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Del Monte M, Edwards AR, Waldron DB, Aird LD, Airhart CK, Robinson LB, Bright D, Calabrese TM, Diederich S, Fitzpatrick H, Frantz J, Haro TM, Hegland A, Ingstrup K, Jenco M, Kim S, Martin SS, Mazziotti D, Phillips M, Poslosky J, Salmon J, Walsh MC, White ML. Successes and Lessons Learned in Responding to the Needs of Pediatricians, Children, and Families During the COVID-19 Pandemic. Pediatrics 2024; 153:e2024066634. [PMID: 38485704 DOI: 10.1542/peds.2024-066634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 06/02/2024] Open
Abstract
The coronavirus disease 2019 pandemic has presented tremendous challenges to the United States health care system, as well as to individual physicians, communities, and families. Throughout the pandemic, the American Academy of Pediatrics (AAP) has striven to elevate the needs of infants, children, and adolescents, as well as the pediatricians who care for this population. Historically, these communities have often been overlooked and deprioritized in health care systems, and these deficits persisted into the pandemic. To fill this gap, the AAP took on an essential role in leading the national response for pediatrics. This article details the AAP pandemic response and includes the perspectives of multiple AAP leaders involved in the response and details on Academy advocacy with high-level staff and officials at federal agencies and the executive branch. The AAP provided initial guidance to pediatricians that predated the World Health Organization's declaration of a public health emergency. The Academy then developed entirely new approaches to meet the unprecedented needs of its practicing members and families by providing timely, rigorous information endorsed by pediatric experts. When coronavirus disease 2019 vaccines were developed, the AAP strongly advised the inclusion of those younger than 18 years in vaccine trials and advocated for equitable distribution plans. The AAP provided its members with strategies for combating misinformation. The Academy was at the forefront of advocating for the safe return to in-person schooling, recognizing that social isolation was contributing to the growing mental health crisis among youth. In 2021, the AAP, the American Academy of Child and Adolescent Psychiatry, and the Children's Hospital Association declared a national emergency in child and adolescent mental health. In addition, the AAP implemented educational and training opportunities for clinicians and developed resources for youth and their families. After the end of the public health emergency, AAP members continue to use innovations and efficiencies developed as part of their pandemic response. The successes of the AAP pandemic response, alongside lessons learned, help define an important model for responding to future pandemics and public health emergencies in ways that support children, families, and the pediatric workforce.
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Gemmell M, Sherby MR, Walsh TJ, Kalb LG, Johnson SB, Coller RJ, DeMuri GP, Nuthals E, McBride J, Newland JG, Gurnett CA. Recommendations for SARS-CoV-2 Testing in Children With Disabilities and Medical Complexity. Pediatrics 2023; 152:e2022060352G. [PMID: 37394506 PMCID: PMC10312279 DOI: 10.1542/peds.2022-060352g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 07/04/2023] Open
Abstract
Schools provide important services that cannot be provided virtually to children with medical complexity and children with intellectual and developmental disabilities, yet these children are among the most at risk from coronavirus disease 2019 (COVID-19). To keep schools open for children with medical complexity and/or intellectual and developmental disabilities during the COVID-19 pandemic, we implemented severe acute respiratory syndrome coronavirus 2 testing at 3 sites across the United States. We evaluated testing strategies for staff and students at each site, including specimen source (nasopharyngeal or saliva), test type (polymerase chain reaction or rapid antigen), and frequency and type (screening versus exposure/symptomatic) of testing provided. Among the greatest barriers to severe acute respiratory syndrome coronavirus 2 testing in these schools was the engagement of caregivers and challenges navigating legal guardianship for consenting adult students. Additionally, variability in testing strategies nationally and in the community, as well as surges in viral transmission across the United States during the course of the pandemic, led to testing hesitancy and variable participation rates. Essential to the successful implementation of testing programs is building a trusted relationship with school administrators and guardians. Leveraging our experiences with COVID-19 and forming lasting school partnerships can help keep schools for vulnerable children safe in future pandemics.
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Affiliation(s)
| | | | | | - Luther G. Kalb
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sara B. Johnson
- Division of General Pediatrics, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ryan J. Coller
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Gregory P. DeMuri
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Erin Nuthals
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Joseph McBride
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Coller RJ, Kelly MM, Eickhoff J, Johnson SB, Zhao Q, Warner G, Katz B, Butteris SM, Ehlenbach ML, Koval S, Howell KD, DeMuri GP. School Attendance Decisions for Children With Medical Complexity During COVID-19. Pediatrics 2023; 152:e2022060352K. [PMID: 37394510 PMCID: PMC10312281 DOI: 10.1542/peds.2022-060352k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVE School attendance by children with medical complexity (CMC) may be influenced by parent perceptions of their child's risk for coronavirus disease 2019 (COVID-19). The authors of this study aimed to quantify in-person school attendance and identify attendance predictors. METHODS From June to August 2021, surveys were collected from English- and Spanish-speaking parents of children aged 5 to 17 years with ≥1 complex chronic condition who received care at an academic tertiary children's hospital in the Midwestern United States and who attended school prepandemic. The outcome, in-person attendance, was defined dichotomously as any in-person attendance versus none. We evaluated parent-perceived school attendance benefits, barriers, motivation, and cues, COVID-19 severity and susceptibility using survey items derived from the health belief model (HBM). Latent HBM constructs were estimated with exploratory factor analysis. Associations between the outcome and the HBM were evaluated with multivariable logistic regression and structural equation models. RESULTS Among 1330 families (response rate 45%), 19% of CMC were not attending in-person school. Few demographic and clinical variables predicted school attendance. In adjusted models, family-perceived barriers, motivation, and cues predicted in-person attendance, whereas benefits, susceptibility, and severity did not. The predicted probability (95% confidence interval) of attendance ranged from 80% (70% to 87%) for high perceived barriers to 99% (95% to 99%) for low perceived barriers. Younger age (P <.01) and previous COVID-19 infection (P = .02) also predicted school attendance. CONCLUSIONS Overall, 1 in 5 CMC did not attend school at the end of the 2020 to 2021 academic year. Family perceptions of schools' mitigation policies and encouragement of attendance may be promising avenues to address this disparity.
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Affiliation(s)
| | | | - Jens Eickhoff
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Qianqian Zhao
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | | | | | | | - Shawn Koval
- Healthy Kids Collaborative, UW Health, Madison, Wisconsin
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Coller RJ, Kelly MM, Howell KD, Warner G, Butteris SM, Ehlenbach ML, Werner N, Katz B, McBride JA, Kieren M, Koval S, DeMuri GP. In-Home COVID-19 Testing for Children With Medical Complexity: Feasibility and Association With School Attendance and Safety Perceptions. Am J Public Health 2022; 112:S878-S882. [PMID: 36108256 PMCID: PMC9707728 DOI: 10.2105/ajph.2022.306971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2022] [Indexed: 01/29/2023]
Abstract
The REstarting Safe Education and Testing program for children with medical complexity was implemented in May 2021 at the University of Wisconsin to evaluate the feasibility of in-home rapid antigen COVID-19 testing among neurocognitively affected children. Parents or guardians administered BinaxNOW rapid antigen self-tests twice weekly for three months and changed to symptom and exposure testing or continued surveillance. In-home testing was feasible: nearly all (92.5%) expected tests were conducted. Symptomatic testing identified seven of nine COVID-19 cases. School safety perceptions were higher among those opting for symptom testing. Clinical Trials.gov identifier: NCT04895085. (Am J Public Health. 2022;112(S9):S878-S882. https://doi.org/10.2105/AJPH.2022.306971).
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Affiliation(s)
- Ryan J Coller
- Ryan J. Coller, Michelle M. Kelly, Kristina Devi Howell, Gemma Warner, Sabrina M. Butteris, Mary L. Ehlenbach, Joseph A. McBride, Madeline Kieren, and Gregory P. DeMuri are with the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison. Nicole Werner is with the Department of Industrial and Systems Engineering, University of Wisconsin-Madison. Barbara Katz is with Family Voices of Wisconsin, Madison. Shawn Koval is with the Health Kids Collaborative, UW Health, Madison, WI
| | - Michelle M Kelly
- Ryan J. Coller, Michelle M. Kelly, Kristina Devi Howell, Gemma Warner, Sabrina M. Butteris, Mary L. Ehlenbach, Joseph A. McBride, Madeline Kieren, and Gregory P. DeMuri are with the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison. Nicole Werner is with the Department of Industrial and Systems Engineering, University of Wisconsin-Madison. Barbara Katz is with Family Voices of Wisconsin, Madison. Shawn Koval is with the Health Kids Collaborative, UW Health, Madison, WI
| | - Kristina Devi Howell
- Ryan J. Coller, Michelle M. Kelly, Kristina Devi Howell, Gemma Warner, Sabrina M. Butteris, Mary L. Ehlenbach, Joseph A. McBride, Madeline Kieren, and Gregory P. DeMuri are with the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison. Nicole Werner is with the Department of Industrial and Systems Engineering, University of Wisconsin-Madison. Barbara Katz is with Family Voices of Wisconsin, Madison. Shawn Koval is with the Health Kids Collaborative, UW Health, Madison, WI
| | - Gemma Warner
- Ryan J. Coller, Michelle M. Kelly, Kristina Devi Howell, Gemma Warner, Sabrina M. Butteris, Mary L. Ehlenbach, Joseph A. McBride, Madeline Kieren, and Gregory P. DeMuri are with the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison. Nicole Werner is with the Department of Industrial and Systems Engineering, University of Wisconsin-Madison. Barbara Katz is with Family Voices of Wisconsin, Madison. Shawn Koval is with the Health Kids Collaborative, UW Health, Madison, WI
| | - Sabrina M Butteris
- Ryan J. Coller, Michelle M. Kelly, Kristina Devi Howell, Gemma Warner, Sabrina M. Butteris, Mary L. Ehlenbach, Joseph A. McBride, Madeline Kieren, and Gregory P. DeMuri are with the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison. Nicole Werner is with the Department of Industrial and Systems Engineering, University of Wisconsin-Madison. Barbara Katz is with Family Voices of Wisconsin, Madison. Shawn Koval is with the Health Kids Collaborative, UW Health, Madison, WI
| | - Mary L Ehlenbach
- Ryan J. Coller, Michelle M. Kelly, Kristina Devi Howell, Gemma Warner, Sabrina M. Butteris, Mary L. Ehlenbach, Joseph A. McBride, Madeline Kieren, and Gregory P. DeMuri are with the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison. Nicole Werner is with the Department of Industrial and Systems Engineering, University of Wisconsin-Madison. Barbara Katz is with Family Voices of Wisconsin, Madison. Shawn Koval is with the Health Kids Collaborative, UW Health, Madison, WI
| | - Nicole Werner
- Ryan J. Coller, Michelle M. Kelly, Kristina Devi Howell, Gemma Warner, Sabrina M. Butteris, Mary L. Ehlenbach, Joseph A. McBride, Madeline Kieren, and Gregory P. DeMuri are with the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison. Nicole Werner is with the Department of Industrial and Systems Engineering, University of Wisconsin-Madison. Barbara Katz is with Family Voices of Wisconsin, Madison. Shawn Koval is with the Health Kids Collaborative, UW Health, Madison, WI
| | - Barbara Katz
- Ryan J. Coller, Michelle M. Kelly, Kristina Devi Howell, Gemma Warner, Sabrina M. Butteris, Mary L. Ehlenbach, Joseph A. McBride, Madeline Kieren, and Gregory P. DeMuri are with the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison. Nicole Werner is with the Department of Industrial and Systems Engineering, University of Wisconsin-Madison. Barbara Katz is with Family Voices of Wisconsin, Madison. Shawn Koval is with the Health Kids Collaborative, UW Health, Madison, WI
| | - Joseph A McBride
- Ryan J. Coller, Michelle M. Kelly, Kristina Devi Howell, Gemma Warner, Sabrina M. Butteris, Mary L. Ehlenbach, Joseph A. McBride, Madeline Kieren, and Gregory P. DeMuri are with the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison. Nicole Werner is with the Department of Industrial and Systems Engineering, University of Wisconsin-Madison. Barbara Katz is with Family Voices of Wisconsin, Madison. Shawn Koval is with the Health Kids Collaborative, UW Health, Madison, WI
| | - Madeline Kieren
- Ryan J. Coller, Michelle M. Kelly, Kristina Devi Howell, Gemma Warner, Sabrina M. Butteris, Mary L. Ehlenbach, Joseph A. McBride, Madeline Kieren, and Gregory P. DeMuri are with the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison. Nicole Werner is with the Department of Industrial and Systems Engineering, University of Wisconsin-Madison. Barbara Katz is with Family Voices of Wisconsin, Madison. Shawn Koval is with the Health Kids Collaborative, UW Health, Madison, WI
| | - Shawn Koval
- Ryan J. Coller, Michelle M. Kelly, Kristina Devi Howell, Gemma Warner, Sabrina M. Butteris, Mary L. Ehlenbach, Joseph A. McBride, Madeline Kieren, and Gregory P. DeMuri are with the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison. Nicole Werner is with the Department of Industrial and Systems Engineering, University of Wisconsin-Madison. Barbara Katz is with Family Voices of Wisconsin, Madison. Shawn Koval is with the Health Kids Collaborative, UW Health, Madison, WI
| | - Gregory P DeMuri
- Ryan J. Coller, Michelle M. Kelly, Kristina Devi Howell, Gemma Warner, Sabrina M. Butteris, Mary L. Ehlenbach, Joseph A. McBride, Madeline Kieren, and Gregory P. DeMuri are with the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison. Nicole Werner is with the Department of Industrial and Systems Engineering, University of Wisconsin-Madison. Barbara Katz is with Family Voices of Wisconsin, Madison. Shawn Koval is with the Health Kids Collaborative, UW Health, Madison, WI
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