Another part of the learning curve is how to incorporate other team members, including fellows, nurses and social workers, into the telehealth exam. We had to figure out solutions where we can all be on the telehealth video or call at the same time.
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Q: What are the chief concerns of your patients and their caregivers during COVID-19?
The big things are questions about how underlying diseases and the medications used to treat them may affect patients’ risk of exposure to the coronavirus and getting sick. One of the good things we’ve found is that, at least according to the current data, children with rheumatic disease on disease-modifying anti-rheumatic drug (DMARD) therapy are not getting sicker or ending up in the hospital any more frequently than other children.
The one exposure that seems to put patients at risk is if they are on higher doses of steroids, with some data suggesting worse outcomes. We just put out guidelines telling providers to reduce steroids in their patients to the lowest dose that can adequately control their disease.
Parents also are asking whether kids with rheumatic disease are at higher risk of multisystem inflammatory syndrome in children (the Kawasaki-like syndrome reported with COVID-19 in some children). What we are finding is that the kids developing this syndrome were previously well and don’t have rheumatic diseases. We just published another guideline on this.
Q: How are you helping patients and their families manage the psychosocial effect of the pandemic on their daily lives?
We try to help them think creatively about how to create some socialization and suggest getting outside for walks, sun and physical activity. In our general clinical guidance, we emphasize that pediatric rheumatologists should be aware that mental health concerns can manifest themselves during a pandemic and to be aware of this and ask about it. Don’t be afraid to ask things like, “How is your child coping?”
Mary Beth Nierengarten is a freelance medical journalist based in Minneapolis.