key: cord-1002026-y3pydjg6
authors: Jiang, Yuwu; Liu, Zhisheng
title: Caring for children with neurological disorders in China during the COVID‐19 pandemic
date: 2020-07-01
journal: Dev Med Child Neurol
DOI: 10.1111/dmcn.14605
sha: c2b00d563761d7147b7d66e67c93555c9a64440b
doc_id: 1002026
cord_uid: y3pydjg6

nan

Editor-The COVID-19 pandemic substantially increased the demand for medical resources in China as large numbers of patients with the virus were admitted to hospitals. To prevent transmission, doctors in COVID-19 screening clinics no longer performed routine outpatient or inpatient work. This resulted in a shortage of medical personnel, even in areas at a relatively low risk. Therefore, hospitals had to drastically reduce non-essential, routine outpatient consultations and non-urgent admissions.

Under such circumstances, it became difficult for patients with chronic conditions but without COVID-19, including children with neurological disorders, to access medical and psychosocial resources. For example, one study found that 10.4% of otherwise healthy children and adolescents showed symptoms of depression after protracted isolation at home during the pandemic. 1 Another study documented significantly higher psychological distress in patients with epilepsy than in population norm controls during the outbreak. 2 Maintaining the daily operation of children's neurology clinics and inpatient wards became a priority. At Peking University First Hospital, a general tertiary hospital in Beijing, we divided our paediatrics clinics into three independent units run by separate medical teams: the screening zone for suspected cases of COVID-19, the non-COVID-19 febrile diseases zone, and the non-febrile diseases zone. A triage nurse assigned each child to one of these zones based on their medical and epidemiological history and temperature. Patients assigned to the screening zone were required to stay there for treatment until the RNA test result came back. If the test was negative, they could go home to continue treatment, if positive, they were transferred to a designated hospital. If emergency admission was needed but COVID-19 could not be ruled out, the patient was transferred to the isolation room of the inpatient ward, and SARS-CoV-2 RNA was tested immediately after admission. Following these control measures and thanks to the hard work of hospital staff, no COVID-19 infection occurred in children with neurological disorders at Peking University First Hospital and Wuhan Children's Hospital. Moreover, because this COVID-19 protection system and guidelines were disseminated throughout the national health care system, to our knowledge, no COVID-19 infections have been reported in hospitalized children with neurological disorders elsewhere in China.

During this pandemic, traditional hospitals and internet hospitals established a new medical service framework, based mainly on mobile internet, 3 that included the patients and their families (promoting self-management with a specially designed smartphone app), community or local support (through local or community hospitals and pharmacy, combined with online consulting at internet hospitals and traditional hospital's websites), and tertiary hospitals (for complex cases, clinics, and inpatient services). Fortunately, the 4G network covered almost all areas of China, even many remote and poor regions, before this epidemic and the 5G network was also available in major cities. These networks were very important in the implementation of telemedicine.

Many services, charities, and volunteers helped patients find the medical services they needed and built up support chains for home delivery of medication. These tasks carried a high risk of COVID-19 infection and their success was due to compassion, perseverance, professional ability, and great teamwork.

It is encouraging that the pandemic is being more effectively controlled in some regions of the world, but full control will depend mainly on an effective vaccine. Chinese philosophy believes that 'there is opportunity in every crisis' and crisis can be a driver for change. Fighting this pandemic highlighted the role of technologies, such as mobile internet-supported telemedicine patient management networks and rapid, accurate distribution of medical supply. This makes us more deeply aware of the possible changes in medical systems in the future. The process of reshaping our public health system and patient care management system by new technologies will undoubtedly accelerate after this pandemic.

Investigation on the status of influencing factors for depression symptom of children and adolescents with home quarantine during the prevalence of novel coronavirus pneumonia

Severe psychological distress among epilepsy patients during the COVID-19 outbreak in southwest China

Epilepsy control during an epidemic: emerging approaches and a new management framework