Supporting Pediatric Populations During COVID-19 in Underserved Communities

At the beginning of the COVID-19 pandemic, many pediatricians at Mass General for Children were seeing fewer patients than prior to the virus. So, they offered their services and support on the front lines in new ways.

One issue for which many bilingual physicians volunteered their time was to support those COVID-19 patients who were immigrants and/or did not speak fluent English, including Carlos Torres, MD, a primary care pediatrician at MGH Chelsea HealthCare Center, who also does work in obesity prevention research and serves an administrative role in diversity and inclusion.

"Many of us got together, particularly when we saw that it was disproportionately affecting communities of color, such as in Chelsea, Massachusetts," Dr. Torres says.

Communication at the Peak of the Pandemic

Mass General has a robust team of medical interpreters and community health workers that worked remotely during the pandemic to limit exposure to the coronavirus and to preserve personal protective equipment (PPE). However, some conversations—especially those regarding critical care patients at all hours of the day and night—needed to be handled in person. Dr. Torres, along with other native Spanish-speaking physicians, joined the Spanish Language Care Group, which includes 62 Spanish-speaking clinicians who help to facilitate communication between patients and health care providers. Among their many efforts, the group recorded public service announcements to help provide accurate information about COVID-19 in Spanish. Dr. Torres joined a similar effort forged by the Mass General Center for Community Health Improvement (CCHI) and MGH Chelsea providing important information and outreach to the Spanish speaking community in Chelsea.

On days when Dr. Torres did not have a clinical shift, he pivoted his role to serve as an interpreter during meetings between physicians, patients and their families. While he saw many familiar faces from the MGH Chelsea HealthCare Center, his focus was on older family members, rather than his usual pediatric patients.

"Many of the families we worked with are immigrants who live together in multigenerational homes," says Dr. Torres. "At one point, we were taking care of three generations in one family—the children, parents and grandparents."

The translation is multifaceted—there is a linguistic component and a cultural component.

"During these times of distress, the cultural component was probably even more important than the language itself," he says.

Moving Toward a New Normal

Now that new COVID-19 cases have slowed down in Massachusetts, the Spanish Language Care Group is becoming a consultant group as its members transition back to their regular work. In the wake of the COVID-19 peak, many pediatricians are facing a new set of challenges: multisystem inflammatory syndrome in children (MIS-C).

Although children were largely unaffected by COVID-19 at the beginning of the pandemic, physicians are now seeing patients with symptoms of MIS-C. This illness affects children approximately a month after coronavirus exposure.

In Chelsea, the city that was hit hardest by COVID-19 in Massachusetts, MIS-C cases started to appear a month ago.

"It is still something that is going on and it is really important to seek care, because they can get very sick," says Dr. Torres.

He explains that it is important to intervene to keep MIS-C patients stable (hydrated and showing good vital signs) and to make sure the heart does not have any damage, because inflammation can involve the heart. These symptoms may indicate that a child is sick:

• Fevers that last several days
• Rash
• Vomiting or diarrhea
• Appearing unwell or dehydrated
• Bloodwork revealing signs of inflammation

Respiratory Illness Clinics

As the pandemic is slowing down for adults, physicians are still seeing pediatric patients at Mass General's Respiratory Illness Clinics (RICs), which offer continued COVID-19 testing, as well as treatment for other respiratory issues such as asthma. The RICs are now providing a way to separate patients so that physicians can continue with childhood vaccinations and developmental screenings while minimizing the potential for exposure to the coronavirus.

Proceeding with Caution

Regardless of the decrease in cases, many people remain fearful of COVID-19 and contracting it from hospital environments.

"One of my patients was a young girl who had broken a bone over a week ago and the family did not seek care because of fears of exposure to the virus," says Dr. Torres.

Mass General's pediatricians are taking a phased approach to a new normal. Evaluation for a sick or injured child or teen starts on the phone with a nurse. Based on the information obtained, the nurse will then assess whether a virtual visit with a doctor is appropriate or if the child should be seen in person. Next, the clinicians and family may talk as a team to decide on the next steps, which might include the RIC for respiratory complaints or COVID testing, in person visit or emergency department. In emergency situations, caregivers should always call 911 or take the child directly to the emergency department. In non-emergency situations, anyone who is sick or injured should still seek care from their medical provider. In many cases, if you delay your health care, your condition could worsen or you may need more serious treatments or procedures.

Long-term Issues

Even when the pandemic is over, children in Chelsea face obstacles with the social determinants of health, the essential things that people need to live, beyond a doctor. For instance, lines at food pantries have been astronomical, says Dr. Torres. Many of his patients' families do not have enough essential supplies, such as diapers, menstrual pads and baby formula.

The need in these communities is dire and through innovative programs such as CCHI’s Healthy Chelsea, a community-based coalition focused on improving the overall health of Chelsea residents, Mass General is working alongside community partners to address the crisis. And Mass General’s Food for Families program, a food pantry located in the health center, continued to distribute much needed food throughout the peak of the pandemic. Additionally, staff members donated other scarce items, such as boxes of diapers, to residents in need.

"We know that it is going to be a hard and long recovery," says Dr. Torres. "But on the other hand, I know that these communities are also very resilient, so I know we are going to be able to pull through."