All it took was a week.
In early March, Dr. Kyle Pronko was on vacation on the California side of Lake Tahoe, reminiscing and reconnecting with college buddies from Boston University.
“I remember going out [to California] thinking it [coronavirus] was a foreign, not very big deal,” recalls Pronko, who has been a pediatric hospitalist at Children’s Wisconsin in Milwaukee since July 2018. There were only couple hundred cases in the U.S. at the time, and most of them were confined to the coasts. Pronko was like most of us: watching the news but unaffected by the novel coronavirus.
Seven days later, he came home.
After traveling back to Wisconsin he was immediately tested for coronavirus. Upon returning to work, the hospital wasn’t the same.
Visitor restrictions were in place; now only one parent can visit their child at a time. Social distancing had set in, with a lot of medical staff and doctors working remotely.
One of the only pieces of good news was how children have been mostly spared from the ravaging effects of coronavirus. As of Thursday, May 7, there have been 58 deaths due to coronavirus of people under the age of 25 in the U.S., according to the CDC. That’s fewer than 0.15% of the total deaths in the country.
“Kids have not developed the degree of severe illness that adults seem to have, especially older adults and people with pre-existing conditions. And the number of cases we’ve seen at Children’s, I can say I personally have been surprised by how small the number of cases have been,” Pronko says, while noting that everyone in the hospital is being tested regardless of symptoms.
Still, the precautions have been great, and that’s forced Pronko and his colleagues to change a lot about how they treat the kids in the hospital.
New Paths, New Teams
“Medicine is a team sport, certainly in pediatrics,” says Pronko, who is also an assistant professor at the Medical College of Wisconsin.
As many as 12 people go from room-to-room visiting patients. That includes a pediatrician like Pronko, a couple of residents and other medical students, nursing or pharmacy or physician assistant students, perhaps a pharmacist, or another nurse, or a specialist.
That would be the “team that varies from day to day,” Pronko says.
Now, because of social distancing rules, it might just be Pronko or another attending physician who visit the patient in-person. A specialist might only join via Zoom on an iPad, or have to follow up with Pronko afterward to help make an accurate diagnosis or appropriate treatment plan.
“The challenge with coronavirus is trying to keep as many people out of the hospital as possible,” says Pronko, a native New Jerseyan. “Follow-ups can be a bit hard because a lot of the doctors’ offices are not open to the same degree that they were, or they’re just doing video visits or whatever it might be.”
Bedside Manner Behind a Mask
Like other hospitals, those diagnosed with the virus at Children’s are housed separately and treated by medical staff who only work with COVID patients. Doctors like Pronko and other medical professionals work with “typical” patients in other parts of the hospital — kids with pneumonia or renal/kidney failure or epilepsy or something undiagnosed.
But interactions with underage patients and their families have been anything but typical.
Most of us at some point over the past few weeks have had an awkward interaction where it’s been tough to understand someone else who is wearing a mask. But it’s worse for Pronko. He has to try to comfort kids and parents going through the scariest parts of their lives with his face covered, missing out on crucial comforting face-to-face communication.
“I think parents have a lot of questions about coronavirus, even if our suspicion that their children have (had any contact) with coronavirus is low just because they see all the changes they see in the hospital. Everyone who is coming into the hospital is wearing a mask and all those other things.”
It’s doubly difficult when he works with kids who are still waiting for tests to come back. For those visits — since Pronko doesn’t work on the wing of the hospital only for coronavirus patients — he and other medical pros have to wear a CAPR (Controlled Air Purifying Respirator).
Sure, the respirator protects him from the potentially deadly disease. But it also makes him look like a beekeeping astronaut from the Andromeda Galaxy. Try explaining to an 8-year-old how a kidney surgery is going to go while also looking like you’re ready to audition for Apollo 13.
“Even passing people in the hallway, you try to smile at them … It makes every interaction more awkward,” he says. “I think that can potentially make it harder on families having to manage being in and out of the hospital. Part of being a pediatrician is trying to make a situation for a child that can be scary, less scary. But that can be hard to do when you look like you’re wearing a spacesuit. When you’re wearing a mask, they can’t see you smile and I think that level of interaction can be harder.”
Discharge and Moving On
While mental health and feelings of isolation are affecting doctors too, those at Children’s have been spared from watching near-constant sickness and death like those in COVID wings of other hospitals.
“Thankfully children haven’t been so affected by this,” Pronko says, so he and his colleagues have avoided “the barrage of sick people and sometimes dying people.”
Still, it’s not like they’ve avoided coronavirus. Anxieties are high. Everyone’s routines, especially those of doctors and nurses, have been affected.
“The regulations and recommendations at the hospital are changing frequently, which I think is stressful. Change is hard. This is change at a pace of three times a day. I think keeping up with that has been a challenge for people,” he says. “We have been busy thinking and planning about coronavirus. But truthfully the numbers of patients in the hospital have been lower, which is based on a lot of factors. Just like everywhere, a lot of elective and non-urgent things have been postponed and aren’t happening right now. And thankfully children haven’t been very affected by the coronavirus and so there wasn’t a big influx of sick kids from the coronavirus, thankfully.”