Lung ultrasound in COVID-19

Editor – We thank Smallwood et al for their timely article about lung ultrasound (US) in COVID-19.¹ We completely agree that US can rule-in COVID-19 and that there is no published data on lung US and screening for COVID-19. We would gladly participate in the pragmatic research trial proposed, and would be happy to help in the set up. We have recently received numerous new US machines, as have many NHS trusts, have participated in a COVID-19 ultrasound database and published our ongoing experience.^2,3 However, the main sticking point to all of this is the number of practitioners who can and/or are ‘signed off‘ to perform a standardised lung US with adequate reporting tools (which hopefully will follow on from the database). I am a respiratory consultant by trade, and very experienced at pleural ultrasound. A few years ago, I had attended a focused acute medicine ultrasound (FAMUS) course with the view to get formally accredited. However, lack of trainers in the north east of England and engagement from radiology colleagues to mentor me locally mean that my colleagues and I are completely self-taught in lung US and know that we are competent and confident. I do not have a set programmed activity for teaching US or any of the governance aspects around it, although we are currently writing up a business case.³ I am sure that I am not alone in the UK. Furthermore, longitudinal competence programmes for basic point-of-care US do not exist.⁴ So, should this pandemic be a time for widespread upskilling of emergency care, acute medicine and respiratory practitioners and not just doctors? Perhaps, but then the governance behind this is mind-boggling, and perhaps hampered by years of underfunding and under-recognition. The recent incorporation of US training into the acute medicine curriculum is welcome but not timely enough.⁵ I am afraid there is no easy answer to any of this, and would welcome any further comments from lung US practitioners.