Editorial: COVID-19 — Lessons Learned in Pediatrics

Michael von Rhein^1*Julia Dratva²Michelle Seiler¹

• ¹University Children's Hospital Zurich, Zurich, Switzerland
• ²ZHAW Zurcher Hochschule fur Angewandte Wissenschaften Departement Gesundheit, Winterthur, Switzerland

Two studies focused on individual patient experiences. Kamel et al. explored long COVID in pediatric patients by describing clinical insights from a long COVID clinic. They described pediatric long COVID as marked by prolonged, multisystem symptoms and concluded, that vaccination may offer symptomatic benefit for some patients, though larger prospective studies are necessary to better define its role (4). Zahnd et al. performed an exploratory qualitative study in pediatric homecare, describing the health experience of children, adolescents and their families during the COVID-19 pandemic. They reported numerous challenges at individual, familial, and community levels, and concluded that society should prepare better for the future, especially regarding the health of children and adolescents particularly in terms of psychosocial support for families (5).Three studies investigated health care utilization and models to predict health seeking behavior. Methi at al. described the accuracy of forecasted hospital admission for respiratory tract infections in children aged 0-5 years for 2017 and 2023. They concluded that in scenarios similar to the COVID-19 pandemic, when the transmission of respiratory viruses is suppressed for an extended period, a simple regression model, assuming that non-hospitalized children would be hospitalized the following season, most accurately forecasted hospital admission numbers. These simple forecasts may be useful for capacity planning activities in hospitals (6). Puntoni et al. described pediatric healthcare service utilization after the end of COVID-19 in a 6year quasi-experimental study using interrupted time-series analysis. They found a persistent rise in hospital admissions for mental health disorders, especially among teenage girls, and concluded that data from their and future studies can inform proactive policies to mitigate disruptions and ensure access to essential pediatric services in future health crises (7). This was in line with the conclusions drawn from Seiler et al. based on their study They investigated regional dynamics in pediatric emergency visits during the pandemic in three tertiary centers throughout Switzerland. They used a novel Geographic visualization technique to illustrate how the pandemic influenced pediatric health care utilization differently across language regions, suggesting multifactorial influences. Their conclusion was that data-based, region-specific strategies are needed to cope with future healthcare crises (8).Kozak et al. introduced a different aspect of lessons learned with a pilot study on the influence of polymorphisms on cytokine profiles in pediatric COVID-19. They examined genes related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) invasion and interferon-induced immunity. Additionally, they investigated genes linked to Kawasaki disease that play roles in immunogenesis and identified significant gene-cytokine associations in pediatric COVID-19 patients, which might hold promise for developing targeted interventions for more personalized treatment approaches (9).In conclusion, the Frontiers Research Topic "COVID-19 -Lessons Learned in Pediatrics" compiled research highlighting the shift from short-term observations to more comprehensive, longitudinal perspectives. These contributions deepened our understanding of the full spectrum of pediatric COVID-19 disease and its aftermath, offering insights that can inform resilient care models not only for future pandemics but also for endemic respiratory diseases such as influenza and RSV. Early in the pandemic, children were often considered relatively spared from severe acute illness. Yet, pediatric healthcare systems faced substantial structural challenges: preventive services were disrupted, access to care varied across regions, mental health needs surged, and uncertainties about long COVID, immunological sequelae, and virus-host interactions in developing systems remained. Notably, most pandemic preparedness plans primarily targeted adults; future strategies must be tailored to the specific need of children, adolescents, and their families. The ripple effects of the pandemic extended into pediatric health services, where routine care was disrupted and recovery proved uneven. These disruptions highlight the need for healthcare structures that are not only reactive but also resilient, capable of adapting and ensuring continuity of care for all pediatric populations. The lessons learned extend beyond emergency pandemic response into daily pediatric practice and system-wide preparedness.To shape future pediatric pandemic readiness, four key lessons can be identified: 1.) embed longitudinal, mixed-methods designs from the onset to capture sustained effects, 2.) develop modular policies adaptable to diverse pediatric subgroups, 3.) ensure resilience includes recovery and catch-up of deferred care, and 4.) build robust forecasting frameworks that recalibrate dynamically under disruption.To translate these insights into practice, pediatric cohorts should be maintained during interepidemic periods, surveillance integrated across all pathogens, adaptive recovery protocols implemented, and equity in pediatric access assured through data-driven spatial and social analyses.