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Higher COVID-19 rates seen in minority socioeconomically disadvantaged children

coronavirus

Minority and socioeconomically disadvantaged children have significantly higher rates of COVID-19 infection, a new study led by Children’s National Hospital researchers shows.

Minority and socioeconomically disadvantaged children have significantly higher rates of COVID-19 infection, a new study led by Children’s National Hospital researchers shows. These findings, reported online August 5 in Pediatrics, parallel similar health disparities for the novel coronavirus that have been found in adults, the authors state.

COVID-19, an infection caused by the novel coronavirus SARS-CoV-2 that emerged in late 2019, has infected more than 4.5 million Americans, including tens of thousands of children. Early in the pandemic, studies highlighted significant disparities in the rates of infection in the U.S., with minorities and socioeconomically disadvantaged adults bearing much higher burdens of infection. However, says Monika Goyal, M.D., M.S.C.E, a pediatric emergency medicine specialist and associate division chief in the Division of Emergency Medicine at Children’s National whose research focuses on health disparities, it’s been unclear whether these disproportionate rates of infection also extend to youth.

To investigate this question, she and her colleagues looked to data collected between March 21, 2020, and April 28, 2020, from a drive-through/walk-up COVID-19 testing site affiliated with Children’s National — one of the first exclusively pediatric testing sites for the virus in the U.S. To access this free testing site, funded by philanthropic support, patients between the ages of 0 and 22 years needed to meet specific criteria: mild symptoms and either known exposure, high-risk status, family member with high-risk status or required testing for work. Physicians referred patients through an online portal that collected basic demographic information, reported symptoms and the reason for referral.

When Dr. Goyal and her colleagues analyzed the data from the first 1,000 patients tested at this site, they found that infection rates differed dramatically among different racial and ethnic groups. While about 7% of non-Hispanic white children were positive for COVID-19, about 30% of non-Hispanic Black and 46% of Hispanic children were positive.

“You’re going from about one in 10 non-Hispanic white children to one in three non-Hispanic Black children and one in two Hispanic children. It’s striking,” says Dr. Goyal.

Using data from the American Families Survey, which uses five-year census estimates derived from home address to estimate median family income, the researchers separated the group of 1,000 patients into estimated family income quartiles. They found marked disparities in COVID-19 positivity rates by income levels: while those in the highest quartile had infection rates of about 9%, about 38% of those in the lowest quartile were infected.

There were additional disparities in exposure status, Dr. Goyal adds. Of the 10% of patients who reported known exposure to COVID-19, about 11% of these were non-Hispanic white. However, non-Hispanic Black children were triple this number.

Although these numbers show clear disparities in COVID-19 infection rates, the authors are now trying to understand why these disparities occur and how they can be mitigated.

“Some possible reasons may be socioeconomic factors that increase exposure, differences in access to health care and resources, as well as structural racism,” says Dr. Goyal.

She adds that Children’s National is working to address those factors that might increase risk for COVID-19 infection and poor outcomes by helping to identify unmet needs — such as food and/or housing insecurity — and steer patients toward resources when patients receive their test results.

“As clinicians and researchers at Children’s National, we pride ourselves on not only being a top-tier research institution that provides cutting-edge care to children, but by being a hospital that cares about the community we serve,” says Denice Cora-Bramble, M.D., M.B.A., chief medical officer of Ambulatory and Community Health Services at Children’s National and the research study’s senior author. “There’s still so much work to be done to achieve health equity for children.”

Other Children’s National researchers who contributed to this study include Joelle N. Simpson, M.D.; Meleah D. Boyle, M.P.H, Gia M. Badolato, M.P.H; Meghan Delaney, D.O,. M.P.H.; and Robert McCarter Jr., Sc.D.

nurse checking boy's hearbeat

Children’s National launches telehealth collaboration with Whittle School & Studios

nurse checking boy's hearbeat

The School-Based Telehealth Program provides students quick access to medical care, rapid diagnosis of medical conditions, and better management of chronic conditions like asthma and diabetes, while minimizing time away from school for children – and from work for parents.

Children’s National Hospital and Whittle School & Studios announced a collaboration to provide students at the Whittle School’s D.C. campus with on-site video connectivity to health professionals at the hospital throughout the 2019-20 school year.

“We are thrilled to collaborate with Children’s National to offer our students world-class medical care from compassionate providers,” said Dennis Bisgaard, head of Whittle’s D.C. campus. “The health and safety of our students is our top priority, and this new collaboration ensures that they’ll be in excellent hands.”

A registered nurse from Children’s National will work on-site at Whittle’s D.C. campus to provide acute care, first aid, immunization record-keeping, medication management, EpiPen storage and training and more.

Children’s National’s School-Based Telehealth Program will also be available at the Whittle School. The on-site nurse will have the ability to use secure video-conferencing technology to connect students with board-certified physicians from Children’s National, if necessary.

The School-Based Telehealth Program provides students quick access to medical care, rapid diagnosis of medical conditions, and better management of chronic conditions like asthma and diabetes, while minimizing time away from school for children – and from work for parents. The program will complement existing care the student may already receive from their medical home or primary care provider.

“We are excited to collaborate with the Whittle School to design a program centered on our shared vision of helping children,” said Denice Cora-Bramble, M.D., executive vice president and chief medical officer, ambulatory and community health services at Children’s National. “Our goal is that this new collaboration will provide access to highly-specialized health care expertise to patients and families and our hope is that school-based nursing services, coupled with telehealth technology, will improve students’ health and education outcomes.”

Cara Lichtenstein

Children’s Community Health Track receives prestigious APA Teaching Program Award

Cara Lichtenstein

“As a community-focused health system, one of our central missions is to train a new generation of residents to create successful community partnerships and integrate public health concepts into the everyday practice of medicine to improve the health of underserved communities,” says Cara Lichtenstein, M.D., MPH.

The Children’s National Community Health Track (CHT) has been recognized by the Academic Pediatric Association with its prestigious Teaching Program Award. The honor was made public at the Pediatric Academic Societies (PAS) annual meeting on May 7, 2018 in Toronto, Ontario. The purpose of the award is to foster interest in the teaching of general pediatrics by giving national recognition to an outstanding general pediatric program. The PAS selection committee chose Children’s CHT for demonstrating excellence in educational teaching methods, acceptance by the community, its adaptability and the outstanding quality of residents trained in the program.

“As a community-focused health system, one of our central missions is to train a new generation of residents to create successful community partnerships and integrate public health concepts into the everyday practice of medicine to improve the health of underserved communities,” says Cara Lichtenstein, M.D., MPH and director of Children’s Community Health Track.

Children’s CHT focuses on underserved populations and the development of skills in health policy, advocacy and community healthcare delivery. Residents spend their outpatient time learning to use public health techniques to identify and address community health needs, becoming a physician advocate and learning more about the sociocultural determinants of health and health disparities. Training for CHT is integrated with Children’s overall pediatrics residency program to ensure excellence in attainment of clinical skills, and to allow residents the opportunity to work with Children’s top-rated primary care, specialty and hospital-based physicians and care teams.

This is the third time in recent years that Children’s National has been honored by the Academic Pediatric Association. In 2013, Mary Ottolini, M.D., MPH and vice chair of medical education was recognized for her leadership of Children’s Master Teacher Leadership Development program. In 2009, Denice Cora-Bramble, M.D., MBA accepted the APA Health Care Delivery Award for the Goldberg Center for Community Pediatric Health at Children’s National.

Children’s offers up to eight residency positions each year designated as Community Health Track positions. The goals of the track are centered on the core competencies of community pediatrics as described by the American Academy of Pediatrics. Primarily to train residents to:

  • Grasp the breadth of diversity inherent in the pediatric population and be familiar with health-related implications of cultural beliefs and practices of groups represented in the community.
  • Recognize the role of the pediatrician in identifying needs and facilitating access to resources for patients, families and communities.
  • Be aware of the risks to health and barriers to care for underserved children in Washington, D.C., and demonstrate skill in improving access to continuous comprehensive health maintenance.
  • Appreciate key issues related to the pediatrician’s role and interactions with local community agencies and advocacy groups.
  • Value the role of schools and childcare settings in supporting the educational and psychosocial development of children and adolescents.
  • Apply key principles about health promotion and disease prevention for children and adolescents over a set period of time.
  • Observe, interpret and report observations about the communities in which they serve.

The fundamental difference in this track compared to the more traditional Categorical Track lies in the outpatient experiences that occur in all three years of training. The CHT utilizes these outpatient experiences to help residents to attain a well-rounded community pediatrics experience.

“Washington, D.C. is an incredibly diverse community with large numbers of vulnerable children and families from D.C. and all over the world. Given our location in our nation’s capital, residents and faculty have the unique opportunity to work with national professional and advocacy organizations that are influencing policy – both locally and nationally – as it relates to children, families and health care,” says Mark Weissman, M.D., chief of general pediatrics and community health at Children’s National. “We’re thrilled to be recognized with the Academic Pediatric Association’s Teaching Program Award and grateful to Dr. Lichtenstein for her leadership and commitment to improving the health of D.C.’s children and training the next generation of pediatricians and advocates.”

Denice Cora-Bramble among the Washington Business Journal Women Who Mean Business

Denice Cora-Bramble, M.D., M.B.A., Chief Medical Officer and Executive Vice President of Ambulatory and Community Health Services at Children’s National Health System, was named to the 2016 list of Women Who Mean Business by the Washington Business Journal. Dr. Cora-Bramble was among a select group of Washington, DC, metropolitan area women who were honored Oct. 13 for having made a significant impact on their community, using their leadership skills and professional accomplishments to break down barriers.

At Children’s National, Dr. Cora-Bramble oversees all regional ambulatory clinical operations including seven pediatric subspecialty regional outpatient centers, two emergency departments, six general pediatrics health centers, 12 pediatric practices, three mobile medical units, as well as nursing services in DC Public Schools and Public Charter Schools. She also has direct responsibility for the Children’s Health Network, which includes more than 1,400 providers in the mid-Atlantic region.

“I am honored to work along-side Dr. Cora-Bramble on a daily basis, and it comes as no surprise to me that she’s being recognized as one of the Washington Business Journal’s Women Who Mean Business. As one of our two Chief Medical Officers, Dr. Cora-Bramble is a crucial component of this organization, and I am so proud to see her honored for her leadership and commitment to our patients,” said Kurt Newman, M.D., President and CEO of Children’s National.

Dr. Cora-Bramble has worked at Children’s National for 14 years in various roles, including overseeing the Diana L and Steven A. Goldberg Center for Community Pediatric Health before she took on the role of Chief Medical Officer of Ambulatory and Community Health Services in 2013. She is a Professor of Pediatrics at the George Washington University School of Medicine and Health Sciences and a Diplomate of the American Board of Pediatrics.

Dr. Cora-Bramble completed her medical and pediatric residency training at Howard University and a Master in Business Administration with a concentration in Medical Services Management from Johns Hopkins University. She has held several leadership positions at the George Washington University Medical Center and the U.S. Department of Health and Human Services.