Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Pediatric emergency care during a time of strict social isolation

Lisa Uherick, MD
Physician
June 18, 2020
76 Shares
Share
Tweet
Share

I am a pediatric trained emergency physician working in a level 1 trauma center.  Our region is not an epicenter for COVID-19.  Like many pediatric departments, our volumes are returning but were less than half of normal for months.  Social distancing has not only flattened the curve for COVID-19, but it has also made our usual summer viruses all but disappear.  Where are all the enteroviruses?

In pre-COVID times, after a good history and physical exam on a well-appearing, febrile child, I could confidently say, “It’s a virus.”  I could also confidently say the same on a listless child who perked up after antipyretics and oral fluids.  Most of the time, I was right, as the odds were on my side.  In my personal experience over the last few months, my confidence in this statement, “it’s just a virus,” has waned.  I believe that this is because the odds have changed.   I have no data to back up this opinion, although I have colleagues who share it.

First, I am finding it more difficult to reassure parents that their child has a virus when they have been careful to socially isolate.  Obviously, there are still grocery carts and handrails, so the incidence of viral infections is not zero.  Many families, however, have been good about staying home and limiting contact.  Curiously, I find myself siding with the parents and saying, “I share your concerns.  Where is the fever coming from?  Could we be missing something else?”  I recognize that I am in a higher alert state.  We all are.

With less person-to-person contact and infections being less common overall, the percentage of more serious infections seems to be higher.  Since the pandemic started, I find that a febrile child with no obvious source is much more likely to have a UTI, occult pneumonia, or a tick-borne illness.  I find myself wanting to check blood work when I have spent my career educating others on the lack of utility of such tests in healthy children.  The other day, when a child did not perk up as quickly as I expected, I ordered a CBC and blood culture, and then considered a dose of Rocephin.  I felt like I had time-warped to the 1980s.  I can feel my practice changing, at least temporarily.

Sick children have always existed.  The art of pediatric emergency medicine is in finding the preverbal “needle in a haystack.”  We strive for a healthy balance of doing just enough to save the one who needs it but not too much for those who will improve on their own.  I suspect the research that we usually use to decide the relative risk is not as accurate during this unique time in history.  For example, I would make an educated guess that the percentage of patients who present with abdominal pain who have acute appendicitis is higher currently.  Similarly, the baby who has a fever and vomiting is more likely to have a urinary tract infection today than she was six months ago when acute gastroenteritis was prevalent.  Research and guidelines will have trouble keeping up with our dynamic clinical environment.

The other contributing factor is the public’s fear of seeking health care during the pandemic.  They are weighing the risks and benefits of coming to the emergency department in a way that they have not had to do before.  The last thing that they want is to come in with a stomachache and leave with COVID-19.  Theoretically, this has also decreased the number of lower acuity cases, making serious diagnoses that require acute intervention more likely.

I imagine that as schools resume, our epidemiology will revert closer to normal.  I hope that my instincts and confidence return as quickly.  I had become comfortable practicing pediatric emergency medicine in the pre-COVID, post-vaccination era.  During these unchartered times, I will continue to be a bit more suspicious and perhaps more cautious before diagnosing an acute viral illness.  I believe that this practice change is justified and perhaps necessary.  At the very least, it is understandable.

Lisa Uherick is a pediatric emergency physician.

Image credit: Shutterstock.com

Prev

When COVID hits memory care

June 18, 2020 Kevin 1
…
Next

4 things people should know about COVID-19 antibody testing

June 18, 2020 Kevin 1
…

Tagged as: Emergency Medicine

Post navigation

< Previous Post
When COVID hits memory care
Next Post >
4 things people should know about COVID-19 antibody testing

Related Posts

  • How social media can help or hurt your health care career

    Health eCareers
  • Why social media may be causing real emotional harm

    Edwin Leap, MD
  • A physician’s addiction to social media

    Amanda Xi, MD
  • Are negative news cycles and social media injurious to our health?

    Rabia Jalal, MD
  • How I used social media to get promoted to professor

    David R. Stukus, MD
  • Denying payment for emergency care: a physician defends insurers

    Michael Kirsch, MD

More in Physician

  • The hidden gems of health care: Unlocking the potential of narrative medicine

    Dr. Najat Fadlallah
  • The dark side of immortality: What if we could live forever?

    Ketan Desai, MD, PhD
  • It’s time for C-suite to contract directly with physicians for part-time work

    Aaron Morgenstein, MD & Corinne Sundar Rao, MD
  • From rural communities to underserved populations: How telemedicine is bridging health care gaps

    Harvey Castro, MD, MBA
  • From solidarity to co-liberation: Understanding the journey towards ending oppression

    Maiysha Clairborne, MD
  • Finding peace through surrender: a personal exploration

    Dympna Weil, MD
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • Why it’s time to question medical traditions [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden gems of health care: Unlocking the potential of narrative medicine

      Dr. Najat Fadlallah | Physician
    • The realities of immigrant health care served hot from America’s melting pot

      Stella Cho | Policy
    • The dark side of immortality: What if we could live forever?

      Ketan Desai, MD, PhD | Physician
    • Lazarus: the dead man brought back to life

      William Lynes, MD | Conditions
    • Revolutionizing COPD management with virtual care solutions [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Doc Moms, Mind the Gap -- $3M Earning Difference by Sex
  • Clinical Note Writing App Powered by GPT-4 Set to Debut This Year
  • Helping Patients Get Fit -- One Walk at a Time
  • TB Cases Rebound to Near Pre-Pandemic Levels, CDC Data Show
  • Marginalized Groups May Benefit More From Decreasing Air Pollution

Meeting Coverage

  • Switch to IL-23 Blocker Yields Deep Responses in Recalcitrant Plaque Psoriasis
  • Biomarkers of Response With Enfortumab Vedotin in Advanced Urothelial Cancer
  • At-Home Topical Therapy for Molluscum Contagiosum Gets High Marks
  • Outlook for Itchy Prurigo Nodularis Continues to Improve With IL-31 Antagonist
  • AAAAI President Shares Highlights From the 2023 Meeting
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • Why it’s time to question medical traditions [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden gems of health care: Unlocking the potential of narrative medicine

      Dr. Najat Fadlallah | Physician
    • The realities of immigrant health care served hot from America’s melting pot

      Stella Cho | Policy
    • The dark side of immortality: What if we could live forever?

      Ketan Desai, MD, PhD | Physician
    • Lazarus: the dead man brought back to life

      William Lynes, MD | Conditions
    • Revolutionizing COPD management with virtual care solutions [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...