Five leisure and training activities to help onco-hematological children to better live hospital isolation during COVID-19.

To the Editor,

On March 11, 2020, the World Health Organization (WHO) declared the coronavirus disease 2019 (COVID‐19) pandemic. One of the recommendations of the WHO for disease control is quarantine. However, many studies have focused on understanding which restrictive measures are most effective in preventing the spread of the virus and to what extent, , , while very few studies have focused on the interventions to be implemented in this situation. , If onco‐hematological patients live in isolation even in the absence of COVID‐19, the more restrictive measures during this period can cause more discomfort (e.g., regarding the entry of visitors and volunteers in the departments). , Another difficulty in this period is that of being able to assure special help and assistance to the hospitalized child, from the physical, intellectual, moral, and social points of view. Many pediatric facilities undertake to respect the rights set out in the “Charter of children's rights in hospital” and to guarantee them to all minors who benefit from the provided health services without any distinction of race, color, sex, religion, political opinion, and financial situation. However, when the isolation measures become more restrictive, as in this period of health emergency, it is necessary to know how to implement new strategies to deal with them. In this regard, in March 2020, in an Italian tertiary hospital, we carried out several initiatives in the pediatric onco‐hematology population to deal with this type of problem.

1. Remote school in hospital

Didactic activities are proposed through an online platform for online teaching. The main purpose is to be able to continue to guarantee to children in hospital the right to culture, and to break down the barriers linked to a moment of historical health emergency that has affected everyone suddenly.

2. Virtual room for adolescents

The rooms of the ordinary hospitalization, the isolation rooms of the transplant center, or the distant rooms of the day hospital have never been so close, as the virtual room allows greater interactions among the teenagers who occupy them. This was possible thanks to “Play4you.” Teenagers admitted to the wards or day hospital can connect to meet, play in a group or individually, and meet people who live the same “patient life,” generating considerable moral support. In the virtual room, there are always one or more operators to encourage and monitor the exchange among the teens.

3 Remote cinema in hospital

Another completely original initiative has been the “Cinema that Cures.” Free secure streaming of first‐run films is granted on personal computers or smartphones via a specially created online platform, with the opportunity to change the movie once per week. In addition, there is the opportunity to organize sessions with some remote film laboratories to talk about movies.

4 Remote clown therapy

The goal is to guarantee, at a distance, the smile therapy service to children who need it. Indeed, parents can book online on a platform specifically created to receive a video call from the doctor's smile, professional clown therapists.

5 Remote martial arts therapy

Martial arts therapy is also available remotely. Virtual lessons of martial arts therapy have been offered for children on online platform that could also be extended to parents and siblings.

After the implementation of these recreational strategies, a small anonymous survey was conducted to evaluate the satisfaction of patients and parents on the undertaken activities. All patients and parents received the satisfaction questionnaire during discharge. The remote school platform has reached 75% of the children, while the cinema platform has reached 60% of the children with 20 different new films made available to users. The project was rated very good/excellent by 90% of patients and 70% reported that it has allowed them to relax for a few hours. The Play4you virtual room was one of the first to start and has had great success as documented in our prior publication. A few more difficulties were observed with Clown Therapy and Martial Arts Therapy at distance. Considering that the appointments had to be booked in advance, the greatest difficulty was to keep the appointments based on the child's state of health in 30% of cases, or to navigate requesting an appointment in 20% of respondents. In general, all the measures were reported as being able to distract (90%), relax (85%), reduce moments of boredom (77%), and improve the quality of hospitalization (70%).

Graphic summary of the interventions: 1: remote school in hospital, 2: virtual room for adolescents, 3: remote cinema in hospital, 4: remote clown therapy, 5: remote martial arts therapy. We have permission and informed consent to present images of all recognizable individuals

In conclusion, through these five education and play initiatives we tried to support the continuity of normalcy, respond to the right to education and game, and contribute to the maintenance and recovery of psycho‐physical balance, since normal daily life has been interrupted by disease and the more restrictive isolation due to the COVID‐19.

CONFLICT OF INTEREST

The authors declare that there is no conflict of interest.