas Department of Health and Environment has put together a helpful chart that breakdowns the various symptoms of COVID-19, the common cold, the flu and allergies.

Special issue of The Link newsletter: