A Pediatrician’s Perspective

How can you best protect your children during COVID-19? Dr. Grant Newman of Pediatrics East in Collierville, TN discusses this important question on this episode of the Main and Mulberry Podcast. He also covers the effectiveness of masks and some unique challenges in diagnosing and treating young patients via tele-health services.

See full transcript below.

Anna Bell: Hello, everyone, I’m Anna Bell. And today, I’m so thankful to have with us Dr  Grant Newman, who’s a pediatric doctor for Pediatrics East in Collierville, to talk with us about how his clinic has been operating in today’s new normal. So, Dr. Grant, thank you so much for taking the  time to talk to us today, we really appreciate it.

Dr. Grant Newman: Yeah, you’re welcome. I’m glad to be here.

AB: Yeah. Let’s start off by kind of talking about the adjustments that pediatric clinics have  had to make during this time, during through the shutdown, and the pandemic, in general. In a pediatric setting, what are some of the unique challenges that you guys have had to face? 

DN: Yeah, so initially when all of this kind of started and we recognized the need to address  the concerns of the community and just the changes that were gonna inevitably affect us, and not  knowing how much real impact of actual sick patients with this virus or how much virus might  actually circulate, but you have to assume it could be walking in your office at any time. So, we had to prepare, just like the hospitals have had to prepare. And for us, our primary concern when we  knew the disease burden of pediatric patients has been consistently really low, especially in this  area, our main concern was just making sure that our patients are getting the care that they still  need. So, specifically, our newborns that have vaccines that are necessary every two to three  months, for their first couple of years, that they’re coming in to get those vaccines and that they both feel safe and are safe as possible when they come into our office to get those.

AB: Right, absolutely. I’m a mother of a four­ year ­old and a one­ year ­old, and so I know I’m  not just gonna walk in the clinic and let you take ’em away. I’m gonna wanna go, too. And so I’m  sure you’ve had to take into account having an extra individual come through the clinic too, right? 

DN: Exactly, that’s right. And so, one of the first things we did, like most of the groups in the area, is to separate our schedule out to where whereas in the past, we would start our day with the  sick clinic for those who before work, before school, wanted to walk in and come get those children seen first right off the bat, is we eliminated those visits, and started our day with a clean office and  only let the well babies in for the first few hours of the day to take care of those visits exclusively.  And the demand has been lower with people either scared to come in and then just the illness, in  general, has been much lower because people aren’t in school, people aren’t around each other so it’s kind of a bit ironic that we’re dealing with so much fear of illness and yet we have less illness than  we’ve had in any two­ month period ever since I’ve been in practice.

AB: Yeah, that’s such a good point, and something I really wouldn’t have thought about but  you’re right, we’re not in contact with one another like normal. So, yeah, that’s interesting to hear  that the illness rate, those patients haven’t been coming in quite as often as normal.

DN: Correct. But we have to stay prepared ’cause we’ve still seen patients come in with  appendicitis or come in with acute things. And some illness, some viral induced things but also  other health issues that just pop up that aren’t from a contagious nature. And we’ve gotta be able to  see them and not tell them, “Well, you might be sick, so we can’t you.” We have to have a safe way  to bring them in and not expose them in and expose them to our healthy babies.

AB: Right, absolutely. Talking about being prepared, how have you and your staff been  holding up? Have you been able to get all the PPE equipment that you needed and your mask,  cleaning supplies? I know some of that stuff has been limited supply.

DN: Right, and we were proactive early on when before any cases were in the country, we  knew to pre­order and order a lot of cleaning type supplies and such but then when it came to  masks, and gowns, and things like that, that’s in short supply everywhere. And we have figured out  ways with the help of some of the hospitals and some of the studies that have shown how to  regenerate some of the N95 masks or how to clean them appropriately, and how to wear gloves and  wash them, so that you don’t have to dispose after every use and things of that nature. But we’re  okay with supplies and it’s still something we’re conscious of and trying to continue to order and get more and conserve appropriately.

AB: Yeah, that’s the best thing you can do, right? Yeah.

DN: That’s right, yeah.

AB: So, one thing that we’ve all noticed during this pandemic is the rise in telehealth medicine. Do you offer telehealth visits at your practice?

DN: We do and that was something that in the state of Tennessee was not legal to offer,  except in very specific circumstances and it didn’t really ever involve a pediatric group, those  circumstances. And so, that was waived when the pandemic started, and so they allowed us to do  that, and we took advantage of that. And for certain types of encounters, it’s really an effective  appropriate way to manage. So, things like mental health issues like our patients with anxiety,  depression, things of that nature. Some things where you can see well enough on a screen, that’s the  hard part ’cause you can’t really do a physical exam on a computer. Unfortunately, we see patients,  we’ve always seen patients that have used telehealth out of state, cause that was legal. It’s kind of a  little weird caveat to medicine, where patients in Memphis could use telehealth from somebody in  New York City, but we couldn’t use it for our own patients. But then what we would see is that  people would utilize that for ear pain. Well, you can’t know what’s going on in an ear and the  percentage of ear pain…

AB: Yeah, if you can’t see it, right?

DN: No, right. So, there are those that… Those type of visits just aren’t appropriate for  telehealth. So, we’ve tried to stay true to what makes sense and offer it where we can and where it’s  in a mutually beneficial situation where we can adequately address the situation, not bring that  patient into physical contact with our office, we’ve done that. And then sometimes we have to say, “No, this isn’t appropriate for telehealth.” And we’re still seeing some patients that have used telehealth through another entity and then come in and were misdiagnosed or treated  inappropriately because the assumption was the ear pain was an ear infection or the assumption was urinary discomfort was an infection when it truly was something completely different.

AB: And different, yeah. I’m just really interested in knowing if you feel like diagnosing  these patients over telehealth visits, children, in particular, do you feel like it’s more difficult to  diagnose children with the telehealth visits versus adults, I guess?

DN: Absolutely. At times, with the younger children, we compare ourselves to veterinarians where your patients don’t exactly speak to you. What you see on the exam or how they  react to your hands on their abdomen tell you as much about how much pain they have as what they answered your questions to. And the parent’s usually the one giving the history and telling you  what’s going on or what their concerns are. We can still get that via telehealth but it’s just so many  things you get from an exam.

AB: You can pick up on those cues.

DN: That’s right. It’s variable. There are a lot of things that are… A lot of our diagnoses come from history, a significant part of it but without the exam, you just can’t rule out certain parts and  there are some things you just flat can’t diagnose accurately without seeing the patient face-­to-­face.  But then there’s a lot of care and you think about patients that maybe don’t need a new diagnosis.  The diagnosis has been made, but it’s just the management of that condition that’s ongoing. And for  those conditions, those appointments can easily be done via telehealth.

AB: Oh, absolutely. Do you see this as being a service that you guys will continue to provide  past once we get to the light at the end of the tunnel of this thing, so to speak? 

DN: Right. So part of it will be the legal implications, will the extension exist to make it  continually legal? But if that is the case, then there will definitely be an ongoing niche where it  could help. There are certain types of appointments, as I mentioned, where we can see the benefit. I  mean we have patients, we see our patients through their college years, so of course, they spend a  large part of the year off out of town and not where they can come into the office anyway. And so  some of those patients where we’re managing their medications and treating and we’ve done that by  phone call, now we can do that by telehealth and have a much more personable, more intimate  encounter and get to see them face-­to-­face and get a better feel for what’s going on and what they  need.

AB: Well, Dr Newman, this helps us better understand what it’s been like in your office the  last few weeks and months. I’d kinda like to switch gears though and get your opinions on the  reopening and the phasing back into business, if you will, from a healthcare standpoint. Do you  think it was the right time for Shelby County to move into phase two? Were we ready to move into  phase two in your opinion?

DN: Yeah, I think we were. And I think early on these decisions were hard. There was no way to make the right decision. You’re basing it on the best information you could get, and a  combination of the fears of the worst possible scenario that we wanted to avoid and balancing that  with what was realistic and what was reasonable. And I think after a period of time goes by and we  didn’t, thankfully in this area, didn’t experience huge burden of disease when it comes to numbers  and overwhelming our hospitals and ICUs, that has not happened, thankfully. It bought us time to  be more prepared that if there is a spike in number of cases that we’ll be more prepared, but not  seeing that disease burden, it was time. One thing we know about this virus is that we don’t know  when the endpoint’s gonna be. We can’t say that two months from now, four months from now, six  months from now the threat will have passed. So you can’t just kick the can down the road forever.  You have to, at some point, start interacting again and live life.

AB: That’s so true. I mean it would be nice if we had a game plan and we knew exactly what  to do and how to handle but we’re all just having to figure this thing out one step at a time, right?

DN: That’s right. When you think about, from our perspective with our newborns, we are  always telling moms how to be so protective and careful during those first two months because the  infants have not gotten vaccines yet. Illnesses and diseases can pop­up. Well, specifically illnesses  can…

AB: They’re susceptible, right?

DN: Yeah, they’re more susceptible and they can manifest within that first two­ month period  and any viral fever that is developed requires a lot of workup and anxiety to make sure they don’t  have something more serious. But it’s a finite period of time. You know at the end of that two  months, okay, now we can allow more interaction. Now we can go back out in the public. Now we  don’t have to be so worried about exposing that infant to other people. Well, in this scenario, we  didn’t have a timeline. And we still don’t have a finite endpoint, so we just have to continue to be  responsible and use our best judgement to try to limit potential of spread. And nobody wants  anybody to get sick, ever. But we just have to be as wise as we can, protect the most vulnerable and  then carry on.

AB: So to that point, another big topic in the last few weeks that’s being politicized is the use  of wearing mask in public. What’s your standpoint there?

DN: So yeah, there are some… When you get into the science of it about how effective the  masks are in preventing or protecting. They’re more effective in preventing the person wearing the  mask from giving the virus than the person wearing the mask getting the virus. And that just has to  do with how the virus is gonna get through that mask, etcetera. But if both people have the mask on, then you’re increasing the level of protection. The type of mask obviously makes a difference but  it’s like something’s better than nothing. And certainly, when we’re in close quarters with people,  you don’t know who might have the virus and who might not. We’re learning through increased  testing that somewhere in the neighborhood of 5% of patients or people aged zero to 21 are gonna  be asymptomatic that test positive. Meaning that they can easily have the virus and be spreading it  and have no symptoms whatsoever. So you can’t know for sure that that well, teenager or a friend of your teenagers doesn’t have the virus. They could. So you just have to be wise about that.

AB: Do you think our kids, we ought to have masks for our children too? When I go into a  store every now and then I do see some children that have the cute little mask on their face. Do you  think our kids should be equipped as well? 

DN: Well, children two and under, definitely not. It’s not safe for them to have the mask on,  their respiratory system is such that it’s just not safe. You need to be able to see their faces and it’s  not realistic that they’re gonna wear it anyway.

AB: That’s true. I know my one year old definitely wouldn’t.

DN: No way. Well and keep it in mind that the mask is really as much for those around the  person wearing it than the person themselves, children aren’t gonna spread the virus by breathing,  coughing as easily because they don’t sneeze as forcefully, they don’t cough as far, they’re just not  as big, they’re not as strong. And so they’re not spreading to this far which is part of the reason.  They’re also because they’re less likely to have as much virus in their system or be symptomatic,  they’re also less likely to spread it for that reason.

DN: So I think when possible we would be well-­advised when we’re going to the store and  the grocery and so forth not to bring the children when we have that option. That’s just smart. But  when you’re in a situation where they’re with you and this thing start opening up and that’s  inevitable, your kids need to come with you. If you’re gonna be in a place where there are gonna be  contact in close quarters, it’s wise to wear a mask. That’s the smartest thing we’re asking our  patients, our parents to wear them in the office for certain and the older patients to wear them as  well, just to protect everybody. But the younger children, no, it’s really not necessary and not  practical for them to have to wear it.

AB: Yeah, these are all really good points. And as we close, is there anything that you’d like  to say? A message maybe to the citizens of Collierville, the parents out there and those in the  community or still maybe a little bit fearful who are wondering, hey, what’s gonna happen here?

DN: Well, I think we have to be smart and we have to be careful and there’s never any fault  in being cautious and being careful. But I come across patients that act like this virus is floating in  the air and is everywhere. And I think we have to try to recognize the true facts and situation and  you’re not gonna get the virus walking outside in space. You can’t get it riding your bicycle. And I  see people wearing masks in those situations or in their car by themselves. And I kind of scratch my head going, “They don’t understand.” I had somebody ask me the other day if it was airborne. And I  said, “Well, only if somebody that has it has just sneezed into that space immediately before you  walk into it. But not when you’re walking down the sidewalk.” So you have to be able to recognize  the true risk. But the other point I’d like to make is that we have in the neighborhood of 25,000  active patients in our group, and we’ve had two positive cases and neither one of them were  particularly ill at all. One of them was a teenager. One of them was a five­ month old infant and  neither was sick at all.

AB: Asymptomatic though, yeah?

DN: Not asymptomatic, but neither… I shouldn’t say weren’t sick at all, but I should say that  neither had any problems getting over the virus both recovered quickly and without any  hospitalization or any specific care. But the point there being that as big of a group as we are with  five different office locations, we’ve only had two positive patients throughout this whole time. And while we still have to act like the next person walking into the office without symptoms or with a  cough could have that virus. And we’re gonna take those precautions and clean the room and ask  them to wear a mask. And we as the practitioners are wearing our mask and wearing our gloves,  real risk of coming to our office to get the necessary care you need, to get your vaccines as your  child’s headed into middle school or headed off to college, hopefully, this fall or our infants,  especially that need their vaccines, it’s a safe place to be. And so we don’t want our patients  reluctant to come in for necessary treatment. And we’ve accommodated them in many different  ways, trying to limit waiting room times and wait times for that reason.

AB: So don’t delay when coming in. If you need to come be proactive, right?

DN: That’s right. And get your kids outside. They need their physical activity. They need  their fresh air and they need their…

AB: The old fashioned sunshine, right?

DN: Yes, absolutely.

AB: I know it. That’s one thing I love seeing in the neighborhood, all the kids have been  outside more than, shoot, since we’ve been here. It’s been wonderful.

DN: Yeah, that’s true.

AB: Dr Newman, thank you so much. We appreciate your time and your insight today and  especially all the service that you’ve given to the community. Thank you.

DN: Thank you. Thank you for having me. Appreciate it.

AB: Absolutely. Until next time I’m Anna Bell sending you all well wishes.

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