COVID-19 Positive cases: 5295*
COVID-19 related deaths: 158
Recovered COVID-19 cases: 2040
Data from Tarrant County Public Heath’s (TCPH) report of COVID-19 activity in Tarrant County, updated Thursday, May 28, 2020. Find more COVID-19 information from TCPH here.
* These data are provisional and are subject to change at any time.
Deaths and recovered cases are included in total COVID-19 positive cases.
By Tammy Camp, MD President, Texas Pediatric Society
Usually at this time of year, children seen in a clinic setting respond with a resounding “yes” when asked if they are ready for school to be out. For many this year, the answer is different. Instead, several have said “No, I can’t wait to go back to school – I miss being there.”
These very thoughts are echoed by the pediatricians who see children and adolescents in their offices. We cannot wait to have children and their caregivers back in our offices so that we can address and treat their physical and emotional needs.
During a disaster such as this pandemic, behavioral health issues in children are likely to be exacerbated. We see this being played out in front of us now. Social isolation has led to increased depression; anxiety is intensified by the relentless news cycle and social media coverage.
The safety net for many children is the education system, but it is no longer functioning in this way for them. While reports of child abuse may be down due to children’s decreased contact with systems that normally watch over them, those children presenting with abuse to emergency rooms unfortunately have injuries far more serious and life-threatening.
Of great concern is data released from Texas Health and Human Services demonstrating a 10% decrease in doses administered every public health region of the state in March of 2020 compared to March of 2019. These decreases suggest that following the current crisis, our children could be faced with another: exposure to vaccine preventable diseases.
While all of this may seem discouraging, there is hope. Pediatricians are prepared to walk alongside their patients, helping them traverse these unprecedented challenges. We are not only prepared, but we long to assist children and caregivers in navigating these rough waters.
As Governor Abbott and his Strike Force team begin to reopen our state, Texas pediatricians stand ready to have the children and adolescents for whom they provide care back in their offices. The Texas Medical Board has instituted minimum standards to assist them in doing this safely. Those standards include that both the patient and the physician wear masks when within 6 feet of one another. Additionally, before encounters, patients must be screened for potential symptoms of COVID-19. Further, prior to procedures that are higher risk for aerosolization for COVID-19, the healthcare provider must use N-95 masks and face shields.
These standards are included in addition to what most offices had already implemented to protect their patients. Many offices are concentrating all well child care visits and behavioral health visits to designated morning times, while seeing patients who are ill in the afternoons. Most have implemented telemedicine appointments for visits that can safely be handled in this manner. The offices use increased cleaning measures between patients and at the end of the day.
Still, some offices may choose not to fully reopen, or may only provide limited access. Pediatricians will use their professional judgment to decide if and when they can resume full provision of services as they value the staff of nurses, receptionists and others in their team who assist in providing care and must place a priority on their health.
So now we ask you, the caregivers of our children, to partner with us as we prepare for the return of a “new normal.” We want to meet the emotional needs of your children. We want to provide you with tips for juggling your parenting responsibilities with your new educating duties. We want to ensure that preparticipation histories and physicals are completed so that your child is ready to safely enter extracurricular activities when they are allowed to resume. We also want to protect your child from another health crisis by keeping their immunizations up to date.
While many of our children eagerly anticipate the return of school, complete with the extracurricular activities and in-person reunions with their friends, we also look forward to welcoming you into our offices.
From the Fort Worth City News Letter. Published on May 20, 2020.
A rare but serious health condition related to COVID-19 is now affecting children in North Texas. Since May 9, four patients have been treated at Cook Children’s Medical Center for multisystem inflammatory syndrome, or MIS-C. The children range in age from 6 to 14.
“All of these children presented to the hospital with symptoms that resembled a severe case of Kawasaki disease,” said Nicholas Rister, an infectious diseases physician at Cook Children’s.
Kawasaki disease is an illness that creates inflammation in blood vessels with no proven cause, but is generally thought to follow various infections after they have otherwise resolved. Rister said the patients with MIS-C arrived at Cook Children’s following exposure to COVID-19 and had symptoms including fever, abdominal pain and outward evidence of inflammation including diffuse rashes, conjunctivitis and swelling. In the more severe cases, evidence of multi-organ dysfunction including respiratory distress, low blood pressures, liver and kidney damage and altered mental status were also seen.
“Of particular concern to us is inflammation of the heart and surrounding major blood vessels which is also seen in Kawasaki’s disease. We have seen this same thing in several of these COVID-19 inflammatory disease patients,” Rister said. “Minimizing the degree of inflammation in these children, while providing supportive care for any organ damage, has been a key component of treatment.”
All four patients were tested for COVID-19. Three tests came back negative and one was positive.
“We believe all of these cases are related to COVID-19,” Rister said. “The three negative results are evidence of how far the infection had progressed, resulting in the inflammatory syndrome.”
Three of the patients have been released from the hospital. One remains in the pediatric intensive care unit.
In addition to the recent appearance of MIS-C cases, the infectious diseases team at Cook Children’s is also looking closely at increased reports of unexplained fevers in the area.
“We want parents to be aware of these cases as COVID-19 continues to spread in our community,” Rister said. “Unexplained fevers for several days and evidence of generalized inflammation may be signs of this illness.”
Symptoms of more severe MIS-C cases include severe abdominal pain, shock from low blood pressure, respiratory distress and lethargy. If a child exhibits any of these symptoms, seek emergency medical care immediately.
Less severe symptoms include fever, abdominal pain and rash. Caregivers should call a pediatrician if these symptoms appear, as they overlap with many other common infections and medical conditions. It is important for these children to be fully evaluated.
by Sneha Sudanagunta, OMS-III
Originally published in the May/June 2020 issue of the Tarrant County Physician.
Medical schools emphasize two main concepts throughout the first two didactic years: medical knowledge and humanism—the art of forming human connections. The first encompasses learning the ins and outs of normal and pathologic functions of the body, different disease states, and how to properly diagnose and treat diseases. This, some can argue, is the most important aspect of medical school. Medical students spend countless hours during the first two years learning as much as they can. During their clinical years, they’re “pimped” on what they learned the first two years and learn how to integrate their book knowledge into the real world. The latter concept, humanism, focuses on the actual human contact part of being a doctor. This includes showing empathy, communicating appropriately, and partnering with patients. During the first two years of medical school, most schools teach humanism through interactions with actor patients. During this course, we are evaluated based on these aspects of humanism. Even our national board exam tests our ability to communicate with patients and empathize with them. It’s engrained into how we interview patients and it seems to come naturally. It’s why we all went to medical school in the first place, right? To help those in need.
However, that’s not how it always works in the real world. Medical knowledge is increased every day and every physician I have encountered during my third-year rotations has an immense fund of knowledge. That aspect of education continues past medical school. In my experience, however, the humanism aspect seems to be dwindling from memory every year a physician is out of medical school. Is this due to burnout? Can it be because physicians become jaded? Or is it because doctors are so overworked? Whatever the reason may be, physicians must strive to remember why they began this journey and keep humanism at the forefront.
“Physicians must strive to remember why they began this journey and keep humanism at the forefront.“
As a third year medical student, I have noticed that appropriate communication with patients is not as emphasized in the real world as it is in our preclinical years. I have seen patient interactions where physicians take the extra minute to educate their patients, and I have also witnessed many occasions where patients are left with more questions than answers. The difference in patient care and outcome is shocking. A young adult female came to the OB/GYN clinic for increased uterine bleeding and had been taking three times the recommended oral contraceptive dose for two weeks longer than protocol. When this mistake in drug use was explained to her, she said she never fully understood the instructions the ER doctor gave her about her new medications. The mother of a five-year-old boy in the hospital for rhabdomyolysis was told her son had high liver enzymes and was transferred to this hospital for better care without further explanation of the disease. I watched as the fear of her son having liver disease left her eyes when I explained to her what rhabdomyolysis is and how it can falsely elevate liver enzymes. When a patient hears 60 percent ejection fraction, do they understand that their heart is pumping effectively and not that it has lost 40 percent of its function? When doctors use words like peritoneum, cardioversion, or even EKG, do patients truly understand what they’re saying or do they begin to zone out?
This is where the ideologies of patient communication that are engrained in us as medical students need to shine. Humanism isn’t just about caring for patients; it’s about effectively communicating with them. As we’re taught in medical school, effective communication includes using language the patient will understand, educating them properly on their disease processes, and developing a treatment plan that the patient is comfortable with and able to maintain. Though knowing medical concepts is imperative as a physician, our job doesn’t end there. We have the unique opportunity to be more than just doctors. We are educators, confidants, and our patients’ best advocates. If we have the ability to be all of these things, why stop at being just healers?
COVID-19 Positive cases: 5039*
COVID-19 related deaths: 144
Recovered COVID-19 cases: 1912
Data from Tarrant County Public Heath’s (TCPH) report of COVID-19 activity in Tarrant County, updated Tuesday, May 26, 2020. Find more COVID-19 information from TCPH here.
* These data are provisional and are subject to change at any time.
Deaths and recovered cases are included in total COVID-19 positive cases.
COVID-19 Positive cases: 4977*
COVID-19 related deaths: 144
Recovered COVID-19 cases: 1834
Data from Tarrant County Public Heath’s (TCPH) report of COVID-19 activity in Tarrant County, updated Sunday, May 24, 2020. Find more COVID-19 information from TCPH here.
* These data are provisional and are subject to change at any time.
Deaths and recovered cases are included in total COVID-19 positive cases.
By Shanna Combs, MD
These are interesting times here in North Texas. I just spent the day completing an eight-hour curricular meeting for our Phase 2 Longitudinal Integrated Clerkship, all through online video conferencing. These are the current social distancing times of COVID-19.
Our students have also adjusted to this new reality, by having all their learning converted to online video conferencing. This includes their small groups, where they work through clinical cases, develop learning objectives, then come back together to teach their fellow students what they have learned. Their clinical skills sessions are also online where our students can work with their physician educator as well as standardized patients to hone their craft. While not an ideal platform for teaching hands-on clinical skills, the students are getting introduced to the ever-increasing telehealth that has become more common during this pandemic and will likely be more common after the pandemic comes to an end. Our students have also been able to engage with patient panels online, where the patients engage with the class in a conversation on their disease processes that are connected to the curricular content the students are learning.
Unfortunately, during this time our students have also had to step away from their clinical duties, which currently includes working with a family medicine or internal medicine physicians for a half day every other week. While the students are not able to participate in direct patient care at this time, they have not been deterred. They now want to find other ways they can contribute to the local community during this pandemic. They are working on a project to do readings of children’s books for children to access online during this time of sheltering in place and distance learning for all students. Our students are also working to support and participate in blood drives as well as working on setting up a PPE drive to obtain the necessary PPE for our local clinics and hospitals who are in need. They truly understand the meaning of being Empathetic Scholars™.
The students are also taking this time to work with their mentors (virtually, of course) for their Scholarly Pursuit and Theses project. This is a four-year long research program where students work one-on-one with a local mentor to develop, perform, and ultimately present their own scholarly work. Lastly, our Prep for Practice course is taking the current situation of the COVID-19 pandemic to highlight the many themes in their course including Ethics, Health Care Delivery, Health Care Policy and Advocacy, Informatics, Patient safety and CQI, Population Health, Physician as Educator, Psychological and Behavior Science, as well as Team-Based Care. So many of these important topics can be highlighted through the lens of the COVID-19 pandemic.
While the pandemic carries on, we at the TCU and UNTHSC School of Medicine continue our work for our students, but ultimately for their future patients. The COVID-19 pandemic will hopefully pass sooner than later, yet our students will continue in their education and be even more prepared for the next crisis in healthcare.
COVID-19 Positive cases: 4951*
COVID-19 related deaths: 143
Recovered COVID-19 cases: 1832
Data from Tarrant County Public Heath’s (TCPH) report of COVID-19 activity in Tarrant County, updated Saturday, May 23, 2020. Find more COVID-19 information from TCPH here.
* These data are provisional and are subject to change at any time.
Deaths and recovered cases are included in total COVID-19 positive cases.
COVID-19 Positive cases: 4899*
COVID-19 related deaths: 141
Recovered COVID-19 cases: 1809
Data from Tarrant County Public Heath’s (TCPH) report of COVID-19 activity in Tarrant County, updated Friday, May 22, 2020. Find more COVID-19 information from TCPH here.
* These data are provisional and are subject to change at any time.
Deaths and recovered cases are included in total COVID-19 positive cases.
As Memorial Day weekend approaches, the North Texas Medical Society Coalition (NTMSC) encourages residents and businesses to continue practicing safe physical distancing. As people gather to celebrate with friends and family, or take in North Texas’ recreational activities, it is critical to continue preventive steps to avoid spreading COVID-19. There is still no vaccine to prevent COVID-19.
“Memorial Day gatherings will be a true test of how well North Texans are able to practice physical distancing. If residents and businesses do not follow physical distancing guidelines, there will likely be a spike in COVID-19 cases in the weeks that follow,” said John Flores, MD, Chair of the North Texas Medical Society Coalition.
NTMSC has produced this video to promote safe physical distancing measures this holiday weekend.
“North Texans have done a great job adhering to the medical community’s advice, which has flattened the COVID-19 curve. Residents and businesses must continue physical distancing efforts this holiday weekend or we risk taking a major step backwards with opening Texas,” said Collin-Fannin County Medical Society President-elect, Sejal Mehta, MD.
COVID-19 is still active and continuing to surge in parts of North Texas. Residents and businesses need to work together to prevent a further spread. The best way to do so is to follow the physical distancing guidelines that have proved successful during the pandemic:
About North Texas Medical Society Coalition:
The NTMSC represents more than 11,500 physicians in the communities of Collin-Fannin, Dallas, Denton, Grayson, and Tarrant County. Founded in 2020, the NTMSC works with community healthcare partners, including public health departments, hospitals, and business leaders, to advise on medical recommendations to serve the health care needs of the residents of North Texas.
Tarrant County Physician Online 