Dear families,
As cases of Covid-19 increase here in Western Australia, we are working closely with our colleagues in general paediatrics to prepare for the care of youth with diabetes who may test COVID positive. The purpose of this letter is to keep you up to date with these plans, give you some information regarding the experience of diabetes teams elsewhere in Australia, and also help to deliver important information about extra support available to families of children with diabetes.
The Current Situation:
- It appears that for most youth, Covid-19 is a mild illness and only a small minority of youth with COVID require admission to hospital. For COVID overall (including earlier variants such as the Delta variant) the rate of admission in youth was around 2%, while more recent data pertaining to the currently dominant Omicron strain suggest the rate appears to be around 1%. Of these the majority do not need more than typical inpatient support (eg. IV fluids for dehydration) and have a brief hospital stay.
- We don’t have a lot of information specific to COVID infections in Australian youth with diabetes yet but, anecdotally, they are doing well too. Some of our fellow teaching hospital colleagues around Australia have reported needing to admit very few (if any) children because of their diabetes in the presence of COVID.
- It remains important to try your best to keep glucose levels in range as much as possible, as it is logical to think that chronically elevated blood glucose levels might increase both the risk of ketones in the presence of a COVID-positive test, and the risk of a more severe COVID illness.
- Know your sick day management plans (Section 7 of your Type 1 Diabetes folder) and how to contact us if you need help with high glucose levels or ketones.
- Youth aged 16 and 17 are now eligible for booster doses of the vaccine and those aged 5-11 are eligible for the age-specific schedule at a lower dose (please see the accompanying information in this newsletter about vaccination).
Additional Support/COVID Care at Home Program:
Importantly, we want to make you aware of an initiative called WA COVID Care at Home. This program offers extra at home monitoring and care for COVID positive people who have other health risk factors (diabetes is included under this category as “moderate risk”), and will complement the clinical care that children with diabetes receive from our team whilst they are COVID-positive.
It is important to note that referral into this COVID service is only via the Department of Health/Calvary Medibank. Upon receiving a positive COVID result, all patients/families will be sent an SMS from the Department of Health with simple screening questions and be asked if they wish to “opt in” to the COVID Care at Home service delivered by Calvary Medibank.
Further screening by Calvary Medibank will then be done to identify children at moderate or higher risk, and these children will be referred to the COVID Care at Home program. The component of that program specific to children is called the Statewide Paediatric and Adolescent Remote Care (SPARC) COVID service and is based at Perth Children’s Hospital. They will be able to help with monitoring and medical advice, and we will work with them to assist with diabetes-specific questions (such as high blood glucose or ketones).
In the event that your child or adolescent tests positive to COVID, we recommend responding to the Dept of Health SMS to “opt in” for assessment of eligibility for the SPARC COVID clinic. Please note that you can’t pre-register for this program; you can only opt in in the case of a positive COVID test. If the result is positive from a Rapid Antigen Test (RAT), then remember that it is required that your result be registered with the Dept of Health too here.
Use of Telehealth for Outpatient Clinics:
In late January, the Chief Health Officer required all clinical teams to use Telehealth where possible and clinically appropriate. This has resulted in us needing to convert regional outreach clinics to Telehealth for the time being, and also in line with requests from our rural and regional health partners to use Telehealth. We hope to return to travelling for face to face care 4 times/year as soon as possible, but we will be guided by directives from the Chief Health Officer and the Health Department.
We can still offer face to face visits at Perth Children’s, where the clinical team and family feel this is medically necessary. We are attempting to balance the importance of maintaining optimal care and support for glucose management through the expected peak wave of the pandemic here in Western Australia with the need to reduce exposure risks for staff and families alike.
We can continue to do essential face to face care for families including those in the newly diagnosed journey, starting on new technology, the very young, and adolescents with diabetes. We have also asked clinic teams to support additional youth where face to face visits are deemed important (such as where recent glucose control has been more challenging) and work with families to see if they would like to keep these face to face appointments. Equally, please know that if you don’t feel comfortable coming to the hospital as case numbers increase in the community, we will support you as much as possible in that decision and utilize Telehealth for your visit.
We learnt a lot about using Telehealth in 2020 during the first wave of the pandemic. It worked well overall, some technical issues notwithstanding, and the feedback we received was that for the most part families appreciated the flexible nature of maintaining the standard of care and diabetes visit frequency. We did learn, though, that it is hard to fully replicate connections made face to face, and we also need accurate data to help you such as growth monitoring, HbA1c, blood pressure measurements, review of insulin injection sites etc.
Please note we will also be happy to send out pathology request forms before or after clinic to help with HbA1c measurements and other monitoring tests in concert with a Telehealth visit. We would like to continue to measure HbA1c at least every 2nd visit if the Telehealth plan needs to continue.
We will continue to watch the Dept of Health directives, follow these and to keep you updated.