In this episode, John W. Harrington, MD, speaks about topics making headlines in pediatric news, including a severe infant formula shortage in the United States, gun violence impacting children and adolescents, COVID-19 vaccines for children, and a shortage of pediatric medical professionals. 

John W. Harrington, MD, is the vice president of quality, safety, and clinical integration at Children’s Hospital of The King’s Daughters and the division director of General Academic Pediatrics (Norfolk, VA).

Jessica Bard : Hello everyone. Welcome to another installment of Podcast 360, your go-to resource for medical news and clinical updates. I'm your moderator, Jessica Bard, with Consultant360 Specialty Network. Firearm related injury is now the leading cause of death among children and adolescents in the United States. Meanwhile, the United States is experiencing a severe shortage of infant formula. Dr John Harrington is here to speak with us today about topics making headlines in pediatric news. Dr Harrington is the Vice President of Quality, Safety, and Clinical Integration and the Division Director of General Academic Pediatrics at Children's Hospital of the King's Daughters in Norfolk, Virginia. Thank you for joining us today, Dr Harrington. Where are we today on the infant formula shortage?

John Harrington : Today is June 1st so we're kind of at an improvement stage, I think, so a lot of the things that occurred in giving people understanding. When we first had the problems with cronabacter, which was found in the formulas, and then that was back in 2021. We really didn't get the stop, can't make any more formula from Abbott back in March when it finally just was closed down. From that time from March to now we're finally getting through that log jam of we just don't have formula. 43% of the formulas were just taken out of the institutions and stuff that usually create those formulas and stuff.

Right now I think we're backlogging that and we're starting to get more formula on shelves for parents and stuff. It's the critical formulas that are difficult, are the ones that are for special diets or kids that have metabolic disorders that were only getting them through that certain company that created them and stuff so there have been substitutions that have been in place. A lot of places like the AAP and the US Department of Health and Human Services have put on stuff on websites for you to look up stuff to find things. Even most of the Department of Health have looked at what are their resources through the states and stuff like that to provide formulas for parents.

That information has gone out to all pediatricians and all the different people that take care of kids, even family practices and stuff, so I think the message is out there now. There was a big push to also breastfeed and stuff, which is usually what we really want kids to do and infants to do, so I think that pushed the breastfeeding initiatives as well. The fact that we have breast milk banks and the breast milk banks can supply that need, if needed, for some of the parents if they didn't want to get a formula and you could always give breast milk if you needed to and so you could get that from a breast milk bank. That was another avenue that some of us who have breast milk banks available to us were able to use in our healthcare systems and stuff so that was exceptionally helpful as well.

Jessica Bard : Another topic, unfortunately making headlines, a rise in gun violence, particularly impacting children and adolescence. What are we seeing with that?

John Harrington : June 3rd, this is Friday, is gun violence awareness or gun safety awareness. I think a lot of pediatricians and a lot of people out there really want change. At least ... Even if it's the smallest incremental change in terms of if a person has a mental health problem, if the person is maybe not a full adult. I think we have changed the idea of is a person who's not trained in the military or whatever, under 21, who has a mental health problem who can get a rapid fire or a multi-firing gun, is that a smart thing for us to be doing and stuff? Things like that need to be discussed openly and transparently so that people can make good decisions about this.

It just seems like it becomes politicized into the your rights and stuff and your gun rights and your second amendment rules and stuff like that. In all honesty, we just want safety. We can drive our car but we have to wear a seatbelt, right? You can buy a gun but you have to be a certain age or you have to have a certain thing in order to get that gun. It doesn't have to be severely limiting, it just has to be sane, sanity things and stuff. There really needs to be a way to do that, that we can't just have to be stuck in this conundrum of well, that'll deny this person, that'll deny this person, that'll deny this person.

I really attribute it to the same thing as car safety. Actually, if you look at the leading causes of death that was in the New England Journal of Medicine for kids and adolescence and stuff, it really does show it drastically. Motor vehicle accidents have come down as a reason for kids dying and the thing that's actually outpacing it now is firearm related injuries. When you look at that you say, "Well, what did we do for cars, how did those come down?" Well, because we made rules. We said you got to wear a seat belt. You have to be in a car seat if you're too small. You have to sit in the back seat. You can't sit in the front seat if you're under 13. All of these things are just rules that were put into place that have saved lives. We need to do that for guns as well. We just need to put in things that will help children not die.

Some of those require that kids shouldn't be buying guns. Right? If you really want to think about the adult brain, you really don't get an adult brain until you're 25 so a kid 21, and now even in our system of kids not really growing up and leaving the house and stuff, there's a lot of kids that are still in the house at 21, which might not have been true 20, 30 years ago. The laws that we have now don't necessarily work for the guns and the things that we have now so they're pretty outdated. Someone was relating it to Model T Fords in terms of how we handle our safety in a car. With gun safety right now versus what we have for cars now, they beep if you get too close to another car, if you're outside of a lane. We have all these safety devices in our cars because we knew they were killing people.

Now we have guns and we have to come up with ways, gun locks, something like that, something that would allow people to make things safer and stuff. We as a system have to come up with that and stuff and hopefully, we will, hopefully, we will.

Jessica Bard : Yeah. I think it's worth noting that firearm-related injury is now the leading cause of death among children and adolescents. Not only is it on the rise but now the leading. Switching gears here now, COVID-19, is something we've obviously been talking about for the last two years, but what are we experiencing now in regard to COVID-19 vaccines among children and adolescents?

John Harrington : Recently, the vaccine for kids five to 12, they approved the booster for that age group. What most people are seeing is even with the Omicron surge and the new variant surge and stuff like that, getting the original vaccine can still provide a degree of protection, especially against serious illness and stuff. Even for adults now, people have gotten their first doses and then they've gotten, now you can get two boosters now, anybody can get two boosters if they want them, it's been five months since the last one.

All of that's happening in the healthcare system. Some people are mandating them. Some people are suggesting them or strongly suggesting them and stuff. In kids, you've got your kids that are five to 12 and 12 to 18 and stuff, but now coming soon to a theater near you is the vaccine for six months to four years of age. That got pushed off a little bit, although they brought out the data and said that the data looks good for kids and that the Pfizer maybe looks a little bit better than the Moderna but you'll need two doses ... I'm sorry, three doses of the Pfizer and only two doses of the Moderna for this age group.

That may also be a game-changer for some parents who want just two shots versus three shots. It'll be a series of shots similar to like what we do with hepatitis B or something like that where you would give a first dose and then three weeks later a second dose. Then two months after the second dose you would get a third dose. Then that would be immunized, initial immunization. Now, whether boosters will be needed will be another decision that they'll have to make once we go through another probably year of COVID and stuff.

At this point in time, if you ask parents and when you look at this situation, the drop-off for wanting a vaccine for kids has gone pretty steeply so most people are not rushing in to get vaccines anymore. I think there'll be a group of people, they'll probably be a third of people who want to get vaccines for the kids six months to four years of age. There'll be a third of people that'll want to wait and there'll be a third of people that say I don't want to get that vaccine. It may be more or less in some of those degrees but I think that's what you're going to see as the three most likely ways of looking at it. I want it, I want to wait or I ain't getting it.

We'll have to deal with that messaging because I think that'll be really important to prevent another outbreak, another surge, and stuff. I think that's going to be a really important thing. Who knows if the next surge will be more deadly than the last one? The last two have not been as bad, meaning we haven't had as many deaths and we haven't had as many kids getting sick with the MIS-C, which is the multi-inflammatory systemic COVID and stuff. We haven't seen that outbreak of that with these last two variants that we thought we would with the Delta and stuff like that so we're hopeful that we will continue along that line having variants that aren't as bad. They may be as contagious but they won't be as likely to cause significant illness and stuff, but we still have to deal with it.

There's still over a million deaths of COVID so we're still probably going to see more deaths over the next year or two, but it hopefully will fall into the ranges of what we see with flu and things like that.

Jessica Bard : The last topic today, what kind of staffing issues are you seeing in pediatric medicine today?

John Harrington : I think all staffing models in every healthcare system have taken a brunt. In the adult world probably more so because of the fact that COVID hit the adult world a little harder than the pediatric world. But, having said that, there are certain areas of the hospital that have significantly lower staffing. One of them that is nationwide is respiratory therapists. Respiratory therapists was right in the heart of it, right? They have to be right with the air and the fluids and the facial stuff so they're close into COVID. We just have not been able to backfill that. A lot of nurses left the institution of nursing and just said, "Hey, I'm not doing this anymore. I'm going to do private duty nurse. I'm going to do home nurse. I'm not going to be in the hospitals anymore," so everybody's struggling with the nursing.

Then the traveling nursing programs came out and so people could travel and go to places and stuff and do things for more money so it was kind of this volume of people moving around the country and filling positions for the highest dollar amount. A lot of places have now petered that out and now we're seeing where does it all fall out now? Most places are probably somewhere in the lower staffing amounts, like 10 to 25% down, and just dealing with it, learning how to work schedules and have less staff and see if you can still do the same things that you were doing before.

Many of the pediatric practices here, we're seeing a lot of the winter flu season and winter viruses that we usually see in the winter and now it's June and we're seeing them now so it's very discouraging to not have as much staff when you have a viral season that looks like winter time in the summer. We're dealing with that. We're having large amounts of people coming to our urgent care centers and our ED with illness, with viruses from everywhere; from croup to RSV to adenovirus. All the viruses are out there right now.

Usually you see them in waves but we're seeing them all at one time, along with COVID, which is now back up to nine or 10% of the testing that we're doing and stuff so it's pretty amazing that the staffing models have held, but I think there's still ... What is unseen is the stress on the staff and stuff and if you push staff long enough eventually they will have burnout and so we have seen that in some of the fields. People are lasting two to three years and they're just saying this is just not, I just can't do this, and so people are burning out.

We're trying to hire, people are being hired, we're seeing people leaving so as fast as you can put people into places people are leaving. That's been a really tricky thing for most staffing models and stuff and I think most people have found that that's the critical issue right now is continuing staffing our healthcare facilities with people who are well trained to do that and stuff. That's the other thing, you have to train people and the training part takes time. It's hard to do that if your turnover is so fast. Many of us are working on those aspects to try and make things better so that the healthcare system can stay healthy.

Jessica Bard : Is there anything else that you'd like to add today, Dr. Harrington?

John Harrington : Well, it's two to two and a half years into the pandemic so we can't really call it an endemic yet because we're still having high rates and stuff so I guess we can call it a continuing demic. I don't know what ... There's not a lot of terms to this, but it is one of these things where you have to work with your healthcare systems and ... Our mental health is really probably the most important aspect and I think that goes with everything; the COVID causing mental health problems, I think with gun safety and stuff like that where mental health is really big.Then we are opening actually a mental health hospital here that'll be 14 stories, with four full floors for inpatient pediatric mental health, because it was so important to us to provide some place to take kids who have real mental health needs and there really wasn't anything available. I think more places are probably going to have to do this because they're winding up in our ERs and we can't find a place for them and we were tired of that. I think that's the next bastion, is to take care of the mental health that is going to play those probably over the next millennium so we'll have to see how that goes.

Jessica Bard : Thank you again, Dr. Harrington, it was a pleasure speaking with you and thanks for all the work that you do with kids today.

John Harrington : Thanks Jessica, you take care