Safely Caring for Patients during COVID-19

Wilder Wittman is just 14 months old, but he has been hospitalized four times for severe infections in his bladder, kidneys, and blood. His parents had been anxiously awaiting a surgery at Lucile Packard Children’s Hospital Stanford to correct a urinary tract defect that was endangering his kidneys. Then the pandemic struck.

Wilder had been so sick that his parents, Katie and Olivia Wittman of Monterey, California, still hoped the surgery could go forward in spite of the virus. They were relieved when Packard Children’s clinicians operated on Wilder on May 22, shortly after the hospital had begun safely resuming care delayed by COVID-19.

“We were so grateful it took place,” Katie Wittman said. “For the last year, we’ve been on edge, wondering when would be the next time we would have to drive up there and drop everything in the middle of the night because that’s the way all of his hospitalizations have happened.”

Wilder suffered his first infection 10 days after he was born, she said. He developed sepsis, a systemic blood infection that can be life-threatening. “It was very scary,” she said. After a second infection, local doctors referred the family to Packard Children’s, where the baby was diagnosed with a congenital condition known as vesicoureteral reflux.

The condition allows urine to flow backward from the bladder to the kidneys. Normally, urine travels down from the kidneys through tubes called ureters, then is stored in the bladder. Patients with the condition have a defect at the position where the ureters meet the bladder, permitting urine to flow the wrong way.

Wilder had a more serious form of the condition, with both kidneys impacted, said William Kennedy, MD, chief of pediatric urology at Stanford Medicine Children’s Health and a professor of urology at Stanford University School of Medicine. He said that reflux used to be the number one reason for kidney transplants in children but this is no longer the case, as it can be effectively corrected with surgery. The procedure is most successful in patients who are at least a year old, Kennedy said.

So Wilder’s parents had to wait it out until he reached his first birthday. The surgery was set for May. In the meantime, Wilder continued to experience recurring infections. In April, at the height of the pandemic, his parents took him to the emergency room at Packard Children’s. “Everyone was extremely careful,” Katie said. “They were masked and gowned, and I felt very comfortable being there.”

During this time, the hospital had put some patient services on pause, including some surgeries, diagnostic tests, and imaging procedures, while it prepared for a possible surge in COVID-19 patients. The hospital ensured that all caregivers had adequate supplies of personal protective gear to guard against infection, instituted physical distancing where possible, and began broadly testing patients and health care providers for the virus. To date, more than 13,500 staff across Stanford Medicine, including Stanford Medicine Children’s Health, have been tested, and 97.7 percent of those have tested negative for the virus.

When it came time for Wilder’s surgery, his parents were anxious, but not about the virus. “I was nervous for the surgery because it was the first time he was put under anesthesia, and it’s a pretty long procedure—about three or four hours,” said Katie, who is a nurse.

Caregivers prepared the family about what to anticipate. “They were incredibly helpful in explaining what the climate was like there with COVID and what to expect when we came to the hospital,” she said. A few days before the surgery, Wilder was tested for the virus while in his car seat, a clinician used a nasal swab. Wilder cried briefly, then recovered.

When they arrived at the hospital, caregivers took Kate’s temperature at the door and gave her a medical-grade mask to wear all the time. The hardest part was not being able to have both parents present before and after procedure, the couple said. Olivia Wittman stayed behind in the car, and Katie joined her there to wait while the surgery was underway. Katie also spent two nights in the hospital in the private room with the couple’s son.

“Having only one parent with him was stressful for both of us,” said Olivia. “He’s a toddler, and he wants to stand and bounce around. He was a monkey, climbing all over Katie, and she was exhausted.” But, she added, “in the scheme of things, it was a short hospitalization, and we got through it and we’re better for it.”

Kennedy said the surgery went extremely well. During the procedure, he opened up the bladder, disconnected the ureters at the faulty junction points, and then redesigned the connections so they would no longer reflux urine.

“He was out in record time,” Kennedy said. “He was sitting up, smiling, eating the next day, and required a minimum of pain medicine. He was the stellar patient for recovery.”

It’s been two weeks, and Wilder is now back to his normal active self. “He’s actually doing remarkably well,” Olivia said. “We both feel our care team prepared us really well for what would come after the surgery. They did a good job of educating us about the benefits and the actual surgery itself and what to expect afterwards. So there have been no surprises on his road to recovery.”

As for the added steps to guard against coronavirus infection, she said, “I have to applaud the Stanford and Lucile Packard Children’s Hospital leadership for taking the measures they do. While some feel it’s super-drastic and some parents are staying away, it’s all for extremely important reasons. While all of these measures might have made our experience more stressful, that’s a function of the virus. And I’m way more grateful for the hospital leadership taking it seriously.”

Kennedy, who has resumed a full operating schedule, said there is “no safer time than right now to have surgery.”

“The hospital is on such high alert for COVID. Everyone is following procedures carefully. All patients are tested. There is hospital-wide testing for staff. There is universal masking. There really is no safer environment than we currently have,” he said.