• Dr. Ryan Hassan MD MPH

Oregon Pediatrics' COVID19 Response

As the COVID19 outbreak has continued to spread across the globe, we at Oregon Pediatrics have been doing our best to protect the health of our patients, by finding ways to continue seeing patients that need to be seen, while also doing our part to mitigate the spread of the pandemic. Here are the steps we have taken to protect our patients and community, and why we feel these steps are so important.

2/26 – Oregon Pediatrics staff first discussed a COVID19 screening protocol on February 26th.

2/27 - After reaching out to the Oregon Health Authority for guidance, we decided to screen all incoming patients for possible exposure to COVID19, so we could connect them with the health department and assist their effort to contain the disease.

2/28 - The first case of laboratory-confirmed COVID19 in Oregon was identified, without a known transmission source.

3/6 - As it became clear that the disease would continue to spread in the community undetected due to insufficient testing capacity in Oregon, we decided to further limit visits in the clinic, so that any patients with symptoms consistent with COVID19 were asked to stay home if their symptoms did not require medical treatment.

3/11 - The WHO declared COVID19 a pandemic, which means it had spread to multiple countries and was affecting a significant fraction of the global population

3/16 - We started setting up our drive through clinic at the Clackamas location, which was up and running by mid-day, so that we could see sick patients who needed medical care in their vehicles, while minimizing the risk of spreading the outbreak.

3/17 - We began seeing only well visits for children 6 months of age and younger, so they could get their critically important newborn care and vaccinations, and diverted all sick visits that could not be cared for remotely to our drive through clinic. For patients who could be seen remotely, we were able to start providing virtual visits via video conference. We also closed our Northeast Portland and Meridian Park locations to patients completely; because they are connected to hospitals, where patients could have a high chance of coming into contact with the pathogen.

3/18 - We started using virtual visits at all of our clinic locations, so that any patients who do not need to be seen face to face can now receive care remotely.

Why we took these actions:

Because we are a pediatric practice, most of our patients, as well as most of our patients’ parents, are at low risk for serious illness from COVID19, which primarily causes complications for older individuals, and those with chronic medical conditions. However, infections in children have so far been a key contributor to the rapid spread of the outbreak, so minimizing spread among children is an essential aspect of minimizing the spread of the disease overall.

The COVID19 pandemic has become the largest infectious disease outbreak in the world since the Spanish flu pandemic of 1918, which killed between 50 million and 100 million people. Because the US did not begin screening for COVID19 in the beginning of the outbreak, the virus was able to start spreading undetected for some time in communities in Washington, Oregon, and California. This is why, when we identified the first case in Oregon on 2/28, the source of infection was unknown, and why the true number of cases in Oregon today is much higher than the number of identified cases. As such, it is no longer possible to contain the outbreak, and public health efforts have been aimed instead at mitigating the spread of the virus, in order to “flatten the curve” of cases, so that our healthcare system can continue providing care to patients who need it.

Without mitigation, the COVID19 virus could rapidly infect millions of people in the US, as infections continue to spread at an exponential rate. This is a new virus, which means that no one is immune to it. There is no vaccine and no treatment to help slow the spread. Estimates this month from the Oregon Health Authority suggest that there could be 75,000 cases in Oregon by mid-May. If the virus spreads too quickly, we could see critical failings in our ability to treat patients. Current estimates are that Oregon could be out of Personal Protective Equipment (PPE) like masks and gloves that are critical for healthcare providers treating the disease within weeks. Local healthcare professionals, including clinic physicians like myself, have already been asked whether they would be able to volunteer to provide hospital level medical care to COVID19 patients, in the event that the number of sick patients begins to overwhelm our capacity to treat them.

The case fatality rate of COVID19 as of 3/31 is 4.9%, according to recorded cases on Johns Hopkins COVID19 map. According to CDC's Dr. Robert Redfield in an interview with NPR this morning, though, it now seems that 25% of people who get infected remain asymptomatic, and that the true percentage of people who get the disease and suffer fatal complications from it is closer to 0.66%. Even this significantly lower fatality rate, though, is 6 times that of seasonal influenza, which has killed over 40,000 people in the US this flu season alone. What’s more, current data show that one in every five people infected with COVID19 develops serious illness requiring medical treatment. This will drive fatality rates up significantly if our mitigation attempts are insufficient. The US has a total of 160,000 ventilators, and 30,000 ICU beds. Whether this will be enough to treat everyone who gets sick in this outbreak will depend largely on our actions now.

Many people continue to claim that aggressive mitigation efforts like those that we’ve seen in Oregon, and the measures we’ve taken at Oregon Pediatrics, are an unnecessary overreaction to what will end up being a mild outbreak. In this way, pandemic response efforts share the same challenge as vaccines: the better they work, the more people will claim they are unnecessary. However, the greatest mistake that the US has made so far has been to underestimate the seriousness of the pandemic, and do too little, too late. The measures we have taken at Oregon Pediatrics will allow us to mitigate spread of COVID19 as much as possible, while still ensuring that all of our patients get the medical care that they need, and we feel it is better to be overprepared than underprepared.

What we recommend for our patients:

There is no need to panic. As I mentioned earlier, most of our patients are at low risk for complications of this illness. As of this writing, children in Oregon are still at higher risk of getting seriously ill from influenza than from COVID19; because the flu is much more dangerous in children, and we should all be mindful of and reduce our risk for contracting it by getting vaccinated and practicing good hand hygiene. The mitigation measures we and other organizations are taking now, while drastic, are still precautionary.

If you think you or your child has COVID19, don’t panic. You and your child will most likely experience a mild cold, with cough, fevers, fatigue, and sore throat, that will resolve on its own within two weeks. The best way to treat this illness is by getting plenty of rest, staying warm, and staying hydrated. Treat pain and discomfort with honey (if your child is over 12 months of age), and Acetaminophen or Ibuprofen. Children under age 6 years should avoid any over the counter medicines for cold and flu symptoms. Anyone with symptoms of illness should stay home and isolate themselves as much as possible.

Your child does not need to see a doctor unless they are having difficulty breathing, confusion or altered mental status, or difficulty staying hydrated. Because testing supplies are still limited, we are unable to test patients for COVID19 as much as we would like in order to track the spread of the outbreak, and the only patients being routinely tested are those who require hospitalization. Testing is not useful or available for patients with mild symptoms, as it does not change the recommended management of the disease.

If you would like to see a provider, or have questions about your child, please call our office and we can schedule a virtual visit, or a visit at our drive through clinic if necessary.

How you can help:

Stay home. Save lives.

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