[Comment] COVID‑19 threat and frontline paediatric care professionals

&lsquo;How prepared are paediatric health professionals for a future pandemic?&rsquo; The answer by Professor Alan Michael Weindling, Professor of Perinatal Medicine at the University of Liverpool&nbsp;(UK), to this question by the Paediatric Virology Study Group&nbsp;(PVSG), almost two years ago, in the context of the &lsquo;4th&nbsp;workshop on Paediatric Virology&rsquo; revealed a difficult reality: &lsquo;Those who work in developing countries may be, but most paediatric health professionals probably are not. Consider how long it took clinicians to appreciate the nature of the AIDS and therefore its best treatment and management&rsquo;&nbsp;(1). Professor Weindling also supported the commitment to &lsquo;lifelong learning&rsquo;, as well as the necessity of increased preparedness of the paediatric care professionals based on the ongoing, at that time, health crises of Ebola and Zika viruses&nbsp;(1,2).<br />Since 2007, the PVSG has focused on continuing medical education of the frontline paediatric professionals&nbsp;(3). The necessity for their increased preparedness against common viral infections, as well as emerging epidemic viral threats has been analysed in detail&nbsp;(4‑8), while in&nbsp;2018, the &lsquo;4th&nbsp;workshop on Paediatric Virology&rsquo; was dedicated to the 100&nbsp;years of the 1918&nbsp;Spanish flu pandemic on the Greek Aegean Sea island of Skyros, which devastated its population in less than 30&nbsp;days&nbsp;(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&nbsp;I).<br />To date, in Greece, a country, which until March&nbsp;30th, 2020 had 1,212&nbsp;cases and 46&nbsp;reported deaths with confirmed SARS‑CoV‑2 infection&nbsp;(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&nbsp;well&nbsp;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&nbsp;(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 &lsquo;Aghia Sophia&rsquo; Children's Hospital in Athens, the Paediatric Infectious Diseases Unit &lsquo;MAKKA&rsquo;, which ceased to treat children with infectious diseases on August&nbsp;2014, was scheduled to re‑open, with a capacity of 20 beds&nbsp;‑&nbsp;including 2&nbsp;beds under negative pressure&nbsp;‑&nbsp;and admit paediatric cases with COVID‑19.<br />The fact that these &lsquo;last‑minute&rsquo; changes are in the correct direction is really encouraging. The future will show&nbsp;‑&nbsp;for one more time&nbsp;‑&nbsp;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&nbsp;(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&nbsp;2010.<br />Acknowledgements<br />This article is published in the context of the foundation of the Institute of Paediatric Virology (IPV; https://<br />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.<br />Funding<br />No funding was received.<br />Availability of data and materials<br />Not applicable.<br />Authors' contributions<br />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.<br />Ethics approval and consent to participate<br />Not applicable.<br />Patient consent for publication<br />Not applicable.<br />Competing interests<br />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.<br />References<br />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.<br />Mammas IN, Spandidos DA and Weindling AM: The future of paediatric education. Exp Ther Med 16: 2803‑2804, 2018.<br />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.<br />Christaki I, Beattie T and Midgley P: The challenge of modern biowarfare: ED preparedness for paediatric victims of the Ebola virus. 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