key: cord-1025946-z9qihvhy authors: Kazachkov, Mikhail; Noah, Terry L.; Murphy, Thomas M. title: The roles of a pediatric pulmonologist during the COVID‐19 pandemic date: 2020-08-17 journal: Pediatr Pulmonol DOI: 10.1002/ppul.25010 sha: b32cee710bb20586087b6ea28751117430f97bf5 doc_id: 1025946 cord_uid: z9qihvhy Pediatric pulmonologists have been involved in the care of adult COVID‐19 patients in a variety of ways, particularly in areas with a high concentration of cases. This invited commentary is a series of questions to Dr Mikhail Kazachkov, a pediatric pulmonologist at New York University, about his experiences to date in a major COVID‐19 “hotspot” and his thoughts about how other pediatric pulmonologists facing this situation can best support their colleagues. The COVID-19 pandemic has resulted in high morbidity and mortality among older adults, particularly those with underlying medical conditions including hypertension, diabetes, obesity, and COPD. 1,2 Data relevant to optimizing or improving care for these patients have emerged rapidly, and the shared anecdotal experience of care teams in highprevalence areas has been extremely helpful for other centers preparing for possible surges in cases. Fortunately, to date, the incidence of severe COVID-19 disease among children has remained relatively low. improve infectious control, all hospital employees underwent mandatory COVID-19 PCR testing, and antibody testing. We did our best to separate COVID Team members from the personnel working at "non-COVID" units of the hospital, but it proved to be a very difficult thing to do because more and more medical personnel were called to join the "COVID Army." At the peak of the pandemic crisis, many of us worked on the COVID-19 wards but continued taking care of children in our direct pediatric subspecialty practices. When the pandemic started, many nonpulmonary physicians joined the "COVID Army." We were all required to go through an orientation process where we were instructed on the logistics and organization of COVID care at NYU (which with time became very well structured). All personnel were divided into highly specialized teams, some of them quite unique and devised specifically for COVID. Some examples of those teams were: a. Medicine and ICU teams, which worked in MICU and COVID step-down wards. They consisted of one to two senior (pulmonary/ICU) and two to three junior physicians. The latter were comprised of various specialists including orthopedic surgeons, cardiologists, pediatricians, and many others. b. Bronchoscopy teams which consisted mostly of thoracic surgeons. Their role was to provide emergency bronchoscopy service to prevent "loss" of endotracheal tubes due to plugging and to help with management of atelectasis related to formation of large mucus plugs. f. Communication teams composed mostly of medical students. Although they were not allowed to directly care for patients, they provided vital communication to family members. It is very important to mention that each team also employed nurses, nurse practitioners, physician assistants, respiratory therapists, medical assistants, and many other supporting staff, which were absolutely instrumental in keeping the teams functioning. I personally would like to acknowledge the outstanding role of our pediatric, medical, and surgical residents and fellows, who functioned in various capacities on all teams and became major contributors to the process. After the teams were established, all non-ICU physicians received a full day of training in a simulation lab. It was rather intense and included hands-on training in resuscitation and management of common acute conditions with special attention to acute respiratory distress syndrome. Our main training experience, however, started in the wards and ICUs where we began our practical learning of COVID-19. At this stage, the situation has evolved quite a bit. Our medical community has been studying COVID-19 practically and academically for several months now, and has accumulated a vast amount of data which is summarized in guidelines, pathways, and algorithms. 3, 4 I think that every health care system has the responsibility to prepare appropriate educational materials and pathways, which can be used in case we have to deal with COVID-19 surges again. It seems logical to imagine that our leading medical organizations and societies would contribute to their development. hope, and love were cherished, and certain "material" things seemed to become bleaker. The COVID-19 pandemic has left us with scars in our souls, but also, in a way, made us better physicians and better human beings, I hope. Predictive symptoms and comorbidities for severe COVID-19 and intensive care unit admission: a systematic review and meta-analysis Obesity in patients younger than 60 years is a risk factor for Covid-19 hospital admission Hospital preparedness for COVID-19: a practical guide from a critical care perspective Surviving sepsis campaign: guidelines on the management of critically Ill adults with coronavirus disease 2019 (COVID-19) The authors declare that there are no conflict of interests.