Impact of COVID-19 pandemic on pediatric cardiac services in India.

Sir,

I read with interest the original article by Choubey et al. titled, “Impact of COVID-19 pandemic on pediatric cardiac services in India”[1] and would like to compliment the authors for the enormous efforts they have put in to conduct this unique multicentric study during prevailing trying circumstances, in order to address one of the most pertinent issues in the current era of severe acute respiratory syndrome coronavirus 2/COVID-19 pandemic. This incredible venture will surely pave a path for future preparation for such eventualities. Undoubtedly, the pandemic has paralyzed the health infrastructure all across the globe, specifically affecting the pediatric health care in a developing country like ours. I would like to put forth following comments pertaining to the article:

It is highly imperative to formulate national guidelines and policy statement based on such studies for children with congenital heart disease, in order to more effectively tackle such a precarious situation not only during subsequent “waves” of the pandemic but also during similar calamitous event in future. Since globally the second “wave” of COVID-19 pandemic has hit harder with larger adverse impact, the data covering this period may also have been included in the study. The study period ended when pandemic was far from being over and many places in the country were yet to reach the peak of it

The delay in the management of congenital heart defect in children during the COVID-19 pandemic, due to multiple constraints, must have led to high morbidity including development of various complications, as well as to mortality. A few children are also likely to reach a stage of inoperability due to this inadvertent delay. The data or registry pertaining to such cases is also desirable

Since mainly pediatric cardiac care centers located in tier-1 metropolitan cities were included in the study, the data may be underrepresentative of general population in its true sense. The lack of data on limitations existing in remote/semiremote areas is likely to produce a skewed or biased interpretation of results of the study. Many sick children from these areas may have just perished as “innocent voiceless bystanders.”[2] Research confirms health disparities (including pre-existing social vulnerability, community resilience, health vulnerability, and response disparity) between urban and rural areas not only in terms of risk factors and life expectancy but also in testing and health-care capacity. Such disparities are a major source of concern during preparation for and response to widespread disasters[3]

In the recent times, the multidimensional concept of telehealth (telemedicine, tele/video consultation) and virtual care has grown by leaps and bounds, undergoing rapid and massive transformation spurred by the COVID-19 pandemic, and has been strongly advocated as the need of the hour. The Supporting Pediatric Research in Outcomes and Utilization of Telehealth (SPROUT) network of the American Academy of Pediatrics, and SPROUT Telehealth Evaluation and Measurement framework of the World Health Organization may be utilized as a guide to develop our own similar telehealth system. The key aspects which need to be addressed include appropriate training of personnel, improvisation of processes, and tools needed for its successful implementation and sustainability, examination of health equity implications, and building up of virtual communication capacity and other resources.[4] Teleconsultation services have streamlined the follow-up care to some extent and have helped in noncontact triaging of these patients for further care.[5]

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Conflicts of interest

There are no conflicts of interest.