[Comment] COVID‑19 threat and frontline paediatric care professionals
Affiliations: COVID‑19 Reference Centre, ‘Rafina’ Health Care Centre, 19009 Rafina, Greece, Paediatric Intensive Care Unit (PICU), University Hospital of Patras, 26504 Rio, Greece, Department of Paediatric Radiology, ‘Mitera’ Children's Hospital, 15123 Athens, Greece, Department of Paediatrics, ‘Penteli’ Children's Hospital, 15236 Palaia Penteli, Greece, Institute of Paediatric Virology, Aliveri, 34500 Island of Euboea, Greece
- Published online on: October 30, 2020 https://doi.org/10.3892/etm.2020.9421
- Article Number: 291
Copyright: © Koutsaftiki et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
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Since 2007, the PVSG has focused on continuing medical education of the frontline paediatric professionals (3). The necessity for their increased preparedness against common viral infections, as well as emerging epidemic viral threats has been analysed in detail (4‑8), while in 2018, the ‘4th workshop on Paediatric Virology’ was dedicated to the 100 years of the 1918 Spanish flu pandemic on the Greek Aegean Sea island of Skyros, which devastated its population in less than 30 days (9‑18). Despite all the discussions, recommendations and encouragement on the necessity to promote infection control measurements, to increase medical preparedness against a future pandemic threat and to intensify research efforts on novel immunization strategies and targeted anti‑viral agents, the COVID‑19 pandemic threat found the frontline paediatric care professionals unprepared, in fact. They were requested to fight on the frontline, in parallel to their colleagues in adult medicine, without proper scenario‑based, undergraduate or postgraduate medical education, no successful targeted therapeutic agents and no effective management and prevention strategies against the new virus, SARS‑CoV‑2; for this reason, the message by the PVSG at the beginning of the current COVID‑19 pandemic threat was referred to the humanitarian and solidarity role of the front line health medical and nursing professionals as well as their pragmatic needs (Table I).
To date, in Greece, a country, which until March 30th, 2020 had 1,212 cases and 46 reported deaths with confirmed SARS‑CoV‑2 infection (19), the aim to increase the preparedness of the frontline paediatric care professionals in a short period of time has focused on advancing infection control measurements in primary, secondary and tertiary paediatric care. Paediatric care professionals in the COVID‑19 reference centres, as well as in general paediatric departments and neonatal units all over the country have attended scenario‑based educational interventions. These evolving educational interventions have been organized by the local Hospital Committees for Infectious Diseases in collaboration with the COVID‑19 reference centres in Greece and the National Public Health Organization over the last month, while paediatric medical and nursing personnel have been encouraged to attend international webinars on COVID‑19. Moreover, additional changes have been tried to be performed regarding the development of triage in paediatric emergency settings, the usage of personal protective equipment (PPE), appropriate decontamination and isolation facilities, as well as general paediatric equipment, negative pressure rooms in tertiary paediatric care as well as new beds in paediatric intensive care units (PICU). Recently, at the ‘Aghia Sophia’ Children's Hospital in Athens, the Paediatric Infectious Diseases Unit ‘MAKKA’, which ceased to treat children with infectious diseases on August 2014, was scheduled to re‑open, with a capacity of 20 beds ‑ including 2 beds under negative pressure ‑ and admit paediatric cases with COVID‑19.
The fact that these ‘last‑minute’ changes are in the correct direction is really encouraging. The future will show ‑ for one more time ‑ if these changes will promote further changes in an organized, evidence‑based, effective manner or not. As the clinical course of the SARS‑CoV‑2 infection in the majority of paediatric population is asymptomatic or mild, paediatric preparedness and current therapeutic protocols for children seem that will not be eventually needed (20-22). If this estimation is proven in the ensuing future, for paediatric health care professionals, the COVID‑19 threat will remain only an excellent virtual preparedness exercise, formulating major incident plans for potential paediatric victims. This exercise, though, should re‑evaluate the priorities in medical education and clinical practice, especially in a country, like Greece, which still encounters the consequences of the 10‑year financial crisis of 2010.
This article is published in the context of the foundation of the Institute of Paediatric Virology (IPV; https://
paediatricvirology.org) based on the island of Euboea (Greece), under the auspices of the World Academy of Sciences (WAS) and the support of the Department of Clinical Virology of the University of Crete School of Medicine and the First Department of Paediatrics of the University of Athens School of Medicine. We would like to thank all the members of the IPV for their valuable comments and corrections.
No funding was received.
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All authors (CK, AP, GP, PK, INM, MT and DAS) contributed to the conception and design of this manuscript, wrote the original draft, edited and critically revised the manuscript, read and approved the final manuscript.
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CK, AP, GP and PK declare that they have no competing interests. INM, MT and DAS are co-founders of the Institute of Paediatric Virology (IPV). DAS is the Editor‑in‑Chief for the journal, but had no personal involvement in the reviewing process, or any influence in terms of adjudicating on the final decision, for this article.
Mammas IN and Spandidos DA: The future of medical education in neonatology, paediatrics and paediatric virology: An interview with Professor Alan Michael Weindling, Professor of Perinatal Medicine at the University of Liverpool. Exp Ther Med 16: 2805‑2808, 2018.
Mammas IN, Spandidos DA and Weindling AM: The future of paediatric education. Exp Ther Med 16: 2803‑2804, 2018.
Mammas IN, Theodoridou M and Spandidos DA: The development of the Paediatric Virology Study Group: Ten years in the making. Exp Ther Med 13: 363, 2017.
Christaki I, Beattie T and Midgley P: The challenge of modern biowarfare: ED preparedness for paediatric victims of the Ebola virus. Int J Mol Med 36: S90, 2015.
Mammas IN, Greenough A, Theodoridou M, Kramvis A, Christaki I, Koutsaftiki C, Koutsaki M, Portaliou DM, Kostagianni G, Panagopoulou P, et al: Current views and advances on Paediatric Virology: An update for paediatric trainees. Exp Ther Med 11: 6‑14, 2016.
Gardner S: It's never just a virus ‑ experiences from the frontline. Int J Mol Med 38: S65, 2016.
Thiagarajan P: Zika virus in pregnancy and infancy ‑ What do the paediatricians need to know? Int J Mol Med 38: S64, 2016.
Mammas IN, Theodoridou M, Kramvis A, Thiagarajan P, Gardner S, Papaioannou G, Melidou A, Koutsaki M, Kostagianni G, Achtsidis V, et al: Paediatric Virology: A rapidly increasing educational challenge. Exp Ther Med 13: 364‑377, 2017.
Mammas IN, Theodoridou M and Spandidos DA: The ‘Spanish’ flu outbreak at the islands of Skyros, Euboea and Andros 100 years ago. Int J Mol Med 42: S22, 2018.
Theodoridou M: Overview of influenza vaccination in children. Int J Mol Med 42: S17, 2018.
Thiagarajan P: Antiviral drugs in the clinical management of children with influenza. Int J Mol Med 42: S18, 2018.
Melidou A: Epidemiology of influenza types and subtypes in childhood. Int J Mol Med 42: S18, 2018.
Papaioannou G: Radiology issues of influenza in children. Int J Mol Med 42: S18, 2018.
Koutsaftiki C and Papatheodoropoulou A: Participation of paediatric health professionals into the vaccination programme against seasonal influenza. Int J Mol Med 42: S18, 2018.
Korovessi P: Prevention and management of influenza in childhood: The effect of probiotics. Int J Mol Med 42: S37, 2018.
Mammas IN, Theodoridou M, Thiagarajan P, Melidou A, Papaioannou G, Korovessi P, Koutsaftiki C, Papatheodoropoulou A, Calachanis M, Dalianis T, et al: A paediatric influenza update 100 years after the Skyros island Spanish flu outbreak. Exp Ther Med 17: 4327‑4336, 2019.
Mammas IN, Theodoridou M and Spandidos DA: The 1918 Spanish flu outbreak that devastated a Greek island underlines past lessons that must never be forgotten. Acta Paediatr 107: 2034, 2018.
Mammas IN, Drysdale SB, Rath B, Theodoridou M, Papaioannou G, Papatheodoropoulou A, Koutsounaki E, Koutsaftiki C, Kozanidou E, Achtsidis V, et al: Update on current views and advances on RSV infection (Review). Int J Mol Med 46: 509‑520, 2020.
National Public Health Organization: Current state of Covid‑19 outbreak in Greece and timeline of key containment events. https://eody.gov.gr/en/current‑state‑of‑covid‑19‑outbreak‑in‑greece‑and‑timeline‑of‑key‑containment‑events/. Accessed
April 4, 2020.
National Public Health Organization: Antiviral medications and therapies of patients infected with the novel coronavirus SARS‑CoV‑2 (In Greek). https://eody.gov.gr/wp‑content/uploads/2020/03/covid‑19‑odigies‑therapeias.pdf. Accessed March 14, 2020.
Tsatsakis A, Calina D, Falzone L, Petrakis D, Mitrut R, Siokas V, Pennisi M, Lanza G, Libra M, Doukas SG, et al: SARS-CoV-2 pathophysiology and its clinical implications: An integrative overview of the pharmacotherapeutic management of COVID-19. Food Chem Toxicol 146: 111769, 2020.
Felsenstein S, Herbert JA, McNamara PS and Hedrich CM: COVID-19: Immunology and treatment options. Clin Immunol 215: 108448, 2020.