How is the coronavirus pandemic affecting your work?

We are all working under much more pressure due to the severity of the virus and the various restrictions to our work regime that have been put in place. Clinical knowledge about the nature of the virus's behaviour is still evolving, and we cannot predict how a patient's condition will develop, unlike with other diseases whose manifestations and progressions are well documented. On top of that, we’re also battling with restrictions resulting due to illnesses or mandatory quarantine of our medical staff.

We are also seeing fewer patients with other health issues, as people are inclined to stay at home due to anti-epidemic regulations. At the same time, we do get extra patients coming in because of a suspected case of covid.  

What has been the biggest change for you?

Many patients chose to stay at home despite being in need of acute treatment or needing a preventative check and we are often compelled to do consultations remotely. We use telephone and video calls, both to consult with the patient about their issue and to evaluate their overall condition or local findings.  But this way of work shouldn’t come as a surprise to us, as it is basically the direction in which the medical field is naturally developing regardless of the pandemic. Many of my general practitioner colleagues have been using the 24/7  Doctor online platform for some time now, where our adult patients can have a consultation with a doctor at any time and from anywhere.

When parents do come to the doctor's office with their children, are the concerns they have the same as before the pandemic?

The spectrum of diagnoses remains the same in both paediatrics and other medical fields. What seems to have decreased are the cases when a patient comes to see their doctor “just to be sure”. Fortunately, what has been preserved is the well-established and structured regime of preventive examinations in paediatrics. They have not been affected or limited in any way and they are in place to capture any developing pathological conditions and diseases just in time. The schedule of regular vaccinations is also preserved and care for chronically ill patients remains highly functioning both in paediatric and adult patients. Unfortunately, this can be negatively affected by quarantine measures on the part of both patients and healthcare professionals.

Are you surprised at how many people in the Czech Republic do not agree with coronavirus vaccination?

Our society is becoming increasingly more liberal, and one of the manifestations of this cultural shift is also a transformation in the extent of decision-making and responsibility that patients have. The result is an increase in the number of people who chose not to agree with standard procedures, including vaccination. Sometimes out of conviction, sometimes out of ignorance, and sometimes out of an effort to attract attention. Due to the deafening rhetoric that is being spread mostly on social media networks, a growing number of people are suddenly uncertain about what to trust. Unfortunately, the number of vaccine sceptics (dubbed anti-vaxxers) is increasing. This is where the crucial role of health professionals as educators comes into play.  The government also needs to participate - in the form of more holistic education of the population starting as early as primary school.

We have been facing extreme pressures for over a year now due to isolation, quarantine, and limitations to lead normal lives. This has led to a generalised feeling of disappointment, desperation and disinformation in society, which is being exploited by conspiracy theorists. I see anti-vaxxers as a standard part of the general population, but how much this group has grown as a result of the circumstances in which we find ourselves does really surprise me. All the more so when we all see the statistics about the sick and dead and when we know that as of yet, there is no cure for Covid-19 and the only viable option that we do have is immunisation through vaccination.

Can children get vaccinated against Covid-19?

At present, children are not being vaccinated, however looking into the future, the development and improvement of the vaccines is inevitable, which means that the broadening of their spectrum of efficacy will certainly happen. This is also the case with other vaccines, starting with the commonly administered influenza vaccine.

Have you seen any change in the approach of parents to vaccinating their children throughout your career?

Before 1989, there was absolutely no question about getting vaccinated.  There were even penalties for those who would refuse vaccination. There has been a significant shift since then, especially in the doctor to patient relationship, that historically had more of a paternalistic relation, whereas now, doctors have taken on the role of educators/partners, where they ensure the patient is as informed about their diagnosis, treatment and consequences of non-compliance with the procedures that will be recommended, and they then have the role of respecting and supporting the patients right to choose. The possibility of free choice of the patient is a positive trend in general, but unfortunately, it can also have negative consequences which come to light in cases where the choice of a parent who represents the rights of their child is medically unfavourable. In addition, refusing to be vaccinated is to the detriment of not only the child but also society’s collective immunity as a whole.

People tend to forget just how many diseases have been eradicated thanks to vaccinations today. Since the beginning of vaccination against tuberculosis in the 1950s, smallpox, as well as polio, tetanus, whooping cough, measles, rubella, mumps, jaundice A and B and others, have all been banished from our scope of worry thanks to effective vaccinations. Just think back to what our grandparents would say about how many children usually died of these diseases before the 1950s. Everyone who is against vaccinations should be forced to watch the Czech film “Jumping Over Puddles”.

Where should parents find reliable sources of information?

On the websites of professional medical societies where the patient has the guarantee that the information they read is supported on evidence-based medicine, such as Hygiene services and the Ministry of Health. The articles that are found on these websites are not articles that show up as first in the search engine, and the content can sometimes be more demanding, but always relevant and reliable. And in any case, parents can turn to their paediatrician, whom they know and trust.

Is closing the schools for a prolonged period of time the right move in the fight against Covid-19?

With the knowledge that children are the most common asymptomatic carriers of the virus, the closure of schools and kindergartens is perfectly fine from an epidemiological point of view as it plays an important role in significantly reducing the spread of the virus in the adult population. The question is whether it was necessary for the closures to have been so long.

What impact can a long absence from kindergarten or removal from team collectives have on the development of a child’s immunity?

There is no simple or straightforward answer to this question. The child’s immune system starts to develop from the day they are born. Younger children tend to be more susceptible to infections as they haven’t acquired enough antibodies and active lymphocytes to protect them. Upon contact with pathogens, antibodies are formed, which protect the individual upon repeated contact with the same infection. In case of repeated contact with infections, an immunologically healthy child will only occasionally suffer from common respiratory infections, especially when in a group – i.e. in pre-school/kindergarten. Once they get to primary school age, children tend to have pretty well-developed immune systems, meaning that illnesses and morbidities are minimal.  

A child with immunodeficiency suffers from recurrent infections, especially of the upper, less often lower respiratory tract, sometimes to the point that temporary exclusion from the preschool environment is part of the treatment. Paradoxically, these children may now be in better health thanks to the long-term closures of pre-school facilities. On the other hand, immunologically healthy children may be more prone to illnesses than prior to the pandemic once they start primary school due to insufficient exposure to common infections.

How is paediatrics advancing in the field of infant care?

Lots of advancements have been made in the care of premature and low birth weight babies. There was a time when an infant born around the 33^rd of gestation was a major problem, and postpartum adaptation and aftercare were disrupted by severe, often incurable complications. Today, it isn’t out of the ordinary that an infant can be born healthy even before the 28^th week of gestation with a weight of less than one kilogram.

For several decades, postpartum care has been part of neonatal screening – i.e. the detection of birth defects. It is a screening for congenital disorders and dysplasia of the hip joints and screening for phenylketonuria. In recent years, it has been expanded to include another spectrum of congenital metabolic defects, thyroid diseases, adrenal disorders, ocular lens cataracts, cystic fibrosis and hearing disorders.

And at Canadian Medical, we have a programme called Materna, which offers comprehensive health care for mothers-to-be and their children before, during, and in the 6 weeks following delivery.

Is there more emphasis on prevention these days?

Absolutely. Regular preventive examinations during the first year of life are essential. This is the time intended for early diagnosis of congenital and acquired diseases- a total of nine preventive examinations, which are also supported by the law.  

A considerable part of paediatrics is prevention. This area of medical care is constantly expanding, and preventive care is becoming recommended or even mandatory and it is being supported by reimbursements from health insurance companies. In recent years, there has been an increase in the examination of autism spectrum disorders at 18 months of age, as well as the assessment of hearing at the age of five. These preventive checks are also covered by the health insurance company.

What are some of the changes that you have noticed in your field within the last ten years?

Enormous progress is being made in the applicability of the results of research into practice. By this I mean the use of new examination methods and treatment options, both medication-based and invasive. Furthermore, it is possible to perform basic laboratory tests and examinations directly in the surgeries, connecting clinics, or online access to X-ray documentation. Or the technological developments- for example, our patients can book an appointment directly via the myCANADIAN phone app, where they also have an overview of what prescriptions they have and when it’s time for a  preventive examination. As a paediatrician, I am looking forward to the option of having shared family profiles, as that is something that is in the works.

But it's not just technology that matters. What I consider to be a great benefit for our smallest patients is that we have so many experts from different specialisations working all under one roof in all of our eight clinics in Prague and Brno. It means, that if I or any of my colleagues decide that our patient needs to see another specialist, it can usually be organised quickly and within the same building.

In what direction is the field of paediatrics headed?

The future I would like to see is one that maintains the high standard of our paediatrics (in comparison with Europe and the developed world in general), one that maintains and exceeds the high vaccination coverage of the paediatric population and that keeps up with modern examination and treatment methods. The future across all disciplines is, of course, telemedicine.

This article was created in collaboration with Finmag magazine.