Hospital or Walk In Clinic…What Has More Germs? – 10 Questions with a Pediatric Infectious Diseases Doctor – Palm Beach Children’s Hospital

The first week the country went into lockdown in 2020, my husband announced (quite dramatically) to the kids that we were not going to the hospital if one of them fell and broke their arm while running around in the backyard…

Guess what happened…

You guessed it. My youngest son tripped over the play set ladder and fell on his arm. Wouldn’t you know…day one of staying at home really meant heading to the emergency room. As a mom things are scary enough, but add the unknown on top of it and I was not in a great place. I had a million questions and a year ago, no one had answers.

Time and experience has shed light on some of those questions other parents are still having.

Here are some of the questions I wish I had answers to then, from Pediatric Infectious Diseases Doctor, Chad R. Sanborn, MD — Palm Beach Children’s Hospital at St. Mary’s Medical Center in West Palm Beach, FL.

Chad R. Sanborn, MD — Palm Beach Children’s Hospital

1) If I need to –  is it better to take my child to a walk in clinic or hospital? Do hospitals have more germs than clinics? Where is there less risk for exposure? 

 Well, I wouldn’t actually make that decision based upon exposure to germs. While the patients at the hospital are generally sicker, that doesn’t mean they are more contagious or that they even have an infection at all. At a busy walk in center you may be exposed to more germs than at a not so busy hospital emergency department, and vice versa. Both are cleaned regularly after each patient and should have COVID protocols in place to keep potentially contagious patients away from non-contagious ones. Everyone in the medical profession these days is paying extra attention to the possibility of transmitting infections. I would make the decision on where to take your child more on the acuity of the illness – in general, moderate to very sick children should be brought to the Emergency Department and minor illness should be brought to a walk in clinic or to the primary care doctor if possible.

The 138-bed Palm Beach Children’s Hospital is the largest between Fort Lauderdale and
Orlando.

2) Are you limiting people at the hospital? How have visitations changed? 

 Yes. So we allow one parent or caretaker with the child while they are in the Emergency Department or are admitted to the floor. We attempt to limit the number of “change outs” of that caretaker as well.  While visitors are great for patient and family morale, this whole pandemic has made us realize that now is not a great time for friends and extended family to visit a child once hospitalized. For that reason we don’t allow visitors at the moment. The whole point is that while we can control what is happening in the hospital and know the potential exposures/risk of exposure for our patients and their immediate family, we are less sure about those extended visitors. We want to minimize the amount of outside germs from people we are not caring for that get brought in. 

Palm Beach Children’s Hospital has four dedicated units including a 14-bed Pediatric Intensive Care Unit and an
entire floor dedicated to pediatric oncology.

3) What are the wait times usually like at the emergency room? Should only one parent come with their child, or are both parents OK? 

 It varies by the day and time of day, but right now wait times are generally down to a few minutes. we recommend that only one parent come with their child for the same reasons as above. We want to limit the amount of crowding in any particular unit and try to keep as much “outside” germs from entering the hospital as we can.

4) What COVID safety measures are in place in the hospital/ emergency room? 

All of our staff at Palm Beach Children’s Hospital have appropriate and sufficient PPE while caring for patients with diagnosed or suspected COVID related infection. We clean all areas of the hospital frequently, and the housekeeping staff is doing a terrific job of keeping hallways, patient rooms, and common areas as spotless and sanitized as possible. We limit the number of caretakers accompanying a child in the ER and on the Pediatric units. Patients with COVID are put under the appropriate isolation measures and we try to limit the entry/exit of individuals from those rooms. Additionally, all staff are reminded to screen for symptoms daily and avoid work and get tested if feeling ill.  Finally, we have offered vaccination to our hospital staff so those who have gotten vaccinated are much less likely to spread infection ourselves.

5) Is the hospital busier now than this time last year, or less? What are you seeing more of than usual? 

Similar to most medical centers, the hospital is less busy than this time last year. We do see some signs of this changing over the last few weeks, however. I think what we have found is that social distancing and wearing masks REALLY works well at keeping the number of “typical” infections to a minimum. We are seeing almost no influenza, for example. We certainly are seeing COVID and the post infectious Multisystem Inflammatory Syndrome in Children (MIS-C) cases, but that is by no means the main thing we are seeing at the Children’s Hospital. What we are seeing a lot of are suspected and confirmed appendicitis cases, injuries, and for whatever reason, more newly diagnosed diabetics. For the last two weeks we have been seeing two common seasonal respiratory viruses, Adenovirus and Rhinovirus, which may mean that people are going out and about a bit more.

Palm Beach Children’s Hospital has a 12 bed dedicated pediatric emergency department and a 45-
bed Neonatal Intensive Care Unit. There is also a DinoSOAR secret garden within the hospital. (pictured above)

6) What do you wish more parents knew about coming to the hospital with their child? 

The hospital IS NOT full of COVID infected children nor is it overcrowded at all. We have safety protocols in place and all staff members are taking great care to ensure that there is no spread of infections throughout the hospital.  The hospital is a safe place for your child to get treated and cared for, and I would not put off an ER visit or doctor visit over fear of you or your child getting infected with Coronavirus as we are all working to care for your family in the safest way possible. 

7) What is the best advice you give to parents about their kids returning back to the classroom? (mask wearing, clothes washing, hand washing) 

All of the above, along with social distancing. I think what we are seeing is that schools do not seem to be “hotspots” of COVID infection, although certainly transmission can occur. I strongly encourage mask wearing as we have found that this works quite well at stopping the spread of infection both in and out of the classroom. To our surprise, what we have seen in many schools and in hospitals/doctor offices is that children, even little ones over age two, are actually quite good at following rules and keeping their masks on! 

I would teach and encourage hand washing as well. While we have found that contact with fomites is not an efficient way to spread COVID, contaminated little hands do find their way to their faces frequently and that may put them higher at risk. I would change and wash the your child’s clothing immediately upon return to the home as well. Finally, it is just as important to monitor what your children are doing after school, be it with friends, in afterschool activities or in sports, particularly if your children are older. We can control what happens within the school and the youngest ones will come home straight away,  but we have to take just as much care with what happens after class and on weekends to prevent the spread of infection. Remember – what you and your children are exposed to affects the entire classroom/school,  not just your immediate family!

DinoSOAR secret garden – a wonderful place for patients and parents to enjoy while undergoing treatment at Palm Beach Children’s Hospital.

8) Most sports and kids activities do not require masks for the children — is this safe? Or would you advise parents to wait to join activities? 

It depends. For outdoor activities, wearing masks may be less important as there is more opportunity for distancing and the virus is being diluted in the air, and there is more airflow in general. For indoor activities, most can be done safely, although this is somewhat higher risk. I would recommend mask wearing when feasible for most indoor activities. I would say whether or not to have your child participate depends on comfort level, developmental stage of the child (i.e. can they follow directions? How self aware are they?) and the home risk factors  (does a high risk unvaccinated individual live with you? Is your child medically fragile or have underlying medical conditions?). So, while there is no “right” answer for everyone, I do think that many activities can be done safely. As with most things, when in doubt, always consult your pediatric provider to see what advice they may have for your particular situation.

9) Is COVID worse in children?

Actually, what we are seeing is the opposite. Children, in general, seem to do quite well with coronavirus infection. While we do care for children acutely sick with COVID in the hospital, that number is surprisingly low. Additionally, we are seeing some incidentally positive children – e.g. patient is admitted for a bad urinary tract infection or an injury and we find that they are COVID positive, but are not sick from COVID. For the children we see with a more serious condition known Multisystem Inflammatory Syndrome in Children (MIS-C), a severe illness that can occur 1-2 months after a coronavirus infection, we often find that the child was infected several weeks prior with minimal if any symptoms. Thankfully this condition is treatable and only a small percentage of infected children go on to develop MIS-C, but we have learned that symptoms from the initial infection in children are often minimal. 

Palm Beach Children’s Hospital provides
resources for the entire family. Child Life Specialists are caring, non-medical professionals who
provide play and diversion therapy to help reduce the stress and anxiety of pediatric patients.

10) What about vaccines for children? When my time comes, should I get one?

So yes, vaccines for children are on the way. There are studies already underway in the 12-18 yr old age group for both the Moderna and Pfizer vaccines, and both manufacturers as well as Johnson and Johnson will soon be studying these vaccines in even younger children in a stepwise fashion. While children do get less sick from infection, it will be very important to have them vaccinated to stop the spread in the community and to keep them from being in that small percentage of children who do get very ill from COVID. 

In the meantime, yes, I wholeheartedly recommend vaccine for parents and their loved ones if and when they qualify to receive the vaccine in their community. What we are finding is that they are safe and are highly effective at keeping you from getting very sick from COVID. Additionally, we are beginning to get data that suggest these vaccines stop the spread of asymptomatic infection, which is truly wonderful news. This is our way out of this mess- even us doctors and nurses want to be able to stop wearing masks, see our friends and family, travel, and have a return to “normal.” We are sick of all this just like you are! So I do urge people to get vaccinated, and ask questions of their medical professionals if they have any doubts. The internet can be a great source of information, but it’s no substitute to talking to a trained professional who knows you and your family’s particular situation. 

Although I would love to never have to visit a hospital, as a mom of two very active boys, I know that I more than likely will. I promise it will be at the worst time too…because that’s when things happen.

Knowing that there are such wonderful state of the art resources and medical personnel in South Florida at Palm Beach Children’s Hospital takes a huge weight off of my shoulders as a parent.

Now for the million other things I still have to worry about……

Find out more about all of the services found at Palm Beach Children’s Hospital and how you too can take some of the worry away from your family medical care choices.

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