Parents fearful of the coronavirus are shying away from pediatricians’ offices, missing those critical visits when children get immunized and opening the door to outbreaks of illnesses more dangerous to young people than COVID-19, local doctors say.
Doctors say that, while researchers are far from developing a vaccine against the coronavirus, parents should not forgo the arsenal of effective shots already available for other highly infectious diseases such as measles, whooping cough, and mumps.
“This is a huge concern for pediatricians across the country and in Massachusetts,” said Dr. Elizabeth Goodman, president of the Massachusetts chapter of the American Academy of Pediatrics. “What we don’t want to see is a rise in vaccine-preventable disease in the midst of trying to deal with coronavirus.”
The pediatric practices affiliated with Boston Children’s Hospital are seeing only one-quarter of their usual in-person visits. At Boston Medical Center’s pediatric primary care clinic, it’s one-fifth the usual number.
Some of these visits can be safely deferred, and others can be handled by phone or video chat.
But many situations require in-person visits, and doctors worry that parents, fearful of the coronavirus, are unwittingly putting their children at greater risk by not seeking care.
Infants and toddlers, in particular, need the doctor’s personal attention: holding and touching to track their growth and assess their health, and, especially, administering the full schedule of vaccinations.
And there’s evidence that’s not happening. In Massachusetts, orders for state-supplied pediatric vaccine doses were down 39 percent in March and 68 percent in the first two weeks of April, compared with the same time periods last year, according to the state Department of Public Health.
Pediatricians are calling and cajoling parents, promising to keep their children safe. Many have taken measures that physically separate the well from the sick — something not always done in the past, but now seen as a necessary accommodation to address COVID-19 fears. Others are trying innovations like drive-through inoculations, or letting parents wait in the car until it’s time to come in.
Boston Medical Center’s pediatricians are going a long step farther, traveling to patients’ homes, conducting office visits in the back of an ambulance.
“We figured we have to do something or we’re going to have a whole cohort of children who were unvaccinated,” said Dr. Eileen Costello, the hospital’s chief of ambulatory pediatrics. “The same population of adults who are suffering from COVID — their kids are going to be suffering from vaccine-preventable illnesses.”
Though in operation for less than three weeks, the program has drawn attention from doctors around the country who want to emulate it, Costello said. Boston Medical Center plans a webinar with the American Academy of Pediatrics, she said.
The program was made possible by a donation: Brewster Ambulance Service provided an ambulance and driver for five days a week. With a nurse and doctor on board, the vehicle has been visiting 10 to 12 families a day since April 13.
When the hospital started calling parents whose children were due for a vaccine, offering to visit, parents were appreciative and surprised — one even thought it was a prank call — said Tami Chase, director of ambulatory nursing.
On Wednesday morning, the ambulance pulled into Rebecca Dittami’s driveway in Dorchester. She stepped onto the porch with her three children and happily greeted their pediatrician, Dr. Rachel S. Sagor. The doctor wore a gown, gloves, mask and face shield, but the protective gear couldn’t conceal her delight.
Sagor loves these home visits. “I love being able to see where my patients live and see them active and healthy,” she said.
The back of the ambulance has been converted into a somewhat cramped mobile doctor’s office. Dittami handed her youngest, 3-month-old Eddie Rucker, to nurse Priscilla Stout, who gently undressed him on the gurney and placed him on a scale. Four-year-old Truth Rucker, who isn’t due for an exam, scrambled into the ambulance to watch.
Sagor listened to the baby’s heart and examined him. Eddie started wailing even before Stout quickly jabbed his thighs with two needles. Sagor gathered him up in her arms and rocked him until he quieted, and handed him back to his mother. Next up for the same routine, Eddie’s sister Loyalty Rucker, 16 months.
Sagor had spoken with Dittami the night before, to get up to speed on her children’s health so sidewalk conversations could be kept to minimum. With two kids checked and vaccinated, the driver, Diego Aparicio — who said he enjoys the change of pace from the gravely ill people usually occupying his vehicle — closed up the back and headed off to the next family.
Dittami, who would normally have to travel to the hospital with three kids in tow, found it all amazingly convenient. “I wish we could do this all the time,” she said.
The ambulance travels only to Boston zip codes. But parents from outside the city can get similar services, by appointment, in a tent outside Boston Medical Center’s Shapiro Building on Albany Street.
While the ambulance home visits are unique, other medical practices are trying new approaches to address parents’ fears.
Atrius Health, a large Eastern Massachusetts physician’s group that includes 17 pediatric practices, reorganized its offices into wellness centers and illness centers. Seven buildings are dedicated to illness care. Three are focusing on routine visits with well children, including offering vaccinations and other checkup evaluations. In a couple of places, sick and well children are seen in the same building, but in separate sections.
“We’ve tried to reassure our patients, by these separate locations, that we can provide safe and important care,” said Dr. Dan Slater, Atrius’s chair of pediatrics. It seems to have worked, according to Slater. “Our wellness locations are extremely busy. We are seeing our newborns,” he said. “Patients are indeed coming in for those vaccines.”
Similarly, Boston Children’s Hospital is holding well child visits and administering vaccines in a separate building, across the street from the clinic.
But many parents are simply terrified of going out, and their fears need to be understood and addressed, said Dr. Claire McCarthy, a pediatrician at Boston Children’s Hospital’s Primary Care Center.
One mother, who lives on the 23rd floor of an apartment building, fears picking up the virus on the elevator. “She has an autistic child who touches everything,” McCarthy said.
Another mother wouldn’t bring her 6-month-old in for a checkup because she relies on public transit and lives with her elderly father, who could get very sick if exposed to the coronavirus.
McCarthy persuaded the mother to come for a visit in May, when she expects to be able to get a car ride.
“I spend a lot of time reassuring people,” McCarthy said. “All employees and all families are wearing masks. We are really being very, very mindful of the risks and doing our best, planning how we’re going to get everyone in and get those shots done.”
McCarthy urges parents to call their doctors before deciding against seeking care, to find out what measures the practice is taking to keep people safe. People have visions of crowded waiting rooms full of sick kids, but that’s not happening today, she said.
“Please call your doctor,” McCarthy said. “Let us work with you. We want your kid to be safe just as much as you do.”
Felice J. Freyer can be reached at firstname.lastname@example.org. Follow her on Twitter @felicejfreyer.