I write this on 26 August. This is an auspicious week on the paediatric calendar in Scotland since it is week 35, notorious for the onset of the cough and cold season. As sure as night follows day the wards will be suddenly busier than usual with coughs and colds from this point forwards. Hopefully, the annual rhinovirus “epidemic” that drives the well-described week 35 phenomenon will be less vigorous due to COVID-related precautions.
But winter is coming, folks, and we need to plan.
COVID-19 has given a number of additional challenges to winter planning. We hope these challenges can be removed shortly. For example, many units have lost some outpatient space to adult services, and we need to regain this space and catch up on the backlog of patients waiting to be seen. Near Me has offered an opportunity to assess many children, but a face-to-face consultation remains the gold standard (especially for new referrals). The threat of a second spike still looms and NHS Scotland’s preparedness for this (eg keeping ITU beds at the numbers available in March) means that routine activity is still not possible.
Children and children’s services are disadvantaged by this preparedness. We know from March to June this year that the burden of morbidity from COVID-19 to children and young people is very low. We also know that late presentations during lockdown lead to potentially avoidable morbidity in several children.
The RCPCH is setting up a programme of work titled “winter pressures”. There are four themes:
- Children are a priority
- Children’s services are integrated
- Children’s services are resourced
- Services are equitable
I am involved in the project, especially theme 1. The voice of clinicians in Scotland will join those from England, Wales and Northern Ireland.
Microsoft Team meetings have carried on apace for me, and the clinical leads from the 14 health boards continue. These are a useful means of communication between clinicians and also between the clinical community and RCPCH and Scottish Government. For example, we are currently looking at a pathway to help primary care colleagues manage a child with a fever or prolonged cough (both symptoms are part and parcel of being a young child in the winter, but also trigger COVID-19 anxiety). Other meetings where I represent RCPCH are the Clinical Cell group (this decides where evidence and guidelines are required, also drafts guidelines), the COVID PICU group (planning care pathways alongside colleagues in the North of England) and CLAGS (the multidisciplinary group who Government consult with on issues related to shielding).
The return to school has gone very well. The media has been quick in headlines to name schools in the context of a spike of cases, only to say in the text that the infection was among staff and likely acquired outside of school. Yesterday I spoke to the mother of a teenager with asthma on modest treatment; she had not sent her son back to school due to quite unshakable COVID-related anxieties. Shielding is currently on hold, but RCPCH continues to update its position on shielding and this resource may be useful to members who are counselling patients and their family/carers.
Another RCPCH resource which you may find useful is the regularly updated COVID evidence summary. This captures the published evidence on topics ranging from infectivity, vertical transmission, complications and treatment.
COVID-19 has impacted on our trainee members in many ways, including the need for some to shield and being redeployed to other clinical areas (both with implications for training time). The MRCPCH Clinical exams in June and October did/will not take place. The RCPCH Exams team is working hard to design a virtual clinical exam.
Sorry to have talked so much about COVID. As we look ahead there is a realisation that all the challenges facing RCPCH members before COVID are still there. Having sufficient trainees to sustain the future workforce, State of Child Health, service redesign as suggested by Facing the Future and many other important challenges which remain as we get back to “normal”... I am delighted that the Stepping Up team has arranged a (virtual) meeting for senior trainees and newly appointed consultants. Green shoots of recovery!
COVID has taught us a lot. The lessons learnt over the last six months will come in very useful in 2021 and beyond.