Perioperative Preparations for COVID-19: The Pediatric Cardiac Team Perspective [published online ahead of print, 2020 Apr 28].
What’s the aim of this editorial?
As described by the authors, this freestanding editorial aims “to review the literature and present current recommendations to inform the pediatric cardiac team preparing to take care of all children and adults during this COVID-19 pandemic”.
Does it do this?
It’s hard to see how this addition to the many volumes now developed covering this territory would help. It is difficult to write something that covers all things for all people but it speaks from a very particular position and context, Colorado, while making sweeping generalisations without noting that specific context.
So “Most healthcare institutions have rapidly set up local and regional COVID-19 command centres, with key stakeholders from local government, hospital leadership, emergency medicine, anesthesiology…” who meet “once or twice per day in online virtual meetings”. The evidence for “Most” is not clear. Apparently “not all HCWs who are ill with COVID-19 symptoms are tested”. If this is about preparing people elsewhere, maybe some mention that there are countries that absolutely test healthcare workers with symptoms would provide a sense of context and balance. Saying “Healthcare facilities cannot inform healthcare workers if any colleagues they work with have tested positive for COVID-19” without discussion of the implications for the workforce of contact tracing is puzzling.
When it comes to pointier elements such as PPE, you might assume a clear description of appropriate levels of PPE and in what context to follow guidance for which one might be included rather than narrative mentions of following WHO and CDC guidelines, using established best practices and following protocols and policies. Perioperative anaesthetic management of COVID-19 positive patients is noted to have been covered in “several excellent review articles” with references but then it just dives into some specifics of aerosolization.
The search for information looks like it was comprehensive. But ultimately the key problem here is that the way the information is presented makes it difficult to draw out any key points that would get you ready. Asked to describe the key features of a forest to a reader, what we have is an exhaustive description of individual features of many trees evident from one vantage point but no real sense of which features matter the most plus a suggestion to go and look at other descriptions of both trees and forests.
This editorial doesn’t really present the current recommendations in a way that you could actually use to efficiently get ready when faced with a challenge. Read something else.
Reviewed by Dr Andrew Weatherall