Since March 6, Texas Children’s Supply Chain Team has worked hard to ensure the organization has enough supplies to care for our patients during the COVID-19 pandemic. Now, four months later, Texas Children’s is still going strong.
With the increasing demand for N-95 masks and other personal protective equipment (PPE), the hospital’s PPE supply has grown significantly since the COVID-19 pandemic began. In early March, Texas Children’s had 10,000 N-95 masks on hand. As of July 22, the organization has 521,000 N-95 masks, which is the largest supply of masks in the Texas Medical Center. The Supply Chain also secured 3 million procedure masks and 1.2 million isolation gowns.
Much of this success is credited to the Supply Chain’s multi-tiered strategy for acquiring products. Texas Children’s obtains PPE in many different ways. The organization can source it through our Group Purchasing Organization (GPO), which most hospitals in the country do, or it can go out into the marketplace to secure aggressive deals.
“Prior to the COVID-19 pandemic, Texas Children’s primarily acquired N-95 masks from a single company,” said Bert Gumeringer, Texas Children’s senior vice president for Facilities Operations. “Since the pandemic, we are now sourcing PPE from three different U.S. suppliers, which has eliminated our need to purchase PPE product from China. If one of our suppliers can’t provide us with PPE, we have two other resources to meet our needs.”
Gumeringer and other leaders meet at least twice a week to discuss PPE and stay abreast of new developments in the global market. They meet daily with our PPE suppliers to discuss plant status, FDA approvals and incoming shipments. Despite rumors of PPE shortages swirling on social media, Gumeringer says there is no shortage.
“There is PPE out there if you know how to acquire it,” Gumeringer said. “Our Supply Chain team is doing an excellent job of helping us acquire product so we can support patient care. We have a good system in place.”
While Supply Chain continues to grow our PPE inventory, Dr. Judith Campbell says it is important for employees and staff to be mindful of their use of PPE and engage in conservation practices as much as possible. Many organizations like Texas Children’s are using a lot of PPE , especially N-95 masks.
“We are using 2,500 N-95 masks per day, which is the highest usage rate in the Texas Medical Center,” said Campbell, medical director of Infection Control and Prevention at Texas Children’s. “To conserve our supply, we encourage our staff to use a clean procedure mask over their N-95 when an N-95 mask is recommended, for example, when seeing a patient under investigation (PUI) for COVID-19. After evaluating the PUI, remove the outer procedure mask, to extend the use of the N-95 mask.”
Campbell says if we all do our part, we can conserve the N-95 masks and other PPE supplies that we do have, which will help us in the months ahead during this pandemic.
Click here for PPE guidelines on the extended use of N-95 masks in certain patient care locations.
So many teams at Texas Children’s have stepped up in remarkable ways since the COVID-19 pandemic began. The Section of Palliative Care (Pediatric Advanced Care Team) is no different. In fact, this often unsung group has proven its value like never before as families desire more connection, enhanced communication and extended conversation.
The multidisciplinary team of 23 serves Medical Center Campus, West Campus and The Woodlands hospitals.
“We provide an extra layer of support for families and patients who are going through an illness,” said Claire Crawford, palliative care social worker. “We help with non-verbal expressions of compassion in the absence of touch, which has been in exceptionally high demand since the pandemic began.”
Crawford adds that with new visitation guidelines, parents are often alone when they receive news that’s hard to hear. Therefore, there is a need for even more support. “On top of that, our nurses and doctors are often delivering this news while wearing masks, goggles and other protective equipment so it is even more challenging for them to convey their empathy. This is where we come in.”
Crawford says the team can consult with other health care workers to ensure that dialogue with families is compassionate and connective.
In addition, the goals of the department are to:
Provide emotional support for children and families
Provide support for difficult hospitalizations
Manage distressing symptoms
Engage social work resources
Help families make difficult decisions
Refer to supportive therapies (psychology, music therapy, art therapy, and Pawsitive Play) for patients
Enhance quality of life
Utilize integrative medicine techniques
Doesn’t palliative care mean “end of life?”
One of the department’s main goals is to educate our patient population on their role and to debunk the myth that palliative care always means that a child may die. “It is true that our services in an adult setting often do mean that the end of life is near, but that is far less the case in a pediatric setting,” said Crawford. “Of course, there are times when we do need do have those discussions, but we are working hard to make sure that when parents hear our name they don’t automatically assume the worst.”
A Texas Children’s dream team
This all-star team is led by Dr. Tammy Kang, section chief of Palliative Care and consists of palliative care specialists, including:
Doctors
Nurses and nurse practitioners
Social workers
Chaplain
Grief and bereavement specialist
Administrators
Psychologist
Researchers
Crawford said the success of the team is built on respect for one another, friendship and an unyielding dedication to provide the best care to patients.
July 20, 2020
Care coordination at Texas Children’s – an already challenging job – has become that much more challenging as COVID-19 cases surge in the Houston area. But in true #oneamazingteam fashion, the team of 52 has risen to the occasion and continues to support their multidisciplinary counterparts.
“The entire team is working remotely,” said Jennifer Thorpe, Director of Care Coordination at main campus. “However, with the help of technology and innovative leadership we are remaining successful.”
The department has two primary responsibilities – first, patient care coordination. This means to effectively prepare families for condition management outside of the inpatient setting. The team focuses on timely and safe discharges that prepare families for appropriate management of their conditions.
Secondly, the team is focused on Utilization Management, which is the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities. In other words, how are services, procedures and facilities being used by a patient? And are these uses necessary, appropriate and efficient? The team focuses on centralized utilization reviews, length of stay management, payer relationships, daily review of observation patients, and authorizations.
“The ability to deliver exceptional care in an effective and cost-efficient way is always the first priority for Texas Children’s,” Thorpe said. “Care coordinators are at the heart of that priority and our resolve is stronger than ever.”
While Thorpe’s team serves main campus patients, there are care coordinators across the system including the health plan team lead by Ashley Simms, the West Campus team lead by Kara Abrameit and The Woodlands team led by Julie Barrett. They all work closely to support one another.
The Department of Care Coordination also has access care coordinators located in the emergency center at Main, West and Woodlands campuses. The access care coordinators focus on patient access at the point of entry, the review for appropriate status, the coordination of admissions, transfers, direct admissions activity at specific locations and partnering with interdisciplinary care teams.
Intended outcomes as defined by Care Coordination success measures are:
Decreased Emergency Center admissions for established patients with chronic conditions.
A decrease in duplication of efforts for the same patient across the system.
A tracking of referrals to community based organizations with appropriate follow up and gap closure.
The use of predictive analytics to decrease high cost care and unnecessary utilization of services based on what has happened to provide a best assessment of what will happen in the future.
Identification of off the scale “outliers” to rising risk conditions that drive cost and work across the system to close care gaps.
An increase in linkage to community based organizations for social determinants of health and tracking of ‘community’ data alongside clinical and claims data to measure intervention care impact on patients with chronic diseases.
Management of length of stay via the use of the 3M bi-directional interface.
The utilization of patient stratification to look for and intervene on high-risk or determined risk families.
Racial justice in health care
In addition to COVID-19, care coordinators are also positioned to respond to our society’s recent focus on racial and social justice. The Department of Care Coordination reports to Senior Vice President Tabitha Rice. Tabitha lives the core values of Texas Children’s and believes in racial, religious, and gender equality. This is evident in her ongoing efforts to champion change as well as the department’s response to identified socioeconomic barriers in vulnerable and underserved populations. As part of the department’s response, they have reignited efforts to adopt a new electronic platform called “Aunt Bertha,” which serves as a portal for valuable resources.
“A large number of racial minorities are included in groups that face socioeconomic issues,” Thorpe said. “When you are facing challenges with literacy, parenting, employment, or live in a food desert, this can affect your overall ability to stay healthy.”
With just a click of a button, Aunt Bertha would allow families to access social service information such as rental assistance, food assistance, mental health services and much more. Thorpe said there are discussions about how to integrate this platform with Epic and MyChart.
The future of care coordination
Prior to the COVID-19 pandemic, the department had excitedly partnered with Dr. Jennifer Sanders, Gail Vozzella and Dr. Michelle Lyn on the initial phases of the Care Coordination Center, a separate Texas Children’s facility that would serve as a care continuum hub between inpatient and outpatient. Phase one goals for the Care Coordination Center include:
All non-TCHP Tier 1 Star Kids patients discharged from an inpatient stay at the hospital will receive a standardized discharge follow-up phone call within 72 hours to ensure they understand their discharge instructions and follow-up visits.
Ensuring continuity of care across health care settings by establishing a standardized process to ensure appointments are made prior to discharge.
Centralizing the process of obtaining Durable Medical Equipment to meet the therapeutic benefits of patients in need and enhance provider satisfaction.
The aim of the Care Coordination Center is to offer one consistent place for patients, families, providers or designees to receive 24/7 high touch coordinated services for recipients of healthcare within the Texas Children’s system. Although the timeline for moving in has been adjusted, those plans are still in the works.
Thorpe reminds the organization that although there are teams 100 perent dedicated to this work, Care Coordination is ultimately the responsibility of both clinical and non-clinical employees throughout Texas Children’s.
When care coordination is done well, we are all adhering to the key elements:
Having a shared care plan that forces us to think through responsibilities and potential problems ahead of time.
Communicating with patients by explaining treatments, procedures and necessary follow-up actions.
Communicating between providers and care givers by telling all the details of the patients’ story when performing a hand-off.
Transitioning a patient efficiently between areas within our system or between their stages of care.
Organizing a patient’s care for their convenience by taking into consideration things like scheduling, transportation, supplies, medications, etc.
Using community resources effectively.
Multidisciplinary team members can access Spok to identify their unit’s assigned Care Coordinator each day. The Care Coordination team is available Monday through Friday 8 a.m. to 5 .m.p and on call until 11 p.m.
Greetings, team. My highest hopes are that everyone is staying safe as we continue to live within a new world order. My last edition of Hayes on the Health Plan was published in April when life with the coronavirus was brand new. In that post I wrote tips on how to work from home effectively.
Since then, my colleagues and I have written numerous articles about our organization’s efforts to adapt to life with the virus. We have also published stories about departments within Texas Children’s Health Plan that are exceeding expectations in phenomenal ways. Speaking of phenomenal, we think it’s pretty phenomenal that our newest department – only five months old when the virus hit – has continued to grow and thrive in spite of a global pandemic. Today, I want to introduce you to the newly created Department of Pharmacy.
Director Peter Peter recently took the time to answer a few of my questions. His answers give us an inside view into the work his department does to keep members healthy, operations efficient and costs manageable.
Q: What is the role of the Pharmacy Department at Texas Children’s Health Plan? A: Director of Pharmacy is a new position, as my predecessor was overseeing both Quality and Pharmacy. Historically, pharmacy at the health plan was seen as a clinical role focusing on medication appeals and provider outreaches. Under my leadership, it is more of an operations role. My department is responsible for overseeing pharmacy benefits for all our members. We also oversee Navitus, our pharmacy benefits management company. In addition, we partner with the Medical Policy team to make sure that medications processed through medical benefits are configured in compliance with the Texas Medicaid Providers Policy Manual (TMPPM). In addition to clinical, there are significant compliance, quality, financial, advocacy, and innovation opportunities that exist within the Health Plan, Texas Children’s system and Texas Medicaid. The health plan is in a unique position because of its access to the hospital system, care coordinators, medical data, and community status compared to other managed care organizations.
Q: How big is the Pharmacy Department and what are the roles of the employees? A: We are a team of two. I started as the Director of Pharmacy in October 2019. Jerry Wong is the Managed Care Pharmacist, and he started June 2020. I am looking to expand the department with several more employees. The specific roles are still being finalized, but will focus on data analysis, project management, interdepartmental coordination, auditing, and clinical program development. I’m also looking to consolidate some tasks that are currently being handled outside of the pharmacy department.
Q: How does the Pharmacy Department work with the Pharmacy Department at the hospital? A: There are several opportunities to coordinate with our hospital and retail/specialty colleagues on various clinical and quality related projects. Examples include coordination of care, identifying system savings, and prescriber education. This is an area I am looking to sync with more after staffing up the pharmacy department at the health plan.
Q: What successes has the department had in recent months, weeks? Especially in light of the pandemic? A: We were able to successfully lobby the state to make formulary changes when COVID-19 shut down Texas to allow members expanded access to medications. We also identified opportunities where members were taking a brand-drug when generic alternatives existed. We launched campaigns to notify prescribers of these opportunities, which have already resulted in significant savings for the system.
Q: What is the vision for the department and what is the greatest work ahead of the department? A: Combining medical and pharmacy data is what Amazon, Walmart, CVS, and other health care organizations are racing to, but what the health plan already has in house. We are ahead in this regard. However, the greatest work ahead of us is focused on alternative payment models where pharmacies can encourage pharmacist-prescriber collaboration, improved care coordination, reduction in adverse medical outcomes, and overall savings. There are also significant opportunities to partner with the Texas Health and Human Services Commission to expand traditional “pharmacist” services and have them more involved as partners in the overall care of the member.
Q: Any fun facts or things that people would be surprised to know about this department? A: The pharmacy department oversees pharmacy benefits for over 400,000 members enrolled in STAR, STAR Kids, and CHIP across Texas.
July 7, 2020
If you hop on social media these days – or even watch the news – it’s hard not to come across conflicting opinions regarding the effectiveness of wearing masks to protect ourselves from the spread of COVID-19.
At Texas Children’s, our employees, staff, patients, families and visitors, are required to wear masks at our health care facilities for one reason – it is a simple and effective way to stop the spread of germs.
“There is numerous scientific research that touts the effectiveness of mask wearing to reduce a person’s risk of contracting or transmitting the virus,” said Chief Safety Officer Dr. Joan Shook. “It is too risky to let our guard down right now, particularly when we are supposed to care for our patients who need us the most.”
While different masks provide different levels of protection, Shook says wearing a mask covering protects everybody around you. Surgical or procedural masks, like the ones distributed at our employee screening check-in locations, provide a protective barrier that prevents respiratory droplets from being easily spread from person to person. The N-95 masks, which are required to be worn by health care staff during aerosol-producing procedures (like intubation) and when providing care to COVID-19 positive patients, have a thicker mesh and fit more tightly around the nose and mouth, providing an additional layer of respiratory protection.
In this video below, Texas Children’s employees and staff share why they wear a face mask.
With the mandatory mask order now in effect across Texas requiring face masks to be worn in public, we must do our part at Texas Children’s to protect ourselves and each other. In addition to wearing a face mask, we must:
Wash our hands frequently
Watch our distance – stay at least 6 feet from others
Hold ourselves and each other accountable
Stay home when we’re not feeling well.
“It is important that we all continue to fully comply with the safety precautions that have proven successful at combatting this pandemic not just at work, but in our personal lives as well,” Shook said. “While some people may feel it is their right to wear or not wear a face mask in public – as we have seen many times on the news and in social media – I believe everyone has a right to feel safe and protected. When we are masked, we are less likely to get sick, and more likely to reduce the community spread of COVID-19.”
When wearing a face mask at work and in public places, the mask should cover your mouth and nose completely and fit securely to your face to maximize its effectiveness. Click here to view this infographic on ways you should and shouldn’t be using your face mask.
Connecting with our patients
Face masks and other personal protective equipment (PPE) worn by staff to keep everyone safe during the pandemic has made it challenging to connect with patients and add that extra dose of warmth a smile often brings to a high-stress situation.
“Anxiety levels are typically pretty high when patients and families walk into our hospital,” said Diane Kaulen, manager of the Texas Children’s Child Life Department. “COVID-19 has added a whole new level to that, but Texas Children’s is finding creative ways to make our patients and families feel as comfortable as possible during their stay with us.”
To give patients an idea of what they look like without PPE, some Child Life specialists are wearing buttons donned with pictures of their faces. Others are reframing a child’s perspective of PPE, placing stickers of beloved characters on face shields and forming connections by asking patients if they think we look like astronauts or scuba divers or a personality of their own imagination.
Child Life Specialist Chandler Townsend’s personal favorite was when a child she was playing with told her she looked like “Forky,” the very personality that was on the coloring page they were working with.
“We here at Texas Children’s are finding innovative ways to meet the holistic needs of the hospitalized child alongside our health care teammates,” Townsend said. “No matter a patient’s level of visible anxiety, we are cognizant that there is more going on than just hospitalization/diagnoses and we continue to validate that.”
Basic comforting tools and behaviors such as physically getting down to a child’s level when you are talking to them, introducing yourself and talking through PPE and why staff is wearing it goes a long way, said Audrey McKim, an Activity Coordinator with Texas Children’s Cancer and Hematology Centers.
“I try to explain that we might be in goggles, masks and shields but those protections let us walk in their door and provide support in the ways pediatric oncology patients need,” McKim said. “This is so important in a time when so many doors shuttered.”
View a photo gallery below of the face buttons that Child Life team members are wearing to connect with patients during the pandemic.
June 22, 2020
A new nine-bay labor and delivery ward at Area 25 Health Center in Lilongwe, Malawi, is providing women a private place to give birth, and clinical workers more space to deliver the same amount of babies per year born at the Pavilion for Women.
“This is a huge step forward for our patients and our clinicians,” said Dr. Jeffrey Wilkinson, vice chair of Global Health and professor, OB-GYN and director of the Global Women’s Health Program. “It falls right in line with our goal of providing the highest quality of care to the women and children we treat through our Global Women’s Health program.”
Formed in 2012, the program is a collaboration between Texas Children’s Hospital, Baylor College of Medicine Children’s Foundation – Malawi and the Ministry of Health of Malawi. This public-private partnership leads the way in the development of transformative programs that benefit thousands of women and babies as well as scores of learners in low resource settings.
Women and children are disproportionately affected by lack of access to health care services, particularly in resource limited settings. Malawian women have some of the worst odds with 675 deaths per 100,000 live births – among the highest maternal mortality ratios in the world. By contrast, the ratio for US women is 14 deaths per 100,000 live births.
To improve these odds, the Global Women’s Health program has invested a lot of time and effort into expanding the quality and quantity of services offered at Area 25 Health Center, significantly alleviating the burden of increasing demand for maternal and neonatal services at Kamuzu Central Hospital (Lilongwe’s referral hospital) and Bwaila Maternity Hospital, the largest maternity unit in the region with 17,500 plus deliveries per year.
With the help of generous donors, a maternal waiting home, a four-room operating theater and now a new labor and maternity ward have been built to help clinicians, midwives and non-medical staff better serve the women and children of Malawi.
Each room in the new labor and delivery ward is equipped with a swinging door that leads out to a nurses’ station. One of the nine rooms has a private bath and shower. The other eight rooms share four private baths and showers, each with a sliding door for easy access.
Prior to opening the new ward, women at Area 25 were delivering their babies in a six-bed labor and delivery ward on beds lined up in one room and separated by only a curtain. Because of the cramped quarters, family members were not able to accompany or help their loves ones during delivery.
The new ward has enough space for one family member to be in the room during delivery, an accommodation that is somewhat unique in health care facilities across Malawi and sub-Saharan Africa. The old labor and maternity ward will be used for anti-labor, triage, admissions and evaluation of patients coming in for labor.
“This has been a transformational gift for the women and babies in this region,” said Dr. Ibe Iwuh, one of the OB-GYNs at Area 25. “It’s helped us not only provide high quality care to women but also to demonstrate the potential between a public-private partnership between a US academic institution, a US health care organization, and the Malawi Ministry of health.”
Dr. Chikondi Chiweza, one of the OB-GYNs at Area 25, said it’s very satisfying to see Area 25 become one of the busiest maternity wards in the area.
“Because of the waiting home, women who might have gone into labor far from a medical institution now have a safe place to wait during their last few weeks and days of pregnancy,” Chiweza said. “The operating theater has enabled us to take care of more complex patients, and the new maternity and labor ward will allow us to better meet the ever-growing demand of births and well-woman services.”
For more information about the Global Women’s Health program and Area 25, click here.
June 15, 2020
The following is based on information from a story published in TMC and a series of interviews conducted with Dr. Daniel Penny, chief of pediatric cardiology, Dr. Eyal Muscal, chief of rheumatology, and Dr. Lara Shekerdemian, chief of critical care.
In recent weeks, health experts in the United States and abroad began to notice a troubling rise in multisystem inflammatory syndrome in children (MIS-C), a condition in which various organs — such as the heart, lungs, kidneys, brain, skin, eyes, esophagus, stomach and intestines — become inflamed. Earlier this month, the Centers for Disease Control and Prevention (CDC) issued a health advisory to warn doctors about the illness, cautioning them to be on the lookout for a constellation of symptoms, including fever, abdominal pain, vomiting, diarrhea, neck pain, rash, bloodshot eyes and lethargy.
Although the exact cause of MIS-C is still unknown, experts are assessing the association between MIS-C and COVID-19, as many children diagnosed with the syndrome have been infected by or previously exposed to SARS-CoV-2, the virus that causes COVID-19.
This lag between the primary infection and the inflammatory response is what is interesting,” Penny said. “What it appears to indicate is that this is not a manifestation of the primary infection with SARS-CoV-2 itself, but rather the body’s inflammatory response to the infection.”
Texas Children’s is treating children and young adults with the syndrome and Penny is leading a cardiology clinic dedicated to those who have previously had SARS-CoV-2 infection in order to make sure that the handful of patients the hospital has already treated is not just the tip of the iceberg.
“Even if they weren’t extremely unwell in the first place,” he added, “we are bringing back these children for cardiology assessment with a cardiography in order to make sure they don’t have abnormalities of the coronary arteries that haven’t manifested clinically at this stage but could be problematic in the longer term.”
Not all children with MIS-C exhibit the same symptoms, the CDC noted, but doctors and parents should be vigilant of emergency warning signs, such as trouble breathing, persistent pain or pressure in the chest, new confusion, inability to wake or stay awake, bluish lips or face and severe abdominal pain.
Symptoms associated with MIS-C were first reported by clinicians in the United Kingdom in late April and have since been identified in other European countries and the United States, starting in New York, the American epicenter of the coronavirus outbreak. At least 17 other states have reported cases of MIS-C, including Texas, California and Washington.
Doctors believe that MIS-C is caused by an overactive immune system in response to COVID-19, leading to abnormal inflammation throughout the body. Most children recover from MIS-C after being treated with immunoglobulins to reset the immune system, steroids and immunosuppressive drugs, such as anakinra and tocilizumab; however, in rare cases, the illness can lead to death.
Understandably, this is very worrying to parents and Texas Children’s has received many questions and concerns about MIS-C. The following are some of those questions and our answers. We are sharing them with our employees because many of you are parents yourselves and might have some of the same concerns.
What are the early signs and symptoms of MIS-C and is there anything parents should be looking out for during the early stages of this condition?
Dr. Muscal: Based on experiences in Europe and the East Coast, so the places in the world that have had a head start on us here in terms of the multi-system inflammatory type of syndrome, it appears as if kids often have unrelenting fever that doesn’t really respond to traditional anti-inflammatory measures. And then, usually, a variety of other problems such as abdominal pain, vomiting, inability to keep fluids down, and then usually a variety of issues like rash, sometimes red eyes, and a general appearance of ill appearance. It appears that those are some of their early symptoms. As a child’s become more ill, perhaps he or she will have chest pain or have more difficulty with their breathing.
How common is MIS-C in children, how long does it last and how serious can it actually get?
Dr. Muscal: It appears that MIS-C is pretty uncommon, actually rare, according to some of the other cities that have had cases for a longer period. Some of the experts in New York city believe that less than 1% of the children that actually are exposed to the coronavirus and get COVID-19 seem to develop this more serious post-infectious process. It can last for days or even a couple of weeks as kids recover from it. It appears to be in many cities with more cases, that most of the cases are treated quickly and are not that serious. Though there are kids that end up in the intensive care unit and unfortunately, exceptionally rare, kids that pass away.
What ages are most typically affected, and how old are the oldest children who do get MIS-C?
Dr. Muscal: So again, with the last six weeks of knowing more about this condition, it appears that even if children have some of the features of another entity called Kawasaki disease, they appear to be a little bit older. So perhaps even teenagers that are getting this, whereas Kawasaki disease is usually a disease of early childhood. It does appear that perhaps young adults can also have features of this syndrome. Unfortunately, many adult physicians have never seen Kawasaki disease and it could be that they’re not aware of some of these signs and symptoms.
Does it seem to be that children with underlying illnesses are more prone to get MIS-C?
Dr. Penny: We don’t believe that this condition is more common in children with preexisting conditions. So what it seems to be is that a child gets the coronavirus infection, and then they get this overactive immune response to the infection. And that’s what results in this syndrome. And so this does not appear to be more common in children who have underlying diseases, such as congenital heart disease.
If a child has congenital heart disease, let’s say a relatively simple defect like an ASD or even something more complex, are they going to be at higher risk of getting MIS-C?
Dr. Penny: We haven’t seen any patients with congenital heart disease who’ve developed MIS-C in our hospital, and I think it’s quite rare throughout the world. I don’t see any reason to believe why children with congenital heart disease will be at more risk of developing the syndrome in the first place. And also, if you have well compensated heart disease, I also don’t believe there should be any particular risk to a patient if they did happen to get the condition in the setting of congenital heart disease.
What is the difference between MIS-C and Kawasaki disease? And does this new syndrome seem to only affect kids who have COVID-19?
Dr. Penny: So MIS-C refers to this syndrome that we see in children, particularly related to coronavirus infection. And that’s according to the recent CDC definition, and this is really specific to coronavirus infection. But we do see similar conditions in other situations. What we see in patients with Kawasaki disease is that, that they get dilated coronary arteries. These abnormal coronary arteries are also seen in some patients with MIS-C. Typically, though, it doesn’t seem to be as common in MIS-C as in Kawasaki disease. One of the other differences between MIS-C and Kawasaki disease is Kawasaki disease tends to be clustered in much younger children. Whereas MIS-C, as we said earlier, can affect older children and even adults.
How many cases of the syndrome do you think we’ve had in Houston so far? And do you expect these cases to rise as they have in other cities on the East Coast?
Dr. Shekerdemian: We have seen a handful of patients with MIS-C at Texas Children’s. We don’t have an exact number because we obviously investigate many more than we end up diagnosing according to the strict criteria. It would certainly be less than 10. And the question about expecting them to rise, it’s a difficult one to answer. I think what we’re seeing in terms of the density of MIS-C around the world, not just in the US, very much mirrors the density of primary COVID-19 infection in those cities. So luckily Houston was not hit anything like as badly or hard in terms of severe COVID-19 infection. I think that would really speak to the fact that, while we’re seeing patients present with MIS-C, it seems to be a steady number. We’re not seeing a huge explosion and, touch wood, we hope that’s going to continue.
Do you think patients who have MIS-C, in general, are they still contagious with coronavirus?
Dr. Shekerdemian: That’s a really important question. We believe that the majority of them will not be contagious at the time that they develop the MIS-C. The typical presentation is around the four week mark, after a primary COVID-19 infection. And the vast majority of children at that stage, or anybody contracting COVID-19, would likely be non-contagious. Of course, we do test them with nasal swabs, as well as the typical antibody tests that are required to confirm the diagnosis. So I think it’s reassuring to a point that most children are not contagious, but we do screen them just in case they’ve still got signs of any active COVID-19 disease.
Is it safe to send children back to daycare or school once they reopen?
Dr. Shekerdemian: To be perfectly honest, there isn’t a simple answer to that. As COVID-19 stays in the community, we have to be hyper vigilant. What I would want to know before sending a child or a loved one to a school or daycare or summer camp is, what sort of screening; the numbers of children or adolescents in a specific space; the respect for social distancing, for hygiene, for hand-washing, etc. and how they’re going to screen any care takers or any workers in those environments, I would hope, on a daily basis; and feedback constantly to parents and to caregivers to reassure them and provide constant updates.
