To the Editor: Since 2020, we in the medical community have found ourselves at the forefront of a seismic shift in global healthcare due to the Sars-CoV-2 pandemic. From the many studies carried out during the various waves, a particular fragility among patients with immunosuppressive diseases has been found.1 Nevertheless, a low susceptibility to the virus was noted in pediatric onco-hematology patients due to the scarce symptoms that were found.2,3 Although this patient population did not encounter major problems related to COVID-19,4 there was a need to create a ward dedicated to these patients who were affected by COVID-195 to ensure that their curative path would continue within our center during the second wave. The ward consisted of six beds and a team of two nurses, one doctor and one health care assistant, which remained open for a total of 2months andmade it possible to continue to guarantee their care.5 According to an interview carried out with the healthcare personnel involved, both weaknesses and strengths were found in reference to the assistance provided during this period. In December 2021, during the third wave when the positive COVID-19 cases began to increase day by day, the need to

Virtual reality (VR) represents a promising digital intervention for managing distress and anxiety in children with tumors undergoing painful medical procedures. In an experimental cross-over study, we administered a VR intervention consisting of relaxing games during central venous catheter (CVC) dressing. The VR sessions were compared with no-VR during CVC medication. We used the distress thermometer and RCMAS-2 scale to assess distress and anxiety levels. We also explored the satisfaction level in patients and families. We enrolled 22 children. The distress levels after medication were lower in the VR group than in those without VR (VR: median 2; IQR 0–2; no-VR: median 4; IQR: 3–5). No variation in anxiety levels was detected by VR intervention. Satisfaction for using VR was very high in children and their families although a total of 12% of children were disappointed by the effect of VR. Most healthcare workers felt that VR would be useful in routine clinical practice. A VR intervention is highly acceptable, may be efficacious in decreasing distress in children with cancer undergoing painful procedures, but it is less likely that it has a measurable impact on anxiety. Evidence from larger studies is needed to assess VR translation into the clinical workflow.

1 Department of Onco-Hematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy 2 University of Rome “Tor Vergata,” Bambino Gesù Children Hospital, IRCCS, Rome, Italy 3 Department of Paediatric Emergency, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy 4 Professional Development, Continuing Education andNursing Research Service, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy