Closing the Immunity Gap with Advocate Children's Hospital

00;00;01;08 - 00;00;39;24
Tom Haederle
Some experts have suggested that RSV respiratory syncytial virus was worse last year because of an immunity gap from several years of social distancing and COVID 19 precautions. And they suggest that COVID 19 is to blame for the early arrival and more devastating effects of RSV and the flu. Welcome to Advancing Health, a podcast from the American Hospital Association.

00;00;40;04 - 00;01;04;01
Tom Haederle
I'm Tom Haederle with AHA Communications. In this episode, Dr. Frank Belmonte, chief medical officer and chairman of pediatrics at Advocate Children's Hospital, joins Kathy Cummings, director of communications at AHA to talk about COVID-19's impact on children's health and how Advocate Children's Hospital is managing the triple threat of COVID-19, RSV and the flu.

00;01;04;23 - 00;01;12;16
Kathy Cummings
Welcome, Frank, to AHA’s Advancing Health Podcast. So thrilled to have you here and I appreciate you spending this time with us.

00;01;12;25 - 00;01;14;16
Frank Belmonte
Thank you so much. So great to be here.

00;01;14;27 - 00;01;34;05
Kathy Cummings
You know, pediatric care has been making headline news lately and we've seen so much about this tridemic. I'm going to get into that, and that's what really kind of led us to this topic. But I first want to hear about you. So, Frank, tell us about yourself in your role at Advocate Children's Hospital.

00;01;34;14 - 00;01;54;21
Frank Belmonte
Sure. I am a primary pediatrician. Primary care pediatrician by background have been in leadership roles at Advocate for the 18 years that I've been at the organization and then have been in the chief medical officer role now at Advocate Children's for the last five years. And that really runs our clinical enterprise across the Chicagoland area.

00;01;55;15 - 00;02;12;14
Kathy Cummings
Terrific. Well, as mentioned, pediatric care has been in the headlines. We've been hearing so much about the flu and RSV arriving earlier and hitting harder this past season than ever before. Is COVID 19 to blame for that?

00;02;12;28 - 00;02;34;11
Frank Belmonte
So there's a lot of theories on that. I think over the next few decades, we're going to unpack a lot about COVID and COVID 19 and what the ramifications are long term. There are some theories that there was an immunity, that these children were basically kept in a bubble for several years, and many of those kids were never exposed to normal childhood illness.

00;02;34;21 - 00;02;48;08
Frank Belmonte
And so this fall, we experienced a real surge, probably the biggest surge I've ever seen in respiratory illness in my time practicing. And we do feel that part of that is related to the pandemic and that immunity debt.

00;02;49;07 - 00;02;55;21
Kathy Cummings
So with that, were you surprised to see the kind of dire effects that it had on kids?

00;02;56;08 - 00;03;21;26
Frank Belmonte
It was really interesting. So from a clinical perspective, we saw, of course, you know, RSV tends to be most deleterious in the under six month of age range. But we saw kids even as old as five or six years old who were coming in with severe respiratory illness due to RSV. And so I think part of that, again, was related to the fact that many of them were pulled out of school, preschool, daycare.

00;03;22;08 - 00;03;33;15
Frank Belmonte
And they did not get exposed early on in life. And so when they were exposed this fall, they had a much more pronounced immune response to the illness.

00;03;33;29 - 00;03;41;06
Kathy Cummings
And what about the parents? Were they ready for this? Were they informed or were they surprised as well?

00;03;41;22 - 00;04;09;24
Frank Belmonte
Yeah, I don't think any of us were really ready for it. You know, we started to see a surge in mid-August of 2022 with Enterovirus surge, and that's another common fall to winter virus that we see. And then that just led right into RSV. And so the confluence of those viruses really overwhelmed the system. And I would say parents were blindsided by it.

00;04;10;03 - 00;04;16;02
Frank Belmonte
I think our health care teams were blindsided by it because it was unlike anything we had ever seen before.

00;04;16;22 - 00;04;31;00
Kathy Cummings
And that followed kind of all the uncertainty that we faced with COVID 19, right? I mean, we were surprised by that pandemic and the dire effects that that had in the health care system. So how do you overcome these challenges? 

00;04;31;16 - 00;04;51;01
Frank Belmonte
Well, I think we're realizing that this living in a constant state of emergency has its toll, takes its toll on everybody. You know, we had to mobilize very quickly. I feel really grateful to be in Children's Hospital that is part of a large health care system because I played a very big role, even as a pediatrician in our pandemic response.

00;04;51;10 - 00;05;13;15
Frank Belmonte
So we applied a lot of those same rules to dealing with the surge. We convened Incident Command very quickly. We involved supply chain and pharmacy and all of the various players to make sure did we have the equipment necessary? We mobilized our health care team. We set up a communication hub to get information out to the teams in a very expedient fashion.

00;05;13;15 - 00;05;24;18
Frank Belmonte
So we certainly used the language and the lessons that we learned during the fall or the spring of 2020 and applied that to this particular viral surge.

00;05;25;08 - 00;05;39;27
Kathy Cummings
Well, it's really impressive to hear you talk about, you know, the fact that your team was able to step up and really manage these incredible challenges that you guys have never faced before. What was that like for you as a leader?

00;05;40;21 - 00;06;02;13
Frank Belmonte
You know, our teams have really been stressed for the last two years. And, you know, pediatrics tends to be a very predictable sport. We know when the viruses are going to hit. We we know when the surges typically happen. Everything is very seasonal. We have not had that sense of predictability in the last few years. And so that's put people really on edge.

00;06;02;29 - 00;06;23;00
Frank Belmonte
So I think, you know, realizing that in in terms of we knew we needed to serve the needs of the children and the parents, we also needed to take care of the teams and emotionally support them. So that communication piece was really key, making sure people knew what we were doing, how we were mobilizing that, how we were putting help and assistance in place.

00;06;23;11 - 00;06;28;05
Frank Belmonte
That I think went a long way to helping people to get through a really difficult time.

00;06;28;20 - 00;06;56;28
Kathy Cummings
You know, I've been hearing a lot of leaders like you talk about the importance of communications during these uncertain times and really using communications as part of process and structure. And usually, you know, communications kind of fell to certain departments. Leaders really didn't have to worry about that too much. But but this has been a game changer and leaders are becoming very instrumental communicators within their organizations.

00;06;57;12 - 00;07;00;08
Kathy Cummings
So is it changed the way that you communicate?

00;07;00;27 - 00;07;20;11
Frank Belmonte
It really has made communication much more real time. So, you know, back in the thick of it this fall, we were having huddles four times a day. We included our physician leaders and those. So that was really more practical. How many beds do we have? How many kids are waiting? How are we going to clear the house to get the new load of kids in?

00;07;21;02 - 00;07;42;05
Frank Belmonte
I think it was really helpful to have nursing leadership and physician leadership working side by side, making those decisions, and then daily we would put out a large communication to the whole organization, including the exact team on the number of patients waiting, how many patients we served, and then every week we would show the viral curves. Where are we at right now?

00;07;42;05 - 00;08;04;01
Frank Belmonte
What is the percent positivity? I think it really helps people to take control of it and know that we were on top of it and responding in real time. But I agree with you that the communication piece has really kind of percolated through the whole organization. We realize it's one of the most important things to keep our teams where they need to be.

00;08;04;02 - 00;08;28;07
Kathy Cummings
And accountable, as you were saying, I think that's a really important point. Let's get back to the unpredictability of what you've been facing lately. What do you see coming kind of ahead of us? Do you expect to see new strains of RSV appear like we've seen with the new strains of COVID 19? Do you expect to kind of continue to live in this unpredictable environment?

00;08;29;00 - 00;08;48;03
Frank Belmonte
So, you know, we're keeping a close eye on that. And again, I think we realize that we don't know what the future holds, but we need to be prepared either way. So one thing that we just recently did is we brought the team together to do a debrief of this fall. What did we learn? What pieces did we put in place?

00;08;48;12 - 00;09;09;10
Frank Belmonte
We actually memorialized that in a playbook and a document. So I think as we learn more, we're even more prepared for the next round if something is to happen. You know, I think viral illnesses are evolving quite quickly. I think there's a whole concept of antibiotic resistance on the bacterial side that we need to be more mindful of.

00;09;09;29 - 00;09;27;01
Frank Belmonte
We also need to be good stewards of our resources because we know that supply chain and pharmaceutical supplies can be in short supply if we're not using them appropriately. So we certainly have learned things that we're putting into daily practice so we can be even better prepared for the next endemic or pandemic.

00;09;27;02 - 00;09;36;29
Kathy Cummings
Yeah, preparedness. Hearing a lot about that as well, right? And speaking of that, are you preparing for another COVID 19 surge?

00;09;37;12 - 00;09;58;22
Frank Belmonte
So, you know, we have had that on the docket. We have daily numbers. We actually analyze this on a weekly basis. And we know that COVID 19 is here to stay. It is endemic. And we will see, you know, times of surge. At the end of December we started to see an increase in COVID 19 in the Chicagoland area.

00;09;58;28 - 00;10;19;01
Frank Belmonte
We suspected and anticipated that. And we just, you know, are preparing our teams to deal with it. But it's definitely a different story now than it was back in March of 2020. We know a lot more. It is a vaccine preventable disease, which makes it a very different game. And I think that that has changed the playing field.

00;10;19;20 - 00;10;42;07
Kathy Cummings
You know, you talked about some of those key learnings from COVID 19 from the pandemic: better communications, more focus on process. Can you tell me a little bit more about how COVID 19 has changed the way hospitals operate and what it means specifically in pediatric care? Like what should parents know about that?

00;10;42;27 - 00;11;06;27
Frank Belmonte
So I'll share a couple of pieces that I've reflected on recently. You know, I think one thing we learned about in COVID 19 is the importance of a multidisciplinary team. So folks like respiratory therapy came. It was really highlighted. These folks went into the fire. They were in many units. We really needed their support. And also needed their feedback about what we can do to improve.

00;11;07;11 - 00;11;28;20
Frank Belmonte
You know, I had never become such friends with our supply chain, but I think physicians, nurses realized how important supply chain is to our daily function. And so they're really embedded in everything we do now. I would say the same about pharmacy, knowing what supplies we needed, what was in shortage. So it really has changed the dynamic and the look of the team.

00;11;29;00 - 00;11;53;07
Frank Belmonte
The team, I think, has expanded into other roles and responsibilities. When I look at how we reacted during the surge, a couple of things come to light. We put a chief triage officer in daily that was working with our transfer center, and so we leveraged virtual health to take care of those kids in outlying areas that were waiting for beds at the Children's Hospital.

00;11;54;04 - 00;12;19;20
Frank Belmonte
That was a very successful model. So these were critical care physicians managing kids across the Chicagoland area and really helping adult emergency room physicians to care for them. And I think that's something that if we see another surge, we would put that back in very quickly. It also taught our critical care physicians their role and responsibility goes beyond the four walls of the unit.

00;12;20;10 - 00;12;42;19
Frank Belmonte
The other piece we learned is leveraging the work, the health care workforce. So we have a very large network of primary care pediatricians that advocate. We actually brought them into the E.R. and had them run an acute care fast track. And so we took physicians that typically are in the outpatient setting, move them into the hospital setting to help us deal with the surge.

00;12;42;19 - 00;13;05;07
Frank Belmonte
And that was a very successful venture. We were able to decrease our left without being seen. Definitely see more kids and really leverage health care, both physicians and EPCs that were typically in the outpatient setting. So I think those two things are, you know, we realize we need to be flexible and people need to be flexible in the work that they do to actually meet the need at any given time.

00;13;05;23 - 00;13;23;20
Kathy Cummings
And that sounds like a strong emphasis on integration and collaboration. These multidisciplinary teams that we're seeing now more than ever, and of course the availability of new technologies to bring those teams together, bring that integration and collaboration together.

00;13;24;01 - 00;13;44;17
Frank Belmonte
Absolutely. The virtual platform, we were really working hard to increase virtual health prior to March of 2020. It really literally exploded following that. And so out of necessity, physicians needed to get comfortable with it. And it really has stuck and I think we're going to continue to see that grow and evolve.

00;13;45;01 - 00;13;59;10
Kathy Cummings
Great. Let's talk a little bit about the COVID 19 vaccine and getting shots into kids arms. We know that in some regions it's been easier to do than others. What is your experience been with that?

00;14;00;05 - 00;14;20;07
Frank Belmonte
I think that the numbers speak for themselves. I have some numbers here which I'll share with you. So in the state of Illinois, when we just look at first dose in the 0 to 4 year range, only 15% of kids have even one dose in the 5 to 11 year range, 54%. And then above 12 years of age, 82%.

00;14;20;17 - 00;14;44;25
Frank Belmonte
So we certainly have to work on convincing parents to vaccinate younger children. There is a ton of misinformation out there. As a pediatrician, I deal with vaccine hesitancy daily. Our entire staff does. And we really need the information to be coming from reputable sources because social media has created a firestorm. And that really puts kids at a disadvantage, unfortunately.

00;14;44;25 - 00;14;45;19
Frank Belmonte
And parents.

00;14;46;07 - 00;15;01;05
Kathy Cummings
Right. We've heard misinformation being one of the the biggest challenges out there that, you know, is happening today and could get even worse as we as we look towards the future. What are some of the other challenges you think that still lie ahead of us?

00;15;01;21 - 00;15;32;10
Frank Belmonte
So, you know, I think initially operations was challenged with how they were going to disseminate this throughout the community. I think we've come a long way in that arena. I think a lot of that has to do with, you know, lifting some of the requirements on storage of this vaccine. I think right now we've done it in Advocate is to really have this available in all of our primary care offices across the network, which really has allowed more families to benefit from having the vaccine.

00;15;33;05 - 00;15;41;03
Frank Belmonte
You know, ease of access to the vaccine. You know, I think basically making sure that it's hardwired and part of our operations is important.

00;15;41;27 - 00;15;51;03
Kathy Cummings
Well, we could talk about this topic for hours. I know there's so much great work that you guys are doing out there. But can you just share a couple of final thoughts with us?

00;15;51;17 - 00;16;12;15
Frank Belmonte
Yeah, I think that, you know, the biggest thing right now is supporting our health care professionals. I think they're tired. I think they're exhausted. We're really doing a lot of work this year to reengage them, to engage them in purpose. You know, we saw communities really come out in support of health care workers early on in the pandemic.

00;16;12;22 - 00;16;37;07
Frank Belmonte
We certainly need that same sense of encouragement now. So I think that would be a lesson learned for me and something that all of our leaders are really going to be working on in 2023. And then I think, again, really restating what you said so nicely earlier is the importance of the multidisciplinary team in really helping us to understand how to best care for patients during these types of emergencies.

00;16;37;21 - 00;16;42;23
Frank Belmonte
That was very well highlighted during this and it will continue to be a part at the forefront of what we do.

00;16;43;20 - 00;17;10;23
Kathy Cummings
Well, I'm so encouraged to hear about, you know, the incredible work that you guys are doing, the idea of this integration and collaboration, communication process that you're constantly learning. And it gives us such hope. I know there's this this focus on resilience, and you guys are really a great example of resilience. So thank you so much for, sharing this time with us and sharing your stories and experiences with us.

00;17;10;24 - 00;17;11;23
Kathy Cummings
I really appreciate it.

00;17;12;08 - 00;17;13;15
Frank Belmonte
Thanks so much for having me.

00;17;14;06 - 00;17;27;27
Kathy Cummings
For more information on COVID 19, the vaccine and the tridemic please visit aha.org/vaccineconfidence. And we'll put the link in the show notes. Thanks.

00;17;28;28 - 00;17;57;22
Tom Haederle
This podcast was funded in part by a cooperative agreement with the Centers for Disease Control and Prevention. The contents of this resource do not necessarily represent the policy of CDC or HHS and should not be considered an endorsement by the federal government.