Primary care physicians, like so many of us, have had to face change, uncertainty and anxiety in recent weeks. And they have done so admirably, making swift and unprecedented changes in their practices to allow them to safely continue caring for the most vulnerable patients. Pediatricians have ramped up their technology remarkably quickly and are able to provide tele-health visits, which are helpful for many conditions. Many practices now schedule well-child visits exclusively in the morning and sick visits in the afternoon so that an office can be decontaminated at the end of the day.
Yet a recent survey of more than 2,600 doctors found more than two-fifths have had to lay off or furlough staff to keep afloat as the large majority, 85%, face dramatic decreases in patient volume. A New York Times article from April 23 noted that fear of COVID-19 has prompted parents to cancel well-child visits nationwide, putting millions of children at risk for whooping cough, measles and other life-threatening illnesses. The lack of appointments is not only financially devastating for some practices; it is also concerning because we know non-COVID-19 medical needs haven’t gone away, despite the pandemic. And many child experts are concerned that the current shelter-in-place orders put children at higher risk for abuse and neglect, which could easily go unnoticed if these families are not being seen by pediatricians and the children are not attending school.
Children who need immunizations, especially those under 2 (years old), still can and should be seen safely in the office. This is allowed under the public health order as an essential service, because it is just as essential to prevent other vaccine-preventable diseases like polio and meningitis as it is to develop a safe and effective coronavirus vaccine. Infants are especially vulnerable, but even older children will suffer if booster shots are missed and immunity begins to wane. Most diseases require herd immunity of 90-95% to prevent outbreaks, which will become more difficult to achieve the longer immunizations are delayed, putting those with immune disorders or chemotherapy-induced immune suppression at even higher risk.
Pediatricians want to promote child well-being; identify developmental delays quickly; prevent illnesses that are preventable; care for children and youth who have acute or chronic medical conditions; and support parents in raising healthy children. But none of those goals can be achieved if patients and families do not seek care, and they will certainly not be achieved if offices close. We have all received a wake-up call about how devastating infectious diseases can be, but we need to remember that COVID-19 is only one of the many threats to children’s health.