Dr Schuman, section editor for Peds v2.0, is clinical assistant professor of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, and editorial advisory board member of Contemporary Pediatrics.
A pediatrician reflects on all the lessons learned from the COVID-19 pandemic.
In the April 2020 issue of Contemporary Pediatrics, I authored a brief “Your Voice” missive entitled “COVID-19: Thoughts while circling the wagons.” At that time my practice was in lockdown, as were most medical practices in the country, and I was doing only virtual visits from home. We positioned 1 brave, young, and healthy colleague in the office, along with a nurse and secretary to evaluate and treat patients who needed to be seen in the office. Our practice was cautious, heeding advice from the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP), and saw children (without COVID-19 symptoms) with injuries, rashes, or exacerbations of chronic problems. We only saw well young babies who needed vaccines and distributed infant scales so babies with feeding issues could be monitored via virtual visits. We continued to do so for 2 months until we all returned to the office. During the lockdown, many pediatricians took advantage of assistance provided via the CARES act to keep their offices afloat financially, and quickly learned new skills to provide virtual visits at home. We all implemented new workflows to use parking lots as waiting rooms, reuse personal protective equipment (PPE) that was suddenly in short supply - and tried to avoid furloughing staff when revenue dropped precipitously.
Now, over a year later we find that millions of adults in the United States have been vaccinated, and children aged 12 years and older are being vaccinated as well. As of this writing, the CDC has recommended that if you are fully vaccinated:
“You can resume activities without wearing a mask or staying 6 feet apart, except where required by federal, state, local, tribal, or territorial laws, rules, and regulations, including local business and workplace guidance”
It would seem that we are nearing the end of a movie where science has defeated an evil scourge, the clouds are parting, and the sun is shining through….
It has been a year and half that will long be remembered. We have learned so much about COVID-19, public health, and how resilient families, teachers, and healthcare providers can be.
Here are some things we have learned along the way:
Most importantly, the COVID-19 has exposed glaring flaws in our health care system. It no longer makes sense for insurance companies to dictate policy for our patients via their control over healthcare purse strings. There needs to be a more efficient way to authorize medications, diagnostic tests, and other services for our patients. The FDA needs to expedite the introduction of vaccines, medical devices and pharmaceuticals. The CDC needs to be apolitical in making its recommendations. These need to be evidence based, and crystal clear.
The way forward may be a bit precarious, but and as COVID-19 variants emerge we will need to routinely vaccinate children and families probably on a yearly basis, and we will likely be able to prescribe new anti-virals that will effectively treat SARS-CoV-2. Hopefully, pediatricians, public health officials and politicians will have learned lessons from the COVID-19 pandemic of 2020/2021. Only time will tell.