Children during the COVID era
An interview with Dr. Richard Lampe and Dr. Amy Thompson
Dr. Amy Thompson
Good afternoon. My name is Dr. Amy Thompson. I'm the Chief Medical
Officer - I'm sorry, I used to be the Chief Medical Officer - now
I’m the Chief Executive Officer at the Covenant Children's Hospital,
and we're so glad to join you this afternoon. Just as a reminder,
the information that we provide during this event is for informational
purposes only. And if you have any questions about the covid 19 pandemic,
please visit our website at Providence.org for medical updates. This event
does not create a doctor-patient relationship and any questions or medical
advice discussed is not considered guidance on what you should do. For
any medical questions, please reach out to your primary care or health
care professional. So thank you guys so much for joining us today. This
is really fun for me. I'm happy to introduce our guest today, who
is an expert on all things infectious disease and COVID, Dr. Richard Lampe.
He is an infectious pediatric disease physician that I have had the privilege
of working with for a long time. He was chairman of the pediatrics department,
how many years Dr. Lampe?
Dr. Richard Lampe
Twenty-seven and a half.
I'm a pediatric hospitalist by training. And actually, my mentor was
Dr. Lampe. I always say the very first real patient I got to see in medical
school was with Dr. Lampe. So it was destined from the beginning that
we would have a long relationship. I call him my pediatric father. So
he has been a great mentor and is so knowledgeable. He works for Texas
Tech University Health Sciences Center and still remains in the capacity
of an infectious disease physician. And in fact, he and I still practice
sometimes. He and I worked together this weekend on a couple of patients.
It is My pleasure to introduce him to you all today. And I'm so excited
Dr. Lampe, for you to provide your perspective and expertise on all things
in relation to COVID for those folks who are joining, to talk a little
bit about what it is that you specifically do as an infectious disease
Well, thank you, Dr. Thompson. It's a real privilege to be invited
to do this. So thank you. I think it would be who, what and why. So who
do infectious disease pediatricians treat? They treat all children all
the way from birth through the teenage years. And then where? They treat
them in hospitals, they may treat them in hospitals in the neonatal intensive
care unit in the pediatric intensive care unit, in the pediatric floor,
and occasionally in specialty units in big hospitals in the hematology-oncology
ward, etc. They treat infections or things that might be causing fever
that can mimic infections and they provide consultation not only to excellent
hospitals like yourself and the people that come in, but also the pediatric
surgeons, pediatric orthopedist, pediatric urologist, pediatric surgeons.
So the surgical side, and we do a lot of consultation with our hematology-oncology
colleagues to the individuals that treat childhood cancer.
Excellent, thank you. So I just want to start a little bit by talking about
COVID. Is it true that children are the least susceptible to COVID? And
if so, why is that?
It is true. And to be honest with you, I simply don't know. I think
we're learning about that. And children are, of course, different
from adults. They are more susceptible to certain bacterial infections
when they're born, and they are certainly more susceptible to certain
virus infections, respiratory virus infections like RSV, but fortunately,
for COVID-19, they are not as susceptible. And that's great from my
Absolutely. And that's been, that's been our experience here at
the Children's Hospital, as well. And also when I've been on service,
we have seen very few symptomatic positive children. And in our specific
hospital setting, I feel like we're seeing actually more asymptomatic
women coming in to deliver than we have seen in positive children. So
what is it that you would tell parents to do if they think that their
child has been exposed to COVID-19?
Well, first of all, I think I've got to give the perspective as a parent
and as a grandparent, I can't imagine both parents and grandparents
not, at this time, worrying about their children or grandchildren. So
that's normal. But from my standpoint, if they have no symptoms, you
don't worry. And then you should also be reassured by the fact that
while there are some serious cases, they are really rare, and no serious
complications. If they have a respiratory infection or respiratory symptoms,
fever or cough, and they know they've been exposed, ask your doctor,
your nurse, your pediatric nurse practitioner, or your health care provider.
As always, follow the rules of the city or the state that you're in,
because each of those is a little different. Variation of the disease
in the United States is quite remarkable.
Yes, I agree. And at the Children's Hospital, we have a lot of things
set up for that very thing. We've got some call-in lines. So wherever
it is that you live, I would encourage you to look in your community for
some resources. We have a number as well that folks can use to call in
if they have specific questions, and especially in relation to COVID.
We've seen the thing that you talked about, which is the kids that
we have seen that are positive, or kids that have had an exposure to someone
that was positive. So are the symptoms the same for kids as the symptoms
for adults, or how does that differ in how their symptoms are looking?
I'll have to qualify this by saying, you know, I don't have 1000
patient experiences with this. So with this, things are not always the
same. Just like any disease, the children's symptoms may not be the
same. There seems to be a little more GI issues with children. It is a
respiratory virus like the adults cough and chest pain. And of course
I think it's mainly the GI issues with everybody. If they have watched
TV, they're worried about this multi system, serious aspect of things
which fortunately, is very, very rare.
Yes. I agree. And I think that that's been the question that I've
been asked the most whenever I'm on service, is in relation to that
multi system inflammatory syndrome. We actually have not had any cases
praise the Lord in our region. I do know in some of the other larger settings
that they are having some folks with this, but luckily we have not. We
have not seen that here.
Well, I'm gonna back up here for just a second. So I did some research,
and I used the American Academy of Pediatrics which keeps track of the
number of confirmed COVID cases in children in the United States by state
and is up to date as of early June. And what I carried away from that
is even in California, and certainly in Oregon and even in Washington
and in Texas where we live, the number of cases of children is low. Five
percent or less of confirmed cases is our children and then the number
of deaths in most of the states is zero. It seems like New York City is
the hotbed for not only the MRIs and this syndrome that looks like Kawasaki
in your hospital, or my hospital. I have consulted on several children
who had Kawasaki syndrome and saw no relationship at all.
Great. So are there kids that you're more worried about? Are there
kids that have certain predispositions or disease types, or things like
this, that folks should be more worried about?
Yes. Because it is a respiratory virus that dominantly affects the lungs,
anybody who is immunocompromised - and when we say immunocompromised,
we're talking about those children who are on chemotherapy for leukemia,
or for a tumor. So that will be one group of children. Another one might
be children with chronic lung disease. Premature infants that are still
on oxygen at home with something called bronchopulmonary dysplasia. It
could be children who were born with cystic fibrosis that are on medicines
for them, they would be at risk. And then probably the biggest number
of children are ones who have asthma, particularly if it is really severe
asthma or anything that would be a respiratory disease, puts them at some risk.
And I would say that's very similar to how we've been approaching
it here in the hospital medically, that those are really the same kids
that are more susceptible to things like flu. And things like RSV, so
when we think of those common respiratory illnesses that we see in the
winter, you know, usually in pediatrics, that's that same population
that we worry about as well with other respiratory illnesses and not just COVID.
You're absolutely right. In fact, we always, pediatricians and health
care providers for children always recommend influenza vaccine for all
children six months of age and above, but in particular right now, the
high risk children and I just have my fingers crossed that the vaccine,
if not available this winter, will be available shortly thereafter.
Dr. Lampe, you've made me proud because I did not expect you to get
through this entire questioning without encouraging the flu vaccine. So
way to be! That's fantastic. So what kind of special precautions are
healthcare providers taking around children and COVID?
Same kind of healthcare precautions we're taking around everybody in
the hospital. It has been a learning opportunity. I've washed my hands,
I believe more in the past three months, and I will continue to do so.
I have been wearing the mask now, when I'm out of the house and certainly
in all of the shopping that I'm doing, if I'm doing any shopping
at all. Certainly in the hospitals I'm wearing a mask full time, and
making the attempt at physically distancing from others. I've had
this discussion about social distancing and physically distancing. Physical
distancing will protect us. I don't think we should socially distance
because we should still communicate with each other.
I agree. And, as the administrator of a children's hospital, I will
tell you that we've taken these types of precautions very seriously
at the hospital. And so really trying to ensure that we have not only
good masking policies on the floors, so you know, that would be like for
nurses and physicians and folks that are seeing those patients. To have
masking techniques for that, but we're also encouraging masking in
public places. And so I'm with you, I'm not wearing my mask right
now, since we're on this phone call, and I'm by myself in my office,
but we are really trying to take that message seriously about masking.
I had one of my employees yesterday that shared a story with me that I
thought was great about this. He was in the grocery store and was wearing
his mask, and this child came up to him and he was talking to the parent
and was like, Oh, this man must be really worried about his health. And
so my employee looked at him and he said, actually, son, this mask is
to help protect you. And I thought it was such a beautiful message, because
it's something that we've talked so much about here, making sure
that we're taking good precautions. I'm with you. I think my hands
are raw from the amount of time that we have washed our hands but, you
know, we would be remiss if we did not encourage you to follow the recommendations
that the CDC and places like that are putting into place about good hand
washing. I would argue we should be doing that stuff, you know, at baseline,
and those things, but I also think that really making sure that we're
taking the protocols seriously. I've also had folks ask me, When are
we going to be done with screening? These kinds of things, and I've
actually likened it a bit to what happened in our world as a result of
911, that the entire industry changed in terms of TSA and, you know, things
that were happening. I don't know, I'm not trying to make the
prediction. But I do think that there are some things that will have long
standing effects in regards to the precautions that we're taking around
I agree with you. One of the things that I'd like to demonstrate to
our viewers and listeners is this little badge I am holding up here. When
I came into Covenant Children's Hospital, it had a little color circle
on it. So I've got a series of colored circles every day that I've
come in. They check my temperature, I sign in, and then I get this, which
allows me to go through. This is protecting children in the hospital,
and the ambulatory care for children is going to offer the same protection.
You're going to be checked before you come in. I know the parents
will get questioned about that. But I applaud this effort. And it helps
me remember to bring my parking sticker because it helps me get into the
parking lot and helps me get into the hospital. And they're right
there to check my temperature to make sure that I'm not bringing anything.
Yeah, I agree. You know, one of the things that I've been asked by
a lot of parents is, Is it still safe to bring my kids in? And obviously,
you know, we have an answer for that in the hospital around things that
are emergent, but what would you tell a parent who's asking you those
questions about safety around taking their child to the pediatrician just
for regular checkups for vaccines, things like this?
Yes, and when this started, we anticipated the need to give those children
who have recently been born and would be born during these months, their
routine childhood immunizations, and it is imperative that that be made
available. So we do not want to see in six months or a year, more pertussis,
or measles and those types of things. So actually, as a pediatric coordinator,
these pediatric practices have continued. They've encouraged those
routine visits. And in fact, it's important for parents and health
care providers for children to get in for routine care. Appropriate safety
measures will be taken. People are not going to come in sick. There's
going to be masks, there's going to be gloves. Appropriate persistency
statistically, in the United States, the number of visits on pediatric
practices for that type of service has fallen off dramatically. It's
really important that we not have another epidemic of some other infectious
disease like pertussis rise because of failure to do what we can now.
I agree. And, I am also concerned about that when they showed the numbers
that vaccines have dropped. Those are things that we're very concerned
about and so trying to get out some public information to folks that it
is safe for them to come to the doctor. We need to make sure we're
still doing all of those things preventatively. So if you have parents
out there that have school age kids, and were about to start school, what
advice would you give them? And what should they be aware of as we're
entering into summer with COVID?
Yeah, good question. Because if they've been school age, they've
already done a lot of homeschooling. I think exploring camps and other
activities, if any outdoor activities I think would be great as well.
So the American Academy of Pediatrics called healthy children.org is a
resource for parents to look at. Things that they can do for children,
not only during the school year, but also afterwards. And it is all very
appropriate for the age of the child all the way from Toddlers and Babies
all the way up to the teenagers. I am blessed with two grandchildren that
live here and love it. And they are going to follow with the physical,
routine hand washing, masks and physical separation. And I think that
that might be good for development.
Yeah, I also have my youngest this week at an outside camp. And so to be
fair, I feel like he was having a hard time being separated from his friends
for the last few weeks of school. And I've been impressed with the
camps here in this area that they're really taking precautions, But
to your point, and especially those activities that are outside, I would
also say are some creative ways that we can help them see their friends.
I was amazed. My youngest is not one who always loves school. And so I
think it was interesting for me because I felt like when school went online,
that he would actually potentially be happier. Because I feel like every
morning he doesn’t want to go to school. And so it was really interesting
to watch him have a different opinion when he really missed his friends.
And it was even funny, there are a couple of teachers that sometimes he
glitches about and, and he was like, I even miss so-and-so, and was talking
about some funny things. So I agree that trying to make sure that we can
do some things with others is important. And that brings me to this idea
of, I do think that there has been some, you know, psychological effects
for COVID-19 on our children. And so, I would love to talk for a minute
about what you think are some of those psychological effects. And then
what are things that parents should be looking for with that, and what
are the kinds of conversations that we can have with our kids about this?
Again, being a child is stressful enough without COVID and being a teenager
is stressful enough without COVID. And so, what this has done is just
add to that complexity. And, again using resources, I have found that
healthy children.org is appropriate even though it says children, It also
deals with adolescence. You know, as a pediatrician, I think the overall
chances of depression or anxiety in American teenagers is very high, 20
or 30%. And this COVID may have aggravated that. I think it's important
for parents or grandparents to be aware of that, and to look at some preventive
things in order to understand that this is hard, that you can't visit
your aunt for example, but how do you think you can communicate with them?
Yeah, we follow the rules, address it, get them involved in that from
the teenage years or the younger years. Like you, I'm concerned about
the grandmothers, she can't come over, we can't go see her. We
can't visit her. How can we visit with her or him the grandfather
and, find out about that and look for ways to communicate with friends
with technology from that standpoint. And I would probably emphasize supervised
technology, but what we're doing today we wouldn't have dreamed
of doing six months ago. So, we are going to learn about these issues.
We are fortunate at the medical school to have Child and Adolescent Psychiatry
interests and then provide resources online, as to what parents can do
with providers as they have telemedicine visits, etc.
That's great. I was saying, you know, I have this interesting phenomenon
to walk through with this. I'm a mother, I have two boys. My oldest
boy was a senior this year. And so I was able to walk through that situation
with him. I actually went with him as a parent sponsor on a mission trip
with his school before this before the COVID thing happened, and he and
I talked a lot on that plane. And I feel like the entire world changed
literally in a week and when I got back in, a lot of overwhelming things
happened at the hospital. But what was interesting for me, as I walked
through this situation was seeing this from the perspective of a CEO,
but then also having to deal with what I was just referring to with a
younger kid who I actually thought would be happy because he didn't
have to go back to school. He had a ton of questions, but then my senior
was having a hard time, you know, having to deal with loss. And there
are just a lot of things at the end of that senior year that they just
didn't get to do. And so, you know, as it turns out, you know, we
were very lucky at our school that the state of Texas after June 1, allowed
them to have an outdoor graduation so we were able to do a semblance of
an outdoor graduation. And we were able to get in some cars and drive
by occasionally, and the teachers and younger students would wave. So
I agree with what you're saying, that the number one thing is, make
sure you're asking your kids about their fears about COVID and then
looking together at ways you can get answers, and then encouraging the
solutions. There has been loss for all of our children in this with different
things that they have not been able to do. One of my best friends has
a grandmother that is in a facility. And after the graduation, we have
pictures that they went in his cap and gown and stood in the yard and
they opened up her window and they did a mock handing of the diploma and
allowed her to take pictures through her window. So I as well echo your
encouragement that we have to think outside of the box, about some type
of ways that we can continue to keep people engaged socially. We've
just got to figure out how to do that with the new rules.
Yeah, I think the schools have done a great job. Like yourself, our grandchildren
graduated high school, one in Dallas and one in Charlotte, North Carolina.
And we were not able to attend those, but we're really proud of them
and have communicated with them. I remember your trip with your son coming
back as it was during the initial phases of this. And we were fortunate
enough to take one of our grandchildren to Peru last year to do the same
thing. And we're so glad we did that, because there's not going
to be any trip this year. That's right. I do think we have a real
privilege and privilege to have them.
Dr. Lampe. I think we have a question that has come in over Facebook. And
so it says, I heard that children are getting multi system inflammatory
syndrome because of COVID-19. What symptoms do I need to watch for? And
are there any vaccines for this syndrome?
Yeah. Good question. In the city of New York or in the state of New York,
I am not sure, there have been 11 childhood deaths. 11 is still too many.
And most of those have probably been related to this syndrome because
there have been, perhaps 70 or 80 cases of this syndrome there, since
it's caused by COVID. When the vaccine becomes available for COVID
hopefully it will prevent that. In the meantime, my advice to my daughters
and daughters in law with smaller children of any age is,if they have
fever, if they have a rash, if you're concerned, talk to your health
care provider immediately, they will know what actions to take depending
on what part of the country you live in. Typically they have high fever,
or they are just not acting well. And they have a rash.
Yeah, and I would echo that the fever and the rash are really the things
you need to look out for.
Yeah. On a statistical basis that worries everybody. But fortunately, it
is so rare. I am just amazed that there have been no pediatric deaths
in Washington state and in California and in Texas.
Yeah. Praise the Lord. I'm so grateful for that. Dr. Lampe, I want
to thank you so much for joining me today. We were laughing before this
thing started that our pictures that they put up here, I think we look
so young. And that you and I've known each other for a very long time.
And this is the first Facebook Live I've ever done. So what a privilege
to have done it with you. And I'm so grateful for those of you who
have watched. Thank you for joining us, and we hope we've answered
some questions about children and COVID-19. And I would just encourage
you to continue to reach out to your healthcare provider if you continue
to have questions. The American Academy of Pediatrics is also a great
site for you to go to get information. I think we have about one minute
left and I have one more question. And it says, Have you seen mental health
providers implement secure messaging to communicate privately? And I will
actually answer that question. One of the things I oversee as CEO of the
Children's Hospital is our mental health, even our adult mental health
practices here at Covenant. And we have implemented this as well. So we
have this both with our psychiatrists, but then also with some counselors
and mental health providers and nurse practitioners, where we have implemented
secure messaging. So I would encourage you to look at your local health
systems. I have seen a big rise, and one of the biggest rises that I've
seen has come out of Providence, which has been so fantastic. The quick
rise of being able to use telemedicine. And so I think that this COVID
situation has provided a huge ramp up for the use of telehealth. So my
guess is that in the area where you live, look at those health systems
and see what it is that they have implemented. Well, doctor Lampe, might
there be any last thoughts as we sign off?
It's a privilege to have done this with you Dr. Thompson. Thank Providence
for sponsoring this.
I agree. Thank you guys so much for joining us and we'll hope to see
you guys soon. God bless.