Session March 11, 2020

1. Complex Integrated Pediatrics ECHO on
Coronavirus & Concerns
Ho-Choong Chang, MD
Timothy Kearney, PhD
Stacy Hankey, DSW, LCSW
March 11, 2020

2. Disclosure
• With respect to the following presentation, there has been
no relevant (direct or indirect) financial relationship
between the party listed above (or spouse/partner) and
any for-profit company in the past 12 months which would
be considered a conflict of interest.
• The views expressed in this presentation are those of the
presenter and may not reflect official policy of Community
Health Center, Inc. and its Weitzman Institute.
• We are obligated to disclose any products which are off-
label, unlabeled, experimental, and/or under investigation
(not FDA approved) and any limitations on the information
that I present, such as data that are preliminary or that
represent ongoing research, interim analyses, and/or
unsupported opinion.

3. Session Disclaimer
Please note that we are not Infectious Disease Experts.
Purpose of today’s session:
– Brief overview of COVID-19
– Best practices for talking to children about the virus
– Self-care for clinicians
– Discuss concerns that you, your patients, and their
parents may have
– Discuss together how can we support our pediatric
patients’ concerns
Please join the discussion today!

4. Disclaimer
Information presented today may be out of date by tomorrow!
Be sure to check:
• CDC and WHO websites for up to date information.
• Also your state’s DPH website for local
recommendations:
– https://www.cdc.gov/coronavirus/2019-ncov/index.html.
– https://www.who.int/emergencies/diseases/novel-coronavirus-2019

5. Poll Question
• Are you in a community with confirmed COVID-19 cases?
– Yes
– No

6. Coronaviruses
• Name comes from spikes on surface which look like a crown.
• Typical coronavirus strains: HKU1, NL63, 229E, OC43.
– Circulate worldwide
– Cause common cold symptoms, more common in children
– Typically in winter and early spring
https://www.uptodate.com/contents/coronaviruses?search=coronavirus&topicRef=126981&s
ource=see_link

7. • Bats are most common natural reservoir of coronaviruses
• Rarely animal species can combine to form novel species, which
can infect humans
– SARS (SARS-CoV): Severe Acute Respiratory Syndrome
• 2003, 8096 cases, 774 deaths, <5% children, 8 cases in US
– MERS (MERS-CoV): Middle East Respiratory Syndrome
• 2012, ~2400 cases, 850 deaths, few children, 2 cases in US
– Coronavirus 2019 (SARS-CoV-2): COVID-19
• 2019-20, >113,000 cases, >4,000 deaths, 600 cases in US
Novel Coronaviruses
Source: Up-to-date: SARS, MERS, COVID-19 sections. WHO.int, CDC.gov sections on COVID-19

8. • Novel coronavirus causing cluster of pneumonias in Wuhan,
Hubei Province, China in December 2019.
• WHO declared emergency 1/30/20
• US declared emergency 1/31/20
• 110 countries/territories worldwide
• 35 states in US
COVID-19
Source: WHO.int and CDC.gov sections on COVID-19

9. COVID-19

11. Specific Clinical Characteristics
• Fever (44% on admission and 89% during hospitalization)
• Cough (68%)
• Diarrhea was uncommon (4%)
• Median incubation was 4 days (range 2 to 7)
• Ground-glass opacity was the most common finding on CT (56%).
• No imaging abnl in 157 of 877 (18%)
• Lymphocytopenia was present in 83%

12. 3-6 feet

13. Evaluation, Management, and Prevention
• Stay current with CDC updates.
• Follow local DPH guidelines.
• Handwashing, cough hygiene, staying home
when you are ill, and social distancing.

14. Testing
• Local and State health departments
• Commercial testing available (Quest, Labcorp)
• Some hospitals and academic centers

15. Poll Question
• How concerned are your patients about COVID-19?
– To a Great Extent
– Somewhat
– Very Little
– Not at All

16. Talking to Children about Coronavirus
Answer their questions or bring it up to give them
permission to talk about it. Start where they are.

17. Take fears seriously while countering catastrophic
fantasies. Communicate comfort with the unknown
and plans to address more information as it is known.
Talking to Children about Coronavirus

18. • Stay on an age appropriate level.
– Preschoolers: limit or eliminate news
coverage. Manage adult anxiety.
– Elementary age: address spoken or
unspoken concerns re friends, family
members, community, and self;
disruption of routine real or anticipated.
– Middle and high school: know your child.
Intellectualizing defenses vs limits of
current knowledge. Distraction vs
dangerous avoidance.
Talking to Children about Coronavirus

19. Talking to Children about Coronavirus
Focus on what is known:
safety factors, whereabouts, and
impact on family and friends.

20. Stress what can be done to prevent spreading the
disease: hand washing for 20 seconds or more,
coughing into sleeve not hands, don’t touch your face
social isolation (school closings).
Talking to Children about Coronavirus

21. Involve children in making and implementing
concrete plans:
• knowing where loved ones are,
• creating plans for separation or quarantine,
• ensuring sufficient food and other supplies are
on hand.
Talking to Children about Coronavirus

22. Talking to Children about Coronavirus
Resources:
• Rachel Ehmke, “Talking to Kids about Coronavirus”, Child Mind
Institute, childmind.org.
• Malaka Gharib, Goats and Soda, “Just for Kids: A Comic
Exploring the New Coronavirus”, February 28, 2020 (Heard on
Morning Edition), npr.org.
• Jessica Grose, “How to talk to kids about Coronavirus”, New
York Times, February 28, 2020.
• Gene Mayers, “How do you talk to children about Corona
Virus?”, USA Today, February 29, 2020

23. Poll Question
• How is your own concern about COVID-19 affecting
your practice?
– To a Great Extent
– Somewhat
– Very Little
– Not at All

24. Self Care for Clinicians

25. • Limit your exposure to news and social media.
• Check in with yourself about how you are feeling and what you need
• Take a lunch break
• Go outside for fresh air
• Meditate in your office or a quiet area
• Take a moment in between patients
• Exercise, sleep well, eat healthy
• Take time to do activities outside of work that you enjoy
• Consult with colleagues
• Schedule self care times to help you stick to your plan
• Set limits with patients, family, and friends
• Access EAP
Suggestions for Self Care

26. Thank You!
For questions or to join our mailing list:
Contact us at
WeitzmanLearning@chc1.com
www.weitzmaninstitute.org

27. We Want to Know:
• What are you seeing with COVID-19 in your area of
the country - how is this impacting your patients?
(Please specify if you are a medical or behavioral
health provider.)
• Can you share some of what your organizations’
current plans are?
• We are all being inundated with emails and news
stories about COVID-19. What do you think is a
healthy way to access information, without
becoming overwhelmed?

28. As a leader in primary care innovation, the Weitzman Institute
is supporting safety net practices and their patients
in response to the spread of COVID-19.
• Weitzman ECHO Session on COVID-19:
https://vimeo.com/395523604
• COVID-19 Emergency Preparedness Video:
https://vimeo.com/395349844
• Learn more at:
www.weitzmaninstitute.org/coronavirus