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Heads turn as a shiny red, white and blue ambulance rolls down a residential street in Dorchester and stops in front of a double-decker. But no one jumps out with a stretcher.
Instead, EMT Diego Aparicio emerges with two brown paper bags: one holds diapers and baby wipes, the other has pasta, red sauce and supplies for the pantry. A nurse inside lays out syringes she’ll soon fill with common childhood vaccines.
There is no way to prevent the coronavirus, but there are vaccines for a dozen-plus diseases that threaten children, in particular. And if kids delay or skip their measles, tetanus, whooping cough and rubella vaccinations, communities in Massachusetts and beyond could find themselves dealing with more than one epidemic.
That was Dr. Eileen Costello’s fear last month when Massachusetts paused elective care and routine visits so that hospitals could focus on patients with COVID-19.
“I worried that if families stopped coming to the hospital, we would have a cohort of unvaccinated children and that would increase the risks to the kids of getting illnesses that are far more dangerous for them than COVID-19,” says Costello, chief of ambulatory pediatrics at Boston Medical Center.
So Costello, working with Tami Chase, BMC’s director of ambulatory nursing, devised a plan: take vaccines to the kids.
They knew home visits wouldn’t work during this period of social isolation, but meeting families outside their homes might. Enter Brewster Ambulance Service.
Brewster’s volume is down 40%, since Gov. Charlie Baker’s stay-at-home advisory took effect and hospitals postponed almost all care that isn’t urgent. So the company had some ambulances and EMTs who weren’t too busy.
Mark Brewster, the company’s president, says he’s more than happy to loan an ambulance or two, along with an EMT driver, to BMC for the time-being.
“We get to help the pediatric population,” Brewster says, “but this also helps me avoid furloughs and lay-offs and keep everybody working.”
So as of last week, one of the ambulances that arrives at BMC every weekday morning is there to pick up a nurse, a pediatrician, a baby scale, a small cooling unit packed with vaccines and those brown paper bags of food and supplies. The team will make 10-12 stops a day.
On a Thursday morning, the first curbside patient is a baby boy who has just turned 1 and is due a slew of vaccines packaged in three shots. Nurse Priscilla Stout, wearing a gown, mask, goggles and gloves, lays baby Juellz onto a stretcher in the back of the ambulance where she’ll weigh and measure him.
Pediatrician Melissa Nass squeezes onto the ambulance bench for an abbreviated check of the baby’s heart and lungs. And then it’s time for the shots. Juellz is quiet for the first two, and then he wails.
Outside the ambulance, while the baby’s older brother Anthony gets one shot, mom Karen Agosto says she’s not sure how long her boys would have gone without their vaccines if the medicine hadn’t come to them. Their pediatrician’s office is at Boston Medical Center, and Agosto doesn’t want her children inside a hospital during the pandemic.
“Since my kid, well, all my kids have asthma problems, I’d rather not take that chance,” she says. “So it’s good that they found a solution.”
Some families have been reluctant to come out even to the curb. Stout says parents may be connecting the ambulance to images on TV of COVID-19 patient transports. Stout has to reassure some parents that the ambulance is clean — it’s not been infected.
“This is different, this is new,” says Nass, “and people have to put their trust in us that what we’re doing is important, which it is.”
The Massachusetts Department of Public Health, which tracks childhood vaccines, says state-supplied vaccine orders were down 39% in March of this year as compared to last and down 68% for the first two weeks of April.
A measles outbreak can occur when just 5-10% of children in an area aren’t vaccinated. It’s not clear how quickly communities in Massachusetts and elsewhere might be vulnerable to eruptions of other diseases on top of COVID-19. But Dr. Jose Romero, the chief of pediatric infectious disease at Arkansas Children’s Hospital, says there’s no time to wait.
“The longer we delay immunizations or delay promoting these routine immunizations, the greater the chances are that we could have outbreaks of vaccine preventable diseases,” says Romero, who chairs the CDC’s advisory committee on immunization practices.
Arkansas Children’s started a drive-through clinic this week for children who are due vaccines. Romero says the Arkansas Department of Health will push to have school nurses administer vaccines if schools reopen in the fall. He says allowing pharmacists to vaccinate older children is another way to increase access to vaccines.
The ambulance is also making stops to check on babies born to mothers who have the coronavirus so that the mothers don’t have to come back into the hospital just for baby visits. Chase mentions one baby who was seen last week and is negative, but the hospital wants to watch the baby closely.
“The nursery is incredibly happy that we can do this work for them,” Chase says.
The mobile pediatric crew is helping specialists across the hospital keep tabs on patients — drawing blood, checking blood pressures, monitoring diabetes.
“Now that we have figured out how to do the vaccines,” Costello says, “this is opening up possibilities for ways that we could engage patients and change the way we deliver care.”
This segment aired on April 24, 2020.
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