A Message from Shelly Voet, MD
December 5, 2021
Hello to my fellow pediatric providers!
Thanks for taking the time to read this issue of Synapse. This issue includes details about new resources CCHMC will be directing toward pediatric mental health, links to the new location G Critical Care building, and a note from Dr. Steve Davis, the new CEO of CCHMC. A special edition of CCHMC Inspire on November 22 paid tribute to Michael Fisher HERE.
Urgent Text - As we approach winter weather and patient volumes increase, please consider having at least a few key staff and providers sign up for the new Urgent Text Messaging system (details in this issue). This text alert will only be for same day situations that would significantly impact care at CCHMC (such as a site closure due to weather or very high census). We expect to use this system 4 or 5 times a year. You can enroll HERE. Thanks to Therese Martin’s team for developing it and our CPAC group for trialing this.
Mental Health in the community - Winter months also bring an increase in mental health concerns each year. In case you are not aware, this fall The Children’s Home of Cincinnati opened a pediatric mental health urgent care within their Best Point Behavioral Health division at the Duck Creek location (tchcincy.org). The urgent care is open M-F 3-10 pm and is appropriate for urgent emotional/social needs not requiring hospital care (family distress/unable to calm/passive suicidality). For patients over 18, the new Glenwood Behavioral Health Hospital (glenwoodbehavioral.com) provides comprehensive mental health services including treatment for patients with dual diagnoses. An adolescent inpatient unit is also planned there.
Epic Link -Our CPAC group has also trialed two factor authentication (2FA) for Epic Link access. 2FA will be necessary soon for all users. Many of us use 2FA for other professional and personal accounts, and I am pleased to report it was straight forward for the CPAC group. Please watch for details on this as we spread it to the larger community in early 2022.
COVID-19 and Flu – The pediatric COVID-19 vaccine is now widely available at many pediatric practices, pharmacies, public health providers, and CCHMC. All locations providing the vaccine can be found on the Health Collaborative’s website: https://healthcollab.org/testandprotectcincy/.
The CCHMC Provider Hub HERE also has flyers in English and Spanish you can print for families.
On Dec 3, the FDA also extended the authorization for a specific combined monoclonal antibody treatment (bamlanivimab and etesevimab) to younger children at risk for severe disease. We will keep you updated if/when this is an available treatment option at CCHMC. The end of my letter has a reminder about the current use of monoclonal antibody (casirivimab and imdevimab) at CCHMC for those over 12 years and 40 kg.
PCPs are also continuing to provide flu vaccination for children, especially as we are seeing the return of influenza infections in our community.
Cincinnati Pediatric Society and Ohio AAP – The CPS Fall Awards Ceremony honored Chief of Staff Patty Manning, MD, Gen Peds PPC provider Tasha Johnson, MD, and resident Elizabeth Ireson, MD. It was uplifting to celebrate the passion and dedication of these fellow pediatricians. I am grateful for the outstanding work that Abby Stein, MD has done leading CPS, and look forward to the leadership of Dr. Nicole Lacasse, who is the president-elect. We also congratulate Chris Peltier, MD, of Mt. Carmel Pediatrics, who was honored by the Ohio AAP this fall with the William Cotton Advocate Award. Details of these awards are featured in this edition of Synapse.
November also marked the passing of giants in neonatology in Cincinnati, Drs. Paul Perlstein and Adekunle Dawodu. I was very privileged to spend a month training with Dr. Perlstein as a resident. You can read their obituaries in this issue of Synapse.
Finally, as December marks her birthday month, I wanted to publicly say a special thank you to Therese Martin on behalf of all of us in the community. None of us would have anticipated that we would still be preparing a weekly email related to COVID-19, but here we are. Therese and her team have faithfully and tirelessly worked on behalf of community PCPs to ensure we have the most up to date information regarding COVID-19. Thank you, Therese!
I hope all of you have restful and enjoyable holidays. Thanks for all you do for the kids in our community.
Shelly
Shelly F. Voet MD
Pediatric Associates PSC
CCHMC Executive Community Physician Leader
December 6, 2021, Monoclonal Antibody Information at CCHMC
Children over age 12 years and 40 kg who test positive for COVID-19 and are at high risk of progression to severe disease may qualify for monoclonal antibody treatment with casirivimab and imdevimab at CCHMC. The patient’s risk factor(s) for progression, course of illness, age, timing, and personal/family preferences should be considered when assessing a patient for monoclonal antibody treatment. The antibody infusion is provided via IV and takes about 3 hours. Most of the medication costs are covered by the federal government but infusion center costs are billed to insurance. Treatment is ideally provided within 4-5 days of symptom onset but could be considered for up to 10 days. If the patient is followed by a CCHMC specialist, the specialist could be contacted regarding the decision or asked to submit the request. Families should be informed that treatment guidelines are based on adult data. There is limited data on the effectiveness in patients 12-18. Benefits for younger patients may not be the same as adults. The EUA for casirivimab and imdevimab was based on double blinded, placebo controlled trial of outpatients over 18. Treatment with the combination reduced the primary outcome of hospitalization from 3.2% in the placebo group to 1.0% in the treatment group. If you have a patient who you think might qualify, please send their name, DOB, date of illness onset, date of test, and underlying risk factors to COVIDmonoclonalrequest@cchmc.org for consideration by the committee. The process map and guidelines are included HERE