CHOC study shows reduced risk of emergency department COVID-19 infection

A new CHOC Children’s study that could help calm public fears about contracting COVID-19 shows that asymptomatic healthcare professionals who work in a community with a low prevalence of the disease and who undergo daily health screenings are unlikely to be carriers of the coronavirus that causes the disease.

Findings of the study, one of the first of its kind and conducted during California’s projected peak of coronavirus-related use of hospital resources, shine an encouraging light on a topic where there are currently limited data available.

CHOC’s study tested patient-facing staff at its Julia and George Argyros Emergency Department during a two-week period in April 2020, using a Polymerase chain reaction (PCR) test for COVID-19 viral RNA. Subjects were asymptomatic and had no fever, as all employees undergo daily pre-shift health and temperature screenings prior to entering the hospital. Testing found just one of 145 subjects was positive for COVID-19, and contact tracing showed that this person was not responsible for any further transmission of infection.

With these findings indicating that strict screening measures in a hospital serving a community with a lower prevalence of COVID-19 are effective in preventing the spread of the disease, the study could also offer some comfort to people who may have been reluctant to seek medical care for themselves or their children because they fear contracting COVID-19 in a healthcare setting. 

“We are encouraged by the results of the study and trust that our community will be reassured to know that the chances of acquiring COVID-19 during a visit to a pediatric emergency department can be lower than during routine activities,” said study co-investigator Dr. Terence Sanger, CHOC’s vice president of research and chief scientific officer. “We continue to urge them to seek prompt expert care for themselves and their children when the need arises.”

Hospitals nationwide have reported a significant drop in emergency department visits for major acute conditions. Patients may seek medical attention too late for adequate treatment, which could have serious, even fatal, consequences.

Preliminary data from California suggest that while healthcare workers represent 10% of all known COVID-19 cases in the state, only 18% of those cases were known to be acquired in a healthcare setting. This indicates the workers likely contacted the disease outside of the healthcare setting.

The low rate of infection in CHOC’s emergency department could be attributed to many factors, including the lower percentage of infection in the surrounding community, as well as people in the community following safety guidelines including social distancing and wearing masks.

Additionally, healthcare workers in a pediatric setting might be expected to have a lower risk of infection than those in an adult healthcare setting due to a lower rate of high-risk aerosolization procedures such as intubation in younger patients.

“We take every precaution we can to prevent the spread of COVID-19 in CHOC care settings,” said Dr. Theodore Heyming, medical director of CHOC’s emergency department and study co-investigator. “While the effects of the coronavirus continue to be devastating, this report offers a ray of hope that brave healthcare workers can continue to administer care to their patients without the added burden of putting themselves or the people they care for at further unnecessary risk.”

Also contributing to the study were Aprille Tongol, a CHOC research administrator; Jennifer MacLean, a CHOC nurse practitioner; and multiple staff from the CHOC Children’s Research Institute.

Learn more about the CHOC Children’s Research Institute.

CHOC study aims to determine COVID-19 antibodies present in Emergency department staff

A CHOC Children’s Hospital study could determine how many patient-facing clinicians and staff in its emergency department have COVID-19 fighting antibodies, easing concerns of asymptomatic carriers exposing others to the virus in an acute care setting.

Using rapid serological testing, the monthlong study will determine the prevalence of viral exposure and incidence of new exposure among staff at the Julia and George Argyros Emergency Department at CHOC Children’s Hospital.

Serological blood testing looks for antibodies developed by the body to fight infection. Antibodies indicate the likelihood of past or recent infection or exposure. While researchers are still learning about COVID-19, it is also possible those who have been exposed to the virus and recovered have produced antibodies to protect them from the infection.

“While COVID-19 antibody screening is in its infancy, CHOC Children’s is pleased to help share data and contribute to this important conversation as the world’s scientific community unites in a race toward universal testing, antiviral treatment, and the development of a vaccine in order to permit a scientifically-based return to  normalcy,” said study co-principal investigator Dr. Terence Sanger, CHOC’s vice president of research and chief scientific officer.

Dr. Terence Sanger, study co-principal investigator and CHOC’s vice president of research and chief scientific officer.

Under the study, participants will undergo rapid antibody serology testing for immunoglobin G (IgG) and immunoglobin M (IgM) against COVID-19 novel coronavirus through a simple finger prick once per shift, with results available in three minutes. Additionally, all subjects will undergo viral RNA testing on their first day of the study, as well as on any day that they show IgM positive for antibodies.

In early results, all 107 people tested so far had negative results on reverse transcriptase polymerase chain reaction (RT-PCR) tests, a COVID-19 test, and all were negative for IgGs against COVID-19. Two tested positive for IgM but their viral RNA testing was negative.

As the study progresses, up to 250 subjects are expected to enroll total, with about 100 participants being tested each day.

Secondary outcomes include determining a correlation between antibody serology and DNA testing for acute infection, test-retest reliability of serology testing, evidence for direct transmission of infection between healthcare workers, and potential for reinfection in previously infected convalescent patients. 

Antibody screening could become an additional element of  CHOC’s toolkit in protecting patients, families, physicians and staff against COVID-19. Already, the hospital conducts health screenings, requires appropriate masks and personal protective equipment and practices social distancing, in addition to stringent cleaning practices.

All combined, an additional critically important benefit of the study would be the establishment of a “safe zone” in the emergency department by reducing concerns that an asymptomatic staff member or clinician could transmit the disease to a patient seeking care, or their family, despite CHOC’s strict safety and infection prevention precautions.

Hospitals and health systems nationwide are reporting declining emergency department visits, attributed to patients delaying care out of fear of contracting COVID-19 in the facility. For example, more than half of respondents in a recent NRC Health survey have delayed healthcare for themselves or someone in their home because of the virus, and 60 percent of respondents thought there was an elevated risk when visiting their providers.

Suggesting the national trend has impacted CHOC, its current emergency department volume is about 25 percent less than typical this time of year, yet patient acuity is much higher than typical.

“Seeking prompt and expert care for children in emergent situations is critically important – especially during a pandemic,” said Dr. Theodore Heyming, medical director of CHOC’s emergency department and principal investigator of the study. “We understand how frightening COVID-19 is for parents and children alike. We are excited by the possibility that this study could further prove CHOC as a haven for worried parents, and a source of safe and expert pediatric care during this outbreak – and always.”

Dr. Theodore Heyming, medical director of CHOC’s emergency department and principal investigator of the study.

The study, expected to run through mid-May, is aided by WytCote, an Irvine-based technologies solutions company that has enabled access to testing kits from Jiangsu SuperBio Medical Inc.

“This pandemic is impacting all our communities and WytCote recognized that gaining access to such testing could play a critical role towards limiting the spread of the virus. We are pleased to be partnering with CHOC Children’s to support the testing and use of this new coronavirus antibody test,” said Frank Gomez, WytCote’s CEO/Founder.

Learn more about the CHOC Children’s Research Institute

In the Spotlight: Seth Brindis, M.D.

In addition to providing high-quality medical care, physicians and staff at the Julia and George Argyros Emergency Department at CHOC Children’s Hospital strive to make the experience less stressful for children and families.  One physician, in particular, has a few tricks to ease his patients’ fear and anxiety.  Dr. Seth Brindis, a board-certified pediatric emergency medicine specialist and medical director of informatics, performs magic for his patients.

“For me, magic makes my job easier, instantly transforming what can be a scary experience for children to something fun. I incorporate magic into my physical exam as it makes the exam easier and more reliable when patients are comfortable with me and distracted. I tend to use coin tricks because they appeal to a wider range of ages, with the added benefit that the coins can be disinfected between patient contacts.”

Luckily, it doesn’t have to be an emergency in order to see Dr. Brindis’ magic. With help from child life, he occasionally puts on impromptu magic shows in the CHOC theater for inpatients, their siblings and parents.

Dabbling in magic since childhood, Dr. Brindis’ interest in magic was revitalized while in residency at Harbor-UCLA Medical Center, where he realized that simple tricks with cards and coins could help make connections with patients and staff. Since then, he has continued to study magic, even taking courses tailored for magic in medicine. Seeing thousands of patients each year, Dr. Brindis gets ample time to try out new tricks and help patients and their families leave with positive experiences and smiles on their faces.

Exclusively dedicated to the treatment of pediatric patients, CHOC’s ED features 31 exam rooms, including two trauma bays, and three triage suites. The ED is staffed with doctors who are board-certified in emergency medicine and specially trained nurses who provide the very best patient- and family-centered care. Child life specialists work with patients to help them feel safe and secure, and make the process a lot less stressful for the entire family.

“The ED is often the gateway for many families who are coming to our organization for the first time. We’re working together to deliver the best care to those who need it most. My job is to understand what is distressing to a parent in the middle of the night and either educate and reassure the family or intervene when called for.”

As the only trauma center in Orange County dedicated exclusively for kids, CHOC is ready to treat injuries 24 hours a day. The trauma team is trained to care for children and their unique physiological, anatomical and emotional needs, and CHOC’s protocols and equipment are specially designed for pediatrics.

The ED saw over 49,000 patients in the first year it opened. This year, it’s on pace to see more than 85,000 patients – an incredible rate of growth, which Dr. Brindis credits to the coordination and cooperation between the ED physicians, EMSOC leadership, and nursing, as well as CHOC administration.

“I love being a part of this team. I feel like we provide exemplary care to every person who enters our doors. Often, I feel like the conductor of an orchestra of care. There is no way I could do my job without the incredible people I work with. It really is impressive to watch our team working in concert to stabilize a really sick child.”

Dr. Brindis received his medical degree from Vanderbilt University. He completed his pediatric residency and pediatric emergency medicine (PEM) fellowship training at Harbor-UCLA Medical Center. In addition to caring for patients in the ED, he is actively involved with the training and teaching of pediatric and emergency medicine residents as well as the PEM fellows.

In his spare time, Dr. Brindis enjoys spending time with his wife, son and daughter. He also enjoys cooking, painting and, of course, working on his magic.

Meet Dr. Mary Jane Piroutek

CHOC Children’s wants its reffering physicians to get to know its specialists. Today, meet Dr. Mary Jane Piroutek, a pediatric emergency medicine specialist.

CHOC Children's

Q: What is your education and training?

A:  I graduated from the University of California, Irvine School of Medicine. I completed my pediatric residency at CHOC Children’s and my pediatric emergency medicine fellowship at Loma Linda University Medical Center.

Q: What are your administrative appointments?

A:  I hold the academic appointment of assistant professor, Department of Emergency Medicine at Loma Linda University.

Q: What are your special clinical interests?

A:  I am especially interested in pediatric trauma, environmental injuries, and endocrine emergencies.

Q: How long have you been on staff at CHOC?

A:  I have been on staff for five years.

Q: What are some new programs or developments within your specialty?

A:  CHOC’s emergency department became a level II pediatric trauma center in 2015. We are the only trauma center in Orange County dedicated exclusively to kids. Or trauma team consists of physicians, nurses, pharmacists, radiology technicians, respiratory therapists, social workers, child life, and a hospital chaplain.

Q: What are your most common diagnoses?

A:  Abdominal pain (from gastroenteritis to appendicitis), seizures, traumatic injuries (lacerations, closed head injuries, fractured arms and legs), and respiratory illnesses (bronchiolitis, asthma, and pneumonia).

Q: What would you most like patients and families to know about you or your division at CHOC?

A:  At CHOC, our emergency department is staffed with fellowship-trained pediatric emergency medicine specialists. Our dual training makes us especially knowledgeable and skilled in caring for your child during their visit. CHOC Children’s is the only emergency department in Orange County that exclusively treats children. Treating children in an environment created especially for them makes what could be a scary experience into something more enjoyable.

Q:  What inspires you most about the care being delivered here at CHOC? 

A:  CHOC delivers the highest level of pediatric care while embracing and caring for the entire family.

Q: Why did you decide to become a doctor? 

A:  In high school I volunteered in a community hospital in the labor and delivery unit. I really enjoyed being part of a family’s joyous occasion. In college I volunteered in the emergency department and marveled at the fast pace, acuity and unpredictably of what the next patient’s case would bring. My academic love for science and solving problems made becoming a physician a very natural fit.

Q: If you weren’t a physician, what would you be and why?

A:  I honestly don’t know. Once I decided that I wanted to be a doctor, I never really considered anything else. I put all of my energy and focus into medicine.

Q: What are your hobbies/interests outside of work?

A:  I like spending time with family and friends and traveling. I am also an avid Anaheim Ducks hockey fan.

Q: What have you learned from your patients? 

A:  Children are brave and have a remarkable capacity for resilience. This is evident in the child that sustains a broken leg playing soccer and is unafraid and eager to play again. Or the teenage cancer patient that is most concerned about how their family is being affected by and is dealing with their illness. My patients are humbling and help me to be a better person.

Q: What was the funniest thing a patient told you?

A:  Kids say funny things all the time. One of my favorites was a little 4 year old girl that had ingested coins and they were stuck in her esophagus. When I asked her what happened she shrugged her shoulder and with a mischievous look in her eyes said, “I ate the money, I’m not supposed to eat the money.”  Also recently a patient told me I looked like Snow White (which I don’t) and she called me Dr. Snow White the whole time I took care of her.

Dr. James Pierog discusses pediatric emergency medicine

A pediatric-dedicated emergency department is staffed with medical professionals who are specially trained to handle pediatric emergencies, Dr. James Pierog, medical director of emergency medical services at CHOC Children’s, tells “American Health Journal.”

Specially trained physicians, nurses, respiratory therapists and pharmacists, as well as child life specialists, are on hand at the Julia and George Argyros Emergency Department at CHOC Children’s to ensure top care for children in need of medical attention, Dr. Pierog says.

Learn more about pediatric emergency services in “American Health Journal,” a television program that airs on PBS and other national network affiliates that reach more than 30 million households.

Each 30-minute episode features six segments with a diverse range of medical specialists discussing a full spectrum of health topics. For more information, visit www.discoverhealth.tv.

James Pierog, M.D., is an emergency medicine specialist, board certified in emergency medicine and pediatric emergency medicine. He attended medical school at UCLA. He completed an internship in internal medicine and his residency in emergency medicine at the USC, Los Angeles County Medical Center.

Get more information about referring patients to CHOC, including a referral information directory, services directory and referral guidelines.