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2.
Hosp Pediatr ; 11(6): e83-e89, 2021 06.
Article in English | MEDLINE | ID: covidwho-1143335

ABSTRACT

OBJECTIVES: To examine visitor guidelines among children's hospitals in the United States in response to the coronavirus 2019 (COVID-19) pandemic. METHODS: A retrospective assessment of visitor guidelines in 239 children's hospitals in the United States. RESULTS: In this study, we present an analysis of 239 children's hospital visitor guidelines posted to hospitals' Web sites during 1 week in June 2020. Of the 239 hospitals, only 28 did not have posted guidelines for review. The guidelines were analyzed and grouped by how the guidelines were updated in response to COVID-19. Parental visitation was restricted to 1 parent in 116 of the posted guidelines (49%). There were no obvious similarities among guidelines associated with their geographical (eg, state or local) location. As of February 2021, 33 of 55 (60%) randomly selected hospitals had not changed their visitor policy since our initial review. CONCLUSIONS: The COVID-19 pandemic triggered changes in publicly reported visitor guidelines across the majority of children's hospitals. With our findings, we suggest wide variation in policies and practices in how guidelines were updated. More work is needed to understand how to optimize public safety and preserve family-centered care and parental authority in times of crisis.


Subject(s)
COVID-19/prevention & control , Cross Infection/prevention & control , Guidelines as Topic , Hospitals, Pediatric/statistics & numerical data , Visitors to Patients/statistics & numerical data , Child , Cross-Sectional Studies , Humans , Pandemics , Retrospective Studies , SARS-CoV-2 , United States
3.
J Pediatr Rehabil Med ; 13(3): 349-354, 2020.
Article in English | MEDLINE | ID: covidwho-971776

ABSTRACT

In the unprecedented disruption and social isolation of the COVID-19 pandemic, families around the world are faced with questions of how their children can thrive in these conditions. On top of the ubiquitous challenges for all children, this public health crisis imparts unique difficulties for children with special health needs. We identify children with Autism Spectrum Disorder (ASD) as being particularly vulnerable to negative impacts of the COVID-19 pandemic. In this paper, we examine why children with ASD are uniquely vulnerable, recommend strategies to mitigate these stressors for children with ASD and their parents, explore the potential challenges of reintegration into society as conditions improve, and examine the obligations of healthcare and community stakeholders to support these families.


Subject(s)
Adaptation, Psychological , Autism Spectrum Disorder/epidemiology , COVID-19/epidemiology , Pandemics , Child , Humans
4.
Am J Infect Control ; 49(4): 516-520, 2021 04.
Article in English | MEDLINE | ID: covidwho-800031

ABSTRACT

A significant change for patients and families during SARs-CoV-2 has been the restriction of visitors for hospitalized patients. We analyzed SARs-CoV-2 hospital visitation policies and found widespread variation in both development and content. This variation has the potential to engender inequity in access. We propose guidance for hospital visitation policies for this pandemic to protect, respect, and support patients, visitors, clinicians, and communities.


Subject(s)
COVID-19/epidemiology , Hospital Administration , Organizational Policy , SARS-CoV-2 , Visitors to Patients , Family , Humans
6.
Neurology ; 95(6): 260-265, 2020 08 11.
Article in English | MEDLINE | ID: covidwho-459171

ABSTRACT

The sudden appearance and proliferation of coronavirus disease 2019 has forced societies and governmental authorities across the world to confront the possibility of resource constraints when critical care facilities are overwhelmed by the sheer numbers of grievously ill patients. As governments and health care systems develop and update policies and guidelines regarding the allocation of resources, patients and families affected by chronic disabilities, including many neuromuscular disorders that affect children and young adults, have become alarmed at the possibility that they may be determined to have less favorable prognoses due to their underlying diagnoses and thus be assigned to lower priority groups. It is important for health care workers, policymakers, and government officials to be aware that the long-term prognoses for children and young adults with neuromuscular disorders are often more promising than previously believed due to a better understanding of the natural history of these diseases, benefits of multidisciplinary supportive care, and novel molecular therapies that can dramatically improve the disease course. Although the realities of a global pandemic have the potential to require a shift from our usual, highly individualistic standards of care to crisis standards of care, shifting priorities should nonetheless be informed by good facts. Resource allocation guidelines with the potential to affect children and young adults with neuromuscular disorders should take into account the known trajectory of acute respiratory illness in this population and rely primarily on contemporary long-term outcome data.


Subject(s)
Betacoronavirus , Clinical Decision-Making/ethics , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Neuromuscular Diseases/diagnosis , Neuromuscular Diseases/epidemiology , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , COVID-19 , Child , Clinical Decision-Making/methods , Coronavirus Infections/therapy , Health Personnel/ethics , Humans , Neuromuscular Diseases/therapy , Pandemics , Pneumonia, Viral/therapy , SARS-CoV-2
7.
Am J Bioeth ; 20(7): 37-43, 2020 07.
Article in English | MEDLINE | ID: covidwho-245575

ABSTRACT

In a crisis, societal needs take precedence over a patient's best interests. Triage guidelines, however, differ on whether limited resources should focus on maximizing lives or life-years. Choosing between these two approaches has implications for neonatology. Neonatal units have ventilators, some adaptable for adults. This raises the question of whether, in crisis conditions, guidelines for treating extremely premature babies should be altered to free-up ventilators. Some adults who need ventilators will have a survival rate higher than some extremely premature babies. But surviving babies will likely live longer, maximizing life-years. Empiric evidence demonstrates that these babies can derive significant survival benefits from ventilation when compared to adults. When "triaging" or choosing between patients, justice demands fair guidelines. Premature babies do not deserve special consideration; they deserve equal consideration. Solidarity is crucial but must consider needs specific to patient populations and avoid biases against people with disabilities and extremely premature babies.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Infant, Extremely Premature , Pneumonia, Viral/therapy , Respiration, Artificial/ethics , Triage/ethics , Aged , COVID-19 , Female , Humans , Infant, Newborn , Male , Pandemics/ethics , SARS-CoV-2
8.
Pediatrics ; 146(1)2020 07.
Article in English | MEDLINE | ID: covidwho-203500

ABSTRACT

The coronavirus disease 2019 pandemic has affected nearly every aspect of medicine and raises numerous moral dilemmas for clinicians. Foremost of these quandaries is how to delineate and implement crisis standards of care and, specifically, how to consider how health care resources should be distributed in times of shortage. We review basic principles of disaster planning and resource stewardship with ethical relevance for this and future public health crises, explore the role of illness severity scoring systems and their limitations and potential contribution to health disparities, and consider the role for exceptionally resource-intensive interventions. We also review the philosophical and practical underpinnings of crisis standards of care and describe historical approaches to scarce resource allocation to offer analysis and guidance for pediatric clinicians. Particular attention is given to the impact on children of this endeavor. Although few children have required hospitalization for symptomatic infection, children nonetheless have the potential to be profoundly affected by the strain on the health care system imposed by the pandemic and should be considered prospectively in resource allocation frameworks.


Subject(s)
Betacoronavirus , Pandemics/ethics , Pediatrics/ethics , Resource Allocation/ethics , COVID-19 , Child , Coronavirus Infections/therapy , Delivery of Health Care/ethics , Delivery of Health Care/methods , Humans , Pediatrics/methods , Pneumonia, Viral/therapy , Resource Allocation/methods , SARS-CoV-2
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