ROCKPORT — William Stephenson, a doctor with Pen Bay Pediatrics, is on heightened alert these days, not, however, in his usual office. Rather, he is at the special Acute Respiratory Clinic (ARC) with fellow nurses and doctors, in a small building adjacent to Pen Bay Medical Center.

The ARC is a dedicated assessment and treatment center established as a direct result of the COVID-19 pandemic. It is in the old skin care clinic at the hospital, which was then converted to administrative offices. 

Now it is repurposed for a pandemic.

At the ARC, Stephenson, along with his colleagues, are helping children and adults who are suffering from fever, cough, shortness of breath and other acute symptoms associated with COVID-19. 

There is a pediatrician and an adult physician on duty there, seven days a week, to see patients. They are outfitted with personal protection equipment (PPE) and prepared to confront the virus.

Waldo County General Hospital, in Belfast, has a similar clinic and assessment facility, as do many other hospitals now in the world. The goal is to keep patients at home, as much as possible, especially those potentially infected with COVID-19.  

To visit the ARC at both hospitals, patients are to first call their primary care providers. For those who do not have a primary care provider, call 207-301-8200, and Pen Bay Medical Center staff will help a patient to get set up. At Waldo County General Hospital, call 207-338-2500.

At the clinic, nurses and doctors talk with patients about symptoms. If remaining at home is appropriate, the patient is encouraged to call back if symptoms change.  But, if a child or adult is having worrisome, but not severe symptoms, they are taken to ARC to be evaluated.  

“It is where we only see people with fevers, cough and colds,” Stephenson said, speaking March 26 over the phone about COVID-19, in relation to children and teenagers. That age group is his concentration, and he is keeping up with the latest research and information about this particular coronavirus’ effect on the physical, mental and emotional health of children and teens.

At the ARC, patients are taken immediately upon arrival into the exam room. Patients wear masks and the pediatrician wears a gown, gloves, face mask, and eye protection. The room is thoroughly cleaned after each patient to ensure safety for the next patient.  

This process leaves the hospital emergency rooms less busy and allows caregivers there to focus on the sickest patients.  

Stephenson is realistic about the presence of COVID-19 in the Midcoast, and operates under the presumption that a cough and fever will be associated with the virus.

“It important to understand that the absence of known cases doesn’t mean we can say it’s not circulating,” he said. “We should assume any sort of respiratory symptom is coronavirus, and why social distancing is so important.”

The stress of this pandemic is felt in many ways, and with children and teens, honest and clear communication about the virus is paramount. 

It is also about striking that balance between reassurance and the crucial need to stay at distance from friends.

With some children, it is important to correct factual misconceptions.  

With older teenagers, is sometimes important to tell them, “no, this is worse than you think it is.”  This, said Stephenson, empowers them to make the necessary sacrifices related to social distancing.  

The following is a Q&A with Dr. Stephenson:

1) What are the best ways of communicating about the current pandemic to specific age groups of children?

For parents, and media at large, we are trying to walk the line between providing comfort and acknowledging that this infection has made a lot of people very sick and especially with older people die.

A good place to start, regardless of age, would be to find out what the children know about the virus.  Find out what they are concerned about.  

Offer them comfort and honesty.  Offer them a way to feel like they have some control. Realize that, as a parent, you don’t have to know all the answers and that what you may believe to be true could use some updating. 

I highly recommend that when questions come up use the websites:

www.cdc.gov

healthychildren.org

kidshealth.org. 

These organizations have doctors and scientists and media experts who have spent time to distill the known science and relay the information to the public.  

Be sure to check in with kids periodically to see if new questions have come up or if they have new concerns.

2) How do parents minimize fear, and at the same time, teach their children the importance of isolation?

Allow children the opportunity to discuss their fears.  There are a number of things to be concerned about with the coronavirus pandemic.  Be aware of how kids are obtaining information about the coronavirus and consider limiting news exposure to a certain amount per day as opposed to the news always being on in the background.  

For parents who are caring for a child or teen with COVID-19:

With adults and teenagers, sequester them in a separate room and give meals outside the door.

Younger children need direct care.

In that case, one adult sequesters with the child.

Keep your house just to yourselves.

Here are guidelines from the CDC:

If possible, have them use a separate bathroom.

Avoid sharing personal household items, like dishes, towels, and bedding

If facemasks are available, have them wear a facemask when they are around people, including you.

If the sick person can’t wear a facemask, you should wear one while in the same room with them, if facemasks are available.

If the sick person needs to be around others (within the home, in a vehicle, or doctor’s office), they should wear a facemask.

Wash your hands often with soap and water for at least 20 seconds, especially after interacting with the sick person.

If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol. Cover all surfaces of your hands and rub them together until they feel dry.

Avoid touching your eyes, nose, and mouth.

Every day, clean all surfaces that are touched often, like counters, tabletops, and doorknobs

Use household cleaning sprays or wipes according to the label instructions.

Wash laundry thoroughly.

If laundry is soiled, wear disposable gloves and keep the soiled items away from your body while laundering. Wash your hands immediately after removing gloves.

Avoid having any unnecessary visitors.

For any additional questions about their care, contact their healthcare provider or state or local health department.

Provide symptom treatment

Make sure the sick person drinks a lot of fluids to stay hydrated and rests at home.

Over-the-counter medicines may help with symptoms.

For most people, symptoms last a few days and get better after a week.

Talk to your children about what they and family, and the wider community are doing to limit the spread of the coronavirus infection. 

Because COVID-19 spreads from person to person, reducing the ways people come in close contact with each other is essential.  It may be tempting to get kids together for play dates or sleepovers, but this should be avoided.  If going outside to play or go for a family walk, which is still a great idea, make sure to keep at least six feet from other people.  If you go to parks, keep kids off the communal equipment (stuff that gets used a lot – there may have been some mucus wiped there)

For teenagers, the severe curtailment of social activities is especially challenging.  To keep them connected, allow them to use Facetime/Skype/Zoom and other platforms to be able to connect in a digital space.  

Families need to be especially careful about visiting with grandparents or having them take over child care duties.  People over 60, or those with other significant health problems, are at an increased risk of getting sick and dying from the coronavirus.  Children are far more likely to be healthy spreaders of the virus with minimal symptoms.  This virus is not the common cold, it can occasionally cause very serious illness in children.  

 Physical distancing only works if everyone does this.  Slowing down or preventing the spread of the virus will save lives.   

At this point, kids need to stay at home. 

3) What symptoms do children exhibit with COVID-19, as opposed to common cold and flu?

It is important to understand that the absence of a significant number of known cases in Knox County should not be understood to mean we do not have the coronavirus locally.  We have to assume that the virus is in the community and act accordingly.  

We are still at the beginning of our understanding of how this infection impacts healthy children and those with moderate to severe medical conditions.     

It appears, based on very small numbers, that infants only contract the virus once out of the womb.  Said another way, an infected mother would not pass the infection to her unborn baby. 

The virus does not appear to spread through breast milk. 

It appears that the virus does not have a negative impact on the developing fetus. 

One study, again from China, looked at nine newborns born to COVID-19-positive mothers.  None of the infants had any more than mild illness.  

4) What would you like to impart specifically to parents and the community about protecting children’s health, and the greater health of the community?

It is important not to lose sight of the importance of well child checks for children under 18 months of age. 

We need to continue to vaccinate these children to prevent the reemergence of illnesses such as whooping cough, measles, and meningitis.  To facilitate this safely Pen Bay Pediatrics has taken some wonderful steps. We are not seeing anyone in our office with fevers or even minor respiratory illnesses nor can someone take the child coming to the office have those symptoms.

This allows us to create a “safe” space where people can feel comfortable bringing healthy children to.  

The result is that we are fielding many sick phone calls from families and encouraging them to stay home as appropriate.  As a result, we are providing lots of education about the best ways to care for minor illnesses in the home.  We are reminding people that over the counter cough/cold medicines have not been show to help children. 

The best cough medicine is honey and if old enough, cough drops. 

A critical piece of information to highlight is when children are no longer considered contagious from an illness. 

We don’t have the ability to test lots of people so we presume anyone with minor cough cold symptoms may have  coronavirus infection.  As such, the current recommendation from the CDC is a person must be fever-free for 72 hours and be at the point of seven days since the onset of illness, whichever is longer before they are considered not contagious.  

For children who have respiratory symptoms who need to be seen, we have the ARC which is open 7 days per week. 

The visits are by appointment only.  You can get an appointment by calling your primary care doctor’s office to arrange for a visit. 

This is a very safe space.  Patients do not wait in the waiting room and are brought immediately back into the exam room upon arrival.  The child/family wears a mask and the pediatrician has on a gown, gloves, facemask, and eye protection.  The room is very thoroughly cleaned afterwards to ensure safety for the next patient.  Our goal is to make sure the only patients seen in the emergency department are only ones who need to be seen there.  

Pen Bay Medical Center has been dramatically ramping up its ability to do phone and video visits.  So rashes, minor respiratory illness, and mental health concerns can be evaluated this way.