COVID Chronicles: Dr. Michael Koster, Pediatric Infectious Diseases Physician

We caught up with Dr. Koster to talk about how COVID-19 has affected his patients, his work and his life.

According to Rhode Island Department of Health data, 580 children and teens have been diagnosed with COVID-19, and fewer than five in both youth categories — zero to nine and ten to nineteen — have required hospitalization.

But in a world gripped by COVID, some children still need treatment for other infectious diseases, including those of the bones and joints, Lyme disease, rheumatic fever, tuberculosis, HIV and other dangerous maladies. We caught up with Dr. Michael Koster, interim pediatric infectious diseases division chief at Hasbro Children’s Hospital, to talk about what’s happening in Hasbro’s pediatric infectious diseases clinic, plus how his work and home lives have changed amidst the outbreak.

Koster, Michael Md 2010

Dr. Michael Koster, via Lifespan

Rhode Island Monthly: First off, how have you been doing? How are your colleagues?
Dr. Michael Koster: My personal health has been good. Early on I had an exposure and a week later developed some mild respiratory and gastrointestinal symptoms that prompted testing. Luckily, my test was negative for COVID-19, but I think everyone has been most disconcerted regarding the uncertainty of what to expect from the pandemic and the illness specifically.
Many of the nurses and doctors vacillate between feeling like this is just a bad flu-like illness to being extremely worried about their safety and life. There is a delicate balance between being well-informed and feeling like you are consuming too much COVID-19 coverage in the news. Within pediatrics, we hold regular conference call updates, which helps ensure that critical information flows to the front lines. Communication and dissemination of information to everyone has been the most challenging aspect of this rapidly and constantly changing environment.
Overall our morale has been good. Many of us do have mixed emotions around what is happening in the adult world, especially in places like New York, where many Rhode Islanders have family and friends on the front lines. I have been personally very lucky to have several colleagues who provide a sense of support and strength for me and I wouldn’t make it through without them. Every aspect of responding to this pandemic has been met with a resounding calm from our outstanding leadership and at Lifespan there is teamwork going on at all levels.

RIM: When you first heard about COVID-19, did you expect it’d reach pandemic proportions?
MK: As the virus began to spread in the early part of this year, most infectious diseases doctors felt there was little doubt that it was going to spread across the globe. I don’t think any of us knew it would be to this degree. We had previous experiences with the Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) types of coronaviruses, but neither of these reached Rhode Island. I think there was a lot of hope that COVID-19 would be similar and that we would be spared.
Lack of early testing availability also very much limited our understanding of how rapidly this was sweeping the country and delayed very effective public health measures, such as identification, contact tracing and targeted isolation of infectious and exposed individuals. There is little doubt that we have all been humbled by the magnitude of this pandemic. I have to say that our infection control director here at Rhode Island Hospital, Dr. Leonard Mermel, is an extraordinary and extremely capable leader. He made some tough but necessary decisions very early on, including conservation of personal protective equipment, universal staff masking and restricted visitor policies, that have been integral in our preparedness. He has connections to infectious diseases specialists around the world and has leveraged those to help implement the right policies here at Lifespan, which has positioned us well.

RIM: What can we expect for COVID-19 and the pediatric population? 
MK: From what the data show us, kids are getting infected at a much lower rate, and COVID-19 is much less severe for them. Children under one year of age, and those with underlying illnesses such as immunodeficiency and pulmonary disease, are at higher risk. In Rhode Island, we don’t expect to see much morbidity or mortality amongst kids.

RIM: How are you treating clinic patients? How has the outbreak and stay-at-home order affected your work with kids who are battling other serious infectious diseases? 
MK: We are rescheduling all non-essential outpatient visits and doing our best to screen patients and families prior to visits. We still need to see sick children and our primary clinic is doing an amazing job for these families who don’t have access to other modes of care. Most of the places for COVID-19 testing are drive-through and that does set up a health disparity situation for many of our families who typically rely on public transportation. We are open for business as usually for patients who need to be evaluated in a timely fashion, and for those children sick enough to need admission. Children, unfortunately, are still being diagnosed with cancer, brain masses and requiring emergent surgery for trauma and other conditions during this challenging time of restricted visitation and physical distancing.

RIM: How can Rhode Islanders support you in your work? 
MK: We all must do our part and stay home. This is especially important if you are sick. Please stay at home! Follow the guidelines that the Rhode Island Department of Health and Governor Raimondo have set in place. We continue to see an outpouring of support from the community, whether a positive word via social media, a local car parade or a passing thank you to a health care worker, and it is much appreciated. This threat brings out the best in us and demonstrates the power of a united human spirit.

RIM: What are you doing to decompress at the end of the day? 
MK: What is interesting, is that I find myself more connected to medical school friends, and talking with them on the phone more than ever before. As a health care provider, there is nothing more supportive than someone who understands the struggle personally. Most of all, I am blessed to have an amazing wife and our three wonderful children who I come home to every day. The kids certainly miss their classmates and friends, but we are privileged to find family time for bike rides, hiking and playing “around the world” on our driveway basketball hoop. My six-year-old always has an uplifting card she’s made each day that expresses her amazing capacity for love in the time of COVID-19. While she understands things are different right now, it is her ever-present playful and cheerful innocence that brings a smile to my face and highlights why I chose to become a pediatrician in the first place.

This interview has been edited and condensed.


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