Italy’s Bergamo is calling back coronavirus survivors. About half say they haven’t fully recovered.
Health & BeautySep 09. 2020A patient gets an X-ray at a Bergamo, Italy, convention center that was converted for covid-19 patients in the spring and is now used for follow-up care. MUST CREDIT: Photo by Alberto Bernasconi for The Washington Post.
By The Washington Post · Chico Harlan, Stefano Pitrelli · WORLD, HEALTH, EUROPE, HEALTH-NEWS BERGAMO, Italy – The first wave is over, thousands have been buried, and in a city that was once the world’s coronavirus epicenter, the hospital is calling back the survivors. It is drawing their blood, examining their hearts, scanning their lungs, asking them about their lives.
Twenty people per day, it is measuring what the coronavirus has left in its wake.
“How are you feeling?” a doctor recently asked the next patient to walk in, a 54-year-old who still can’t ascend a flight of steps without losing her breath.
“I feel like I’m 80 years old,” the woman said.
Six months ago, Bergamo was a startling warning sign of the virus’s fury, a city where sirens rang through the night and military trucks lined up outside the public hospital to ferry away the dead. Bergamo has dramatically curtailed the virus’s spread, but it is now offering another kind of warning, this one about the long aftermath, where recoveries are proving incomplete and sometimes excruciating.
Those who survived the peak of the outbreak in March and April are now negative. The virus is officially gone from their systems.
“But we are asking: Are you feeling cured? Almost half the patients say no,” said Serena Venturelli, an infectious-disease specialist at the hospital.
The follow-ups are the basis for medical research: Data on the patients now fills 17 bankers’ boxes, and scientific reports are on the way. Bergamo doctors say the disease clearly has full-body ramifications but leaves wildly differing marks from one patient to the next, and in some cases few marks at all. Among the first 750 patients screened, some 30% still have lung scarring and breathing trouble. The virus has left another 30% with problems linked to inflammation and clotting, such as heart abnormalities and artery blockages. A few are at risk of organ failure.
Beyond that, according to interviews with eight Pope John XXIII Hospital doctors involved in the work, many patients months later are dealing with a galaxy of daily conditions and have no clear answer on when it will all subside: leg pain, tingling in the extremities, hair loss, depression, severe fatigue.
Some patients had preexisting conditions, but doctors say survivors are not simply experiencing a version of old problems.
“We are talking about something new,” said Marco Rizzi, the head of the hospital’s infectious-disease unit.
One patient, Giuseppe Vavassori, 65, has developed short-term memory loss and now lives under a mountain of Post-it notes and handwritten reminders, with names and phone numbers, so he can still run his funeral home business. A post-covid MRI showed dot-like lesions on his brain.
Another, Guido Padoa, 61, recovered well enough that he was able to go on vacation this summer. But he sleeps four extra hours per night and sometimes falls asleep suddenly midday, head on the computer keyboard.
Some patients who were self-reliant before contracting the virus remain so weakened that, when they arrive for their follow-up appointments, they’re helped to the waiting room by relatives, or in wheelchairs. Four people so far were too frail to make it through the several hours of testing and were rushed instead to the emergency room. Other times, people show up months later, having been through the worst – oxygen support, intubations – and are, improbably, almost fine. Doctors say one of the virus’s mysteries is how recoveries can be swift for some and brutal for others.
Venturelli mentioned a man in his 80s who’d come in for his follow-up visit, mostly recovered. His son, who’d also been infected, hadn’t fared as well. When Venturelli tried to refer the father to a specialist, he said he was too busy these days.
Covid had turned the father into his son’s caretaker.
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The Bergamo research is being led by the same doctors who worked frantic 14-hour days in March, sometimes falling sick themselves, while watching patients rapidly outnumber the beds. Now, wearing just masks, those same doctors and patients are sitting down together in a way that was impossible months ago.
“We did feel a moral obligation to call them back,” said Venturelli, who helped start the study in early May. “It was such a tsunami for us. What we saw in March was a tragedy, not a normal hospitalization.”
Bergamo, in March, was a place with six-hour waits for ambulances and 16-hour waits in the ER. At one point, the hospital had 92 people on ventilators – compared with 143 now in all of Italy – and so many who required breathing assistance that it needed to pipe in oxygen from a rush-delivered emergency tank. In the province of 1.1 million people, 10,000 were hospitalized, including more than 2,000 at Pope John XXIII.
“I have a picture in my mind from that time of the ER with eight ambulances queuing outside,” said doctor Monica Casati. Inside the hospital, she said, people were crying, moaning and gasping for air. “It was a noise that would remind you of Dante’s inferno,” she said.
The hospital was admitting only the worst cases, and to keep pace with the influx, it sometimes had to discharge patients before they were fully ready – something confirmed when the hospital started calling people for the follow-ups. In addition to the 440 people who died while hospitalized, 220 died after being told to go home.
The study in Bergamo is one of multiple efforts around the world to examine aspects of covid’s lingering damage. One German study of 100 people found that nearly 80% had heart abnormalities several months after infection. Other studies are underway to look specifically at “long-haulers” – a subset of people, some never hospitalized, who nonetheless have fatigue and other symptoms months after the illness.
Some of the doctors in Bergamo see reasons for encouragement in their findings, especially given the severity of what patients faced in March and April and the trial-and-error treatments they were given. They say that patients’ breathing seems to gradually improve, even though the lung scarring is permanent. Doctors have found nobody with a fever.
“Many of them coming in for repeat visits, they are doing better now than they were in May,” said Caterina Conti, a lung specialist.
For the patients who have been able to regain a semblance of their lives, the last barrier is the trauma itself – the raw memory of being in a hospital where so many were dying, and wondering if they might be next. Padoa, a photographer, said he remembers hearing others in his ward struggling to breathe, and seeing hospital workers remove the bodies, change the bedsheets. With his own lungs on the brink of failure, he worried what might happen if he let his eyes close, so he drew on his training four decades earlier as a paratrooper. Under an oxygen helmet, as it beeped and hissed, he willed himself to stay awake for five days, he said.
“It’s like when you are on a high mountain in the cold,” Padoa said. “If you fall asleep, you die.”
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But the gravest patients of all, like Mirco Carrara, 55, have no recovery in sight.
By the time he arrived for his follow-up, it was late August, and he’d moved back into his home on the outskirts of Bergamo. He’d started going to work again, as a manager at a military parts company. But he was also coming to terms with how drastically his life had changed.
He had spent more than a month in a medically induced coma. In the middle of that, he was transferred on a German medevac plane to a hospital in Cologne. Doctors there saw that his lungs had developed not only scars but also a fungal infection. He was removed from the ventilator, re-intubated after his lung collapsed, then removed again. By the time he returned, conscious, to a rehabilitation center in Italy, Carrara had lost 45 pounds. He needed to relearn to swallow and stand.
And even that he had felt capable of doing, until doctors told him one more thing. The full trauma of covid – the ventilation, the treatment, the compounding infections – meant there were now fungus-filled bubbles inside his lungs, each a bomb-like threat that could critically impair his breathing if it burst.
“I started crying,” Carrara said. “Up until that point, I had thought I’d be able to recover.”
In an interview, Simone Benatti, the doctor at Pope John XXIII who consulted with Carrara, described the air and fungus bubbles as a “bad complication” and mentioned a separate Italian study showing that some deceased covid victims were found to have bacterial or fungal abscesses in their lungs.
“There is an interplay between covid and other infections,” Benatti said.
Carrara said the bubbles were like a “Damocles sword,” and soon enough, in early June, a cough sent his oxygen levels dipping. His girlfriend rushed him to the hospital. He had a tube inserted into his lungs for a week. A month later, it happened again – dipping oxygen; another hospital trip; another surgery to drain his lung – except this time, he wasn’t even sure what set it off. He felt a rage about his body. He said he wished the surgeon would “just cut my lung out.”
He arrived for his follow-up in Bergamo carrying a thick stack of medical paperwork and figured there was only so much more about his body he cared to know. Like the others, he submitted to a CT scan, an echocardiogram and blood tests. But when filling out a survey about how he was feeling and coping, he checked all the boxes in the “middle,” he said – moderate, good, OK.
“I lied,” Carrara said.
He didn’t mention how deep his despair has been, as he comes to grips with his lungs. He didn’t mention the guilt he felt, wondering if he passed the virus to his father, who had not survived. He didn’t mention his first nights back home, when he lay fully awake, one night and then two nights and then three. He didn’t say how his partner then said enough was enough, and went to the pharmacy to get sleeping pills, and how he’d agreed to take them, because that was the one way to briefly quiet his mind six months after being infected with covid-19.
“The bubbles will remain. They’re not going anywhere,” Carrara said, and he figured it was just a matter of time before he was back in the hospital again.
By Syndication Washington Post, Bloomberg · Jason Gale · NATIONAL, HEALTH, SCIENCE-ENVIRONMENT, HEALTH-NEWS Covid-19 patients have active and prolonged gut viral infection, even in the absence of gastrointestinal symptoms, scientists found.
The coronavirus may continue to infect and replicate in the digestive tract after clearing in the airways, researchers at the Chinese University of Hong Kong said in a statement Monday. The findings, published in the medical journal GUT, have implications for identifying and treating cases, they said.
SARS-CoV-2 spreads mainly through respiratory droplets — spatters of virus-laden discharge from the mouth and nose, according to the World Health Organization. Since the first weeks of the pandemic, however, scientists have said infectious virus in the stool of patients may also play a role in transmission.
A February study of 73 patients hospitalized with the coronavirus in China’s Guangdong province found more than half tested positive for the virus in their stool.
“We used to think of SARS-CoV-2 as just a pulmonary or respiratory disease,” said Siew Chien Ng, assistant dean of medicine and associate director of the university’s Centre for Gut Microbiota Research, in an interview Tuesday. “But over the last couple months, a lot of evidence has emerged that SARS-CoV-2 also affects the intestinal tract.”
Ng and colleagues scientists studied stool samples from 15 patients to better understand the virus’s activity in the gastrointestinal tract. They found active gut infection in seven of them, some of whom had no nausea, diarrhea or other digestive symptoms. Patients’ stool continued to test positive about a week after their respiratory samples were negative, Ng said. One patient was still positive after 30 days, she said.
Ng and colleagues plan to conduct further tests to demonstrate virus particles from stool are capable of causing disease after finding surrogate biomarkers that indicate they are infectious.
It’s not yet known how SARS-CoV-2 makes its way to the gastrointestinal tract to cause an infection there, according to Ng. It’s possible some infectious particles survive the stomach’s acidic environment.
Treatments that modulate the gut microbiome should be explored, Ng said. The gut bacteria of patients with a gastrointestinal coronavirus infection showed a loss of protective microbes and a proliferation of disease-causing ones. The effects were worsened in the covid-19 cases treated with antibiotics, she said.
The Chinese University has offered free screening stool tests to travelers arriving at the airport since late March, and identified six infected children among more than 2,000 samples tested. From Monday, up to 2,000 covid-19 tests will be done daily as part of targeted detection of asymptomatic people.
More than one patient tested positive even though their respiratory samples were negative, said Francis K.L. Chan, the university’s dean of medicine and director of the Centre for Gut Microbiota Research.
“Stool test is accurate and safe, making it suitable and more effective for Covid-19 screening for specific groups of people,” Chan said in the statement. Some regulators including the U.S. Food and Drug Administration have reached out about stool tests.
By The Washington Post · Christopher Rowland · NATIONAL, BUSINESS, HEALTH, HEALTH-NEWS The chief executives of nine drug companies pledged Tuesday not to seek regulatory approval before the safety and efficacy of their experimental coronavirus vaccines has been established in Phase 3 clinical trials, an extraordinary effort to bolster public faith in a vaccine amid President Donald Trump’s public rush to introduce a vaccine before Election Day.
“We believe this pledge will help ensure public confidence in the rigorous scientific and regulatory process by which covid-19 vaccines are evaluated and may ultimately be approved,” the executives wrote in their joint statement. The Wall Street Journal first reported Friday that a statement from the companies would be forthcoming.
The statement included a vow that the companies would “only submit for approval or emergency use authorization after demonstrating safety and efficacy through a Phase 3 clinical study that is designed and conducted to meet requirements of expert regulatory authorities such as FDA.”
They also vowed to “always make the safety and well-being of vaccinated individuals our top priority.”
The statement left open the door for partial data from the massive Phase 3 vaccine trials – which require the participation of at least 30,000 test subjects – being used to seek emergency-use authorization. Such trials typically take years to complete and require lengthy follow-up to see how long protection from a vaccine may last.
The executives signing the pledge included the leaders of AstraZeneca, Johnson & Johnson, Merck, Moderna, and Novavax, as well as those heading two joint vaccine projects, Pfizer and BioNTech, and Sanofi and GlaxoSmithKline.
In most contexts, pledges by drug companies that they will adhere to safety and efficacy standards would be unremarkable. But their joint resolve in the current political environment – and the headline pasted on their statement: “BIOPHARMA LEADERS UNITE TO STAND WITH SCIENCE” – make clear their intent to ease growing worries about the race for a vaccine amid intense White House pressure.
The companies issued their statement as Trump has increasingly tied his reelection hopes to introduction of a vaccine before Nov. 3. The White House said in a statement Monday that Trump has no intention of cutting corners.
“The American people can rest assured that any approval will maintain the FDA’s gold standard for safety and testing to ensure a vaccine or therapeutic is effective,” said White House spokesman Judd Deere, in an email. “This false narrative that the media and now the Democratic nominee for vice president (Sen. Kamala Harris) are suggesting that politics is influencing approvals is not only false but is a danger to the American public.”
Harris, D-Calif., said on CNN’s “State of the Union” Sunday that she would “not take his word for it” and would “not trust” Trump’s declarations about the safety of a vaccine.
Vaccine manufacturers want to bolster public faith in the safety and efficacy of a vaccine to counter perceptions that the Food and Drug Administration will cave to political pressure, said Amesh Adalja, senior scholar at the Johns Hopkins University Center for Health Security.
“It just reflects the fact that we have seen political meddling from the start in this pandemic response,” Adalja said.
He cited the FDA’s hasty emergency-use authorization of hydroxychloroquine to treat the novel coronavirus. That authorization was withdrawn in June after clinical trials showed hydroxychloroquine provided no benefit while potentially increasing risks of fatal heart arrhythmia, as well as the botched rollout of last month’s emergency-use authorization for convalescent plasma, when FDA Commissioner Stephen Hahn overstated potential benefits of the transfusions.
Convincing the public that a vaccine is safe and effective will be vital to making sure enough of the population gets immunized against SARS-CoV-2 to stem the tide of the pandemic, Adalja added.
“There is a thriving anti-vaccine movement that will use any kind of misstep when it comes to vaccine safety to undermine confidence in all vaccines,” he said.
The drug executives’ statement Tuesday emphasized that the FDA has established a rigorous set of rules for evaluating vaccines.
“FDA’s guidance and criteria are based on the scientific and medical principles necessary to clearly demonstrate the safety and efficacy of potential covid-19 vaccines,” they said. “More specifically, the agency requires that scientific evidence for regulatory approval must come from large, high quality clinical trials that are randomized and observer-blinded, with an expectation of appropriately designed studies with significant numbers of participants across diverse populations.”
The companies also stated they collectively have previous experience creating 70 successful vaccines “that have helped to eradicate some of the world’s most complex and deadly public health threats.”
Trump’s own top vaccine adviser, Operation Warp Speed co-chief Moncef Slaoui, said in an interview on NPR last week that it is “very unlikely” a vaccine would be authorized before Election Day. Slaoui was responding to reports that the Trump administration had told states to prepare to distribute vaccine by Nov. 1, two days before the election.
“There is a very, very low chance that the trials that are running as we speak could [be completed] before the end of October and therefore there could be – if all other conditions required for an Emergency Use Authorization are met – an approval,” Slaoui told NPR. “I think it’s extremely unlikely but not impossible, and therefore it’s the right thing to do to be prepared, in case.”
Slaoui said in a separate interview with the news site Science that he would not remain in the administration if he detected “undue” political pressure in vaccine approval.
“I would immediately resign if there is undue interference in this process,” he said, adding: “I have to say there has been absolutely no interference.”
บรรเลงโดยวงรอยัลแบงค์คอกซิมโฟนีออร์เคสตร้า นำเสนอ 3 บทเพลงยุคบาโรก คือ Brandenburg Concerto No.3 และ Concerto for Two Violins in D minor ผลงานไวโอลินคอนแชร์โตสำหรับไวโอลินสองคัน ซึ่งสร้างชื่อเสียงมากให้กับโยฮันน์ เซบาสเตียน บาค คีตกวีชาวเยอรมัน ร่วมด้วย 2 ศิลปินเดี่ยวไวโอลิน คือ บิง ฮาน และโชติ บัวสุวรรณ บรรเลงเดี่ยวกับวงสตริงเชมเบอร์จบด้วยงานชิ้นสำคัญของอันโต นิโอ วิวัลดิ คีตกวีชาวอิตาเลียน คือ ไวโอลินคอนแชร์โตชุด “The Four Seasons“ (บทเพลงสี่ฤดูกาล) ซึ่งประพันธ์ในแบบดนตรีพรรณนา การแสดงครั้งนี้ หัวหน้าวงจะเป็นผู้นำวงบรรเลงร่วมกับศิลปินเดี่ยวโดยไม่มีผู้อำนวยเพลง กำหนดแสดงวันเสาร์ที่ 12 กันยายน 2563 เวลา 19.30 น.ณ ห้องบอลรูม โรงแรมอนันตรา สยาม กรุงเทพ
รายการเริ่มด้วย 2 บทเพลงของบาค คือ Brandenburg Concerto No. 3 ซึ่งประพันธ์ให้ผู้บรรเลงแต่ละคนมีโอกาสได้แสดงฝีมืออย่างทัดเทียมกัน และบทเพลง Concerto for Two Violins in D minor บาค ประพันธ์ทำนองเดี่ยวสำหรับไวโอลินสองคัน บรรเลงประชันกับวงสตริงเชมเบอร์ได้อย่างสวยงามสมบูรณ์ที่สุด ท่อนสุดท้ายผู้บรรเลงเดี่ยวได้แสดงฝีมือเต็มที่ด้วยท่วงทำนองและลีลาเข้มข้น จบลงอย่างหนักแน่น เพลงสุดท้ายไวโอลินคอนแชร์โตชุด “The Four Seasons” ของวิวัลดิ ดนตรีบรรยายบรรยากาศที่แตกต่างของฤดูทั้ง 4 คือ ฤดูใบใม้ผลิ ฤดูร้อน ฤดูใบไม้ร่วง และฤดูหนาว ได้อย่างลงตัว
By The Washington Post · Marlene Cimons · HEALTH, HEALTH-FEATURES Joanna Dolgoff, a pediatrician in Paulding County, Ga., cringed when she saw the photo on Facebook: a crowded high school hallway full of maskless students, an image that quickly went viral. “I was shocked at how closely the kids were packed together and that they weren’t wearing masks,” she says.
Then it got worse. “I didn’t know where the photo was from,” she says. The moment she learned these students were from North Paulding High School, where some of her patients attend classes, “I got a sinking feeling in my stomach,” she says. “These are my kids. These are the patients I take care of.”
As classes resume in person in some parts of the country, pediatricians – like parents, children and teachers – also are feeling the strain of the ongoing pandemic. They must not only provide a safe space to see patients, who range from newborns to 18-year-olds, and ensure a supply of personal protective equipment, but also determine whether that coughing child with a sore throat and fever has a common cold, the flu – or covid-19.
“We are facing unprecedented challenges as the school year opens, and we’re scrambling to figure out how to handle everything,” Dolgoff says.
Six students and three staff members from North Paulding High tested positive in the days following widespread circulation of the photo. (For privacy reasons, Dolgoff won’t disclose whether any of her patients were among them.) She is angry that young people risk exposure when school districts such as hers fail to follow established public health measures.
“The rule in the county is that you don’t have to wear a mask,” she says. In addition, she says, the schools are saying they can’t social distance because the buildings aren’t big enough. “It’s not safe to go back to school if they aren’t requiring masks, or enforcing social distancing. It’s just not safe for the kids, their teachers or the staff.”
Parents are in a terrible bind because “they had no choice but to send their kids back to school,” she adds. “Most of them had to go back to work and couldn’t stay home.”
The school year has started in various formats in many parts of the country, making it difficult to protect kids, especially those attending in person.
“I’ve been practicing for over 30 years and this spring, summer and fall are not like anything I’ve ever seen before,” says Sara “Sally” Goza, president of the American Academy of Pediatrics, whose website has posted a covid-19 resource page for pediatricians. “We’ve seen this all across the country. All practices are a little anxious about what will happen in the fall.”
Katie Lockwood, a pediatrician with Children’s Hospital of Philadelphia, agrees. “Everything has changed,” she says. “There’s a higher stress level that seems universal and . . . the effects of it are visible. My patients are dealing with food insecurity, job furloughs, challenges of distance learning, loss of family members, missing life events, social isolation and more, which impacts their physical and mental health. This fall, we are facing more unknowns as we enter a new season with covid and the added issue of influenza and other viral illnesses.”
Pediatricians are girding for an increase in respiratory illnesses once colder weather sets in.
“Kids will come in with symptoms – sniffles, a fever, sore throat and cough – that a year ago we would have dismissed as a common cold or flu,” Dolgoff says. “Now we have to take it much more seriously. There’s no way to tell the difference based on symptoms alone. The only way to know is to test.”
When test supplies are limited, “the sickest children will get a test, as well as those who might have been exposed . . . If we don’t have enough tests, we treat all possible covid patients as if they have covid,” she says.
In the absence of a test, “we have to err on the side of caution and quarantine for 10 days from the onset of symptoms, until the symptoms decrease and there is no fever for 24 hours,” she adds, citing guidelines from the Centers for Disease Control and Prevention. “Only patients whose symptoms are not consistent with covid may return to school.”
Elizabeth Murray, who practices emergency pediatric medicine at the University of Rochester Medical Center’s Golisano Children’s Hospital, predicts that local public health officials will be watching disease transmission rates of all common respiratory illnesses closely once all schools open, and likely will advise providers about testing.
“As pediatricians, we know we will be facing covid-19 in some shape or form, although we don’t know how severe it’s going to be,” she says. “The only certainty is that we are full of uncertainty.”
Children represent 9.5% of all cases, with more than 476,439 cases reported since the onset of the epidemic, according to the pediatrics academy. Between July 9 and Aug. 6, pediatric cases rose by 179,000, a 90% increase from the previous total that “caught everyone’s eye,” Goza says.
Although most pediatric cases are not severe, and do not require hospitalization, recent research suggests children play a much larger role in community transmission than previously thought, shedding virus for weeks as asymptomatic spreaders.
“There is risk of infection not just from the symptomatic child, but from asymptomatic children,” says Michael Martin, a Vienna, Va., pediatrician and president of the Academy’s Virginia chapter. “That is the big unknown.”
Moreover, physical symptoms are not the only health issues related to covid-19 that worry pediatricians. Many say they are seeing more mental health problems among their young patients, requiring the intervention of pediatric psychologists.
“It’s rampant around the country,” says Dolgoff, a member of the academy’s covid-19 task force. “We see anxiety, depression, developmental regression, acting out. They’re scared about dying of covid. They’re scared about their family dying of covid. They’re depressed because they aren’t seeing their friends. Younger kids are wetting the bed. Not having a social structure is leading to depression in children.”
Martin agrees, noting that typical childhood stresses usually ease in the summer “as kids are able to unwind at camps and during family trips,” he says. “This did not happen this year.”
Still, after a drop in the spring, children are returning to pediatric offices for checkups, immunizations and sports physicals. At the start of the pandemic, when many people shunned doctor visits, some offices were forced to furlough staff members they couldn’t pay. Visits still may decrease in areas with virtual learning, since children isolated at home are less likely to get sick – a good thing for public health, although less so for pediatric business.
“No one wants children getting ill with ear infections, colds or the flu, so fewer sick children would be great,” says Gary Bergman, a pediatrician who practices in Alexandria and Fairfax, Va. “But as a business owner, I also have a responsibility to my staff – and their families – to keep them employed.”
When the pandemic began, Bergman says, visits to his office dropped by half. Now they are rising again.
“Our numbers have rebounded, but not all the way to pre-pandemic numbers,” he says. “It appears parents are finally starting to feel more comfortable coming into a medical office, especially for delayed checkups and overdue vaccinations.”
When patients and children return, they will find waiting rooms looking very different. Children no longer sprawl on the floor, playing with toys or with each other. Parents no longer sit and chat. Instead, they sit in their cars and wait for a call telling them a room is available. Once inside, there is little, if any, wait time. Everyone must wear a mask. Chairs are stacked, or stored. There are no toys, books or magazines. Practices clean and disinfect each room between patients. Doctors and staff all wear PPE, a sight increasingly familiar to young patients.
“Children have been very tolerant of my PPE,” Lockwood says. “Sometimes I don’t recognize my colleagues under our PPE, but the children don’t seem fazed. If a patient does look hesitant, I try to make a joke about my ‘superhero mask’ or ‘bug-eyed goggles.’ “
While protecting patients, pediatricians also must remember to protect themselves, Martin says. “We have experience mitigating this risk,” he says. “Many of us have continued to practice throughout the pandemic without getting ill. We have learned that the risk of infection stems from letting our guard down with each other, and taking masks off in lunchrooms and common areas, and not social distancing with peers when we should.”
To be sure, the pressures are great, but pediatricians are adjusting, Goza says. “It’s amazing how practices are adapting,” she says. “They are making it work.”
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A patient gets an X-ray at a Bergamo, Italy, convention center that was converted for covid-19 patients in the spring and is now used for follow-up care. MUST CREDIT: Photo by Alberto Bernasconi for The Washington Post. 
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