Year End 2020

How do you remember the major milestones of your life? Do you divide them into significant life events, such as the start of secondary school, or use specific decades related to your age? Perhaps you may base it on geography – where your ‘home’ was at any given time?

There is a significant chance that the COVID-19 pandemic will create a new reference point, that of everything pre- and post-pandemic.

It isn’t easy to go back to January 2020 and imagine what you thought 2020 might be like. So much has happened in the last 12 months that expectations have perhaps been irrevocably altered, leaving the retrospectoscope even more biased than it always has been.

I can objectively demonstrate that at the beginning of the year, I had some funded research I would like to publish; I was looking forward to several international conferences and was already wondering how winter 2020 would pan out (feeling that we’d got lucky in 2019 which hadn’t been quite as bad as 2018). I can’t remember what I expected concerning new interventions and developments in paediatric emergency medicine. Still, even with hindsight bias, it’s reasonable to assume that I suspected many things were likely to remain in the status quo.

At the beginning of 2020, there was no reliable biomarker for identifying serious bacterial illness in sepsis (and still isn’t). By the end of 2020, asthma and wheeze management will remain unchanged (although we know magnesium sulphate nebulisers probably don’t add much). A systemic review of asthma management essentially said (with all respect to the authors just interpreting available evidence), “more research is needed”. No major practice-changing studies have been done in managing gastroenteritis, seizures or bronchiolitis. In fact, in many countries, the less-is-more approach to bronchiolitis was easy to implement as the public health response to # COVID-19 appeared to remove it completely as a disease entity.

What about personal plans? Did you think about what you wanted to achieve at the beginning of this year?

Do you ever?

And if not, why not? Should we not have a semblance of some goals, however small and sparse in detail? Or do you argue that a random calendar month, which happens to be the one Julius Caesar determined a new year should start, is a poor method to do this?

Pushing philosophical questions aside, it’s likely that COVID-19 has revised or ripped up many strategies of individuals, departments, and organisations. The consequences aren’t clear, and it may never be possible to determine the overall positive or negative impact. There is a delicate balance between what has been gained that wouldn’t have normally occurred versus those critical investments and interventions which haven’t.

As the DFTB review has clearly highlighted, the pathophysiological consequence of COVID-19 on children is limited, but the wider impact is potentially extreme. Adapting to many enforced changes is vital regardless of how the outcomes swing. The cancellation of DFTB20 was a great sadness. Still, at the close of DFTB: Live + Connected, it was clear it could generate an atmosphere of collaboration and solidarity even when participants are distanced by thousands of miles. Future DFTB conferences, whether digital OR in-person, will utilise this learning for the benefit of either medium. 

Without wishing to overlook the immense emotional trauma and financial hardship #COVID-19 has had on society, we must all use 2020 to examine its impact on us as individuals. This will be through both our personal and professional lives. For the former, lockdown may have brought your immediate family and friends together or pushed them apart. In the latter, the utter transformation of adult and children healthcare services will have altered your role in your department. This may have placed you in positions of leadership or responsibility that you have thrived in or perhaps opened your eyes to a stale status quo, which had been implicitly tolerating without really enjoying. Every year brings the chance to reflect and grow but this year has given everyone a different lens to view their lives.

#COVID19 will have changed the world around you, but I’d argue you may have changed more. 2020 may well be the milestone with which many new life journeys begin.