Our world is upside down-COVID-19 is the culprit

March 23, 2020

The world in which we live, work, socialize, learn, and play has turned upside down and is spinning out of control, directly related to COVID-19. Numerous questions have emerged and more emerge every day: How do we make sense of our world that changes direction within a millisecond of time?

On March 6, 2020, I received the table of contents of articles to select for my monthly commentary for Contemporary Pediatrics. There were several fabulous articles to review but I first read the infectious disease article titled “What to tell parents about coronavirus and influenzaby Miranda Hester. I totally agree with the information about providing the influenza vaccine to all children aged 6 months and older, all pregnant women, and all who will come in contact with any baby aged younger than 6 months. However, between March 6, 2020, and March 19, 2020, the world in which we live, work, socialize, learn, and play has turned upside down and is spinning out of control, directly related to COVID-19.

Numerous questions have emerged and more emerge every day: How do we make sense of our world that changes direction within a millisecond of time? How do we talk with parents who are frightened for their children, especially those with a chronic illness, themselves, and the elders in their family? How do we comfort parents whose children can no longer attend school, and they themselves are suddenly out of work? What do we say to parents of adolescents, and young adults who believe that they will not be affected by COVID-19? How do we as health care professionals support our colleagues providing frontline diagnostic screening and care for patients with COVID-19 symptoms who are facing an unprecedented uncertainty about their personal well-being? How do we prevent “COVID-19–induced posttraumatic stress disorder” and “COVID-19–related suicides”?

Making sense of our world that changes direction within a millisecond

We are in uncharted territories and must rely on our national Infectious Disease experts at the Centers for Disease Control and Prevention (CDC) for guidance on COVID-19 and how to diagnose and treat patients, and most importantly on how to prevent transmission. Health care providers (HCPs) should review the CDC website daily as it provides the most current information to inform clinical decision-making. Collectively, all HCPs must critically appraise every health care encounter to make the best possible decisions for the care of each individual to prevent further spread of this aggressive virus. Stop, think, if it doesn’t make sense or seem right, rethink your decision. Trust your core body of knowledge and feel empowered by your education and your clinical experiences that your clinical decisions interrupt millisecond changes and will succeed. Telehealth and telemedicine are more established in rural areas, but the reality in this moment in time is telehealth and telemedicine may be the best way to manage patients in urban and suburban settings who can stay home while seeking medical advice, care, and treatment.

Communicating with parents

Parents are also in uncharted waters with their children suddenly out of school about to have lessons online for the first time, and, for many, fears related to food insecurity. Parents may be out of work for an unknown period of time. Parents of children with a chronic illness are fearful of how the child will be affected if they contract COVID-19. Parents are also fearful for their healthy children because reliable statistics for how COVID-19 affects healthy children are not available. What can we say to the parents in our practices?

Ms. Hester provides the essential basics based on CDC recommendations surrounding possible exposure and contacting HCPs for any child who is febrile, coughing, and/or short of breath. Parents trust their HCPs, thus speaking with them is an essential part of the treatment plan, especially for parents of children with chronic illnesses. Prevention is critical, so following the recommendations from the national experts should be discussed with each parent. Parents may want to know the “temperature” of their entire household: Should we recommend taking everyone’s temperature twice a day until we no longer have any reported cases of COVID-19? Advise parents to call their HCP first before going for a routine office visit. Practices should consider asking pre-questions to elicit a history of possible exposure and make recommendations for care based on the assessment findings. Another form of communication is via social networking. Practices can create a Facebook practice group or use texting to keep in contact with parents. Let parents know that any and all of these preventive efforts are to keep their family healthy.

Communicating with parents of teenagers and young adults

The time is now for parents to establish firm rules for teenagers and young adults in their households to assume personal responsibility for their actions and how they may adversely affect the lives of their family members. With the unanticipated closure of elementary schools, high schools, and colleges, parental actions are paramount to controlling the spread of COVID-19. Inform parents “School is in session ONLINE across the United States-have no doubt.” Teachers and college professors are prepared to provide quality education for every student online BUT parental support, in particular, establishing the rules and enforcing them, is critical to achieving the academic goals for each child, adolescent, and college student.

Supporting our colleagues on the front lines every day battling COVID-19

We are fortunate that we have HCPs who are committed to providing high-quality health care to all. Supporting each individual through our words and actions is a top priority. We are also fortunate that we are digital. It takes only a few seconds to send a text, an email, or a social media post that says each person in the health care industry is so appreciated and so valuable.

Never be too distracted to connect COVID-19 and the social determinant of health

As HCPs, we must recognize and act upon the enormous stress COVID-19 is placing on families whose environment places them at high risk for adversity. Families affected by the social determinants of health often lack the coping skills to maintain the physical and mental health of the family. Establish maintaining mental health a top priority now. Do not permit COVID-19 to be our only focus! Think and ask about the stressors in individual and family lives. Think critically about preventing those so stressed by these unknown circumstances totally outside their control, who turn to illicit drugs for relief, or excessive use of alcohol, or even worse, suicide. Establish and implement mental health treatment plans that go hand-in-hand with the diagnosis of COVID-19.