UNICEF Innocenti: Children and COVID-19 Research Library

Age-dependent effects in the transmission and control of COVID-19 epidemics

AUTHOR(S)
Nicholas Davies; Petra Klepac; Yang Liu

Published: July 2020 Nature Medicine

The COVID-19 pandemic has shown a markedly low proportion of cases among children. Age disparities in observed cases could be explained by children having lower susceptibility to infection, lower propensity to show clinical symptoms or both. We evaluate these possibilities by fitting an age-structured mathematical model to epidemic data from China, Italy, Japan, Singapore, Canada and South Korea. We estimate that susceptibility to infection in individuals under 20 years of age is approximately half that of adults aged over 20 years, and that clinical symptoms manifest in 21% (95% credible interval: 12–31%) of infections in 10- to 19-year-olds, rising to 69% (57–82%) of infections in people aged over 70 years. Accordingly, we find that interventions aimed at children might have a relatively small impact on reducing SARS-CoV-2 transmission, particularly if the transmissibility of subclinical infections is low. Our age-specific clinical fraction and susceptibility estimates have implications for the expected global burden of COVID-19, as a result of demographic differences across settings. In countries with younger population structures—such as many low-income countries—the expected per capita incidence of clinical cases would be lower than in countries with older population structures, although it is likely that comorbidities in low-income countries will also influence disease severity. Without effective control measures, regions with relatively older populations could see disproportionally more cases of COVID-19, particularly in the later stages of an unmitigated epidemic.

Cite this research | No. of pages: 22 | Tags: children, pandemic, COVID-19 response, COVID-19, impact | Topics: Health | Countries: Canada, China, Italy, Japan, Korea, Democratic People's Republic Of, Singapore

Journal article

Routine Childhood Immunisation During the COVID-19 Pandemic in Africa: A Benefit–Risk Analysis of Health Benefits Versus Excess Risk of SARS-CoV-2 Infection

AUTHOR(S)
Kaja Abbas; Simon R Procter; Kevin Van Zanvoort; et al.

Published: July 2020 The Lancet Global Health

National immunisation programmes globally are at risk of suspension due to the severe health system constraints and physical distancing measures in place to mitigate the ongoing COVID-19 pandemic. We aimed to compare the health benefits of sustaining routine childhood immunisation in Africa with the risk of acquiring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection through visiting routine vaccination service delivery points.

Cite this research | Open access | Tags: child immunization, children, health, vaccination, pandemic, COVID-19 response, COVID-19 | Topics: Health

Research Report

Save Our Education: Protect every child’s right to learn in the COVID-19 response and recovery

AUTHOR(S)
Emma Wagner; Hollie Warner

Published: July 2020 Save the Children International

New analysis in this global report shows how COVID-19 may impact the funding of education, as well as the countries most at risk of falling behind. It also highlights the change we want to see for children and recommendations for governments and the international community so we can keep learning alive, support every child to return to school and build back for better learning.

Journal article

Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study

AUTHOR(S)
Timothy Robertson; Emily Carter; Victoria Chou; et al.

Published: July 2020 The Lancet Global Health

While the COVID-19 pandemic will increase mortality due to the virus, it is also likely to increase mortality indirectly. This study estimates the additional maternal and under-5 child deaths resulting from the potential disruption of health systems and decreased access to food. Estimates show that if routine health care is disrupted and access to food is decreased (as a result of unavoidable shocks, health system collapse, or intentional choices made in responding to the pandemic), the increase in child and maternal deaths will be substantial.

Cite this research | Open access | Tags: child mortality, maternal and child health, maternal mortality, COVID-19, low-income countries, middle-income countries | Topics: Health

Journal article

Reflection on lower rates of COVID-19 in children: Does childhood immunizations offer unexpected protection?

AUTHOR(S)
Lyu Jinglu; Tianyu Miao; Ranran Cao; et al.

Published: July 2020 Medical Hypotheses

The incidence of COVID-19 in children and teenagers is only about 2% in China. Children had mild symptoms and hardly infected other children or adults. It is worth considering that children are the most vulnerable to respiratory pathogens, but fatal SARS-like virus had not caused severe cases among them. According to the pathological studies of COVID-19 and SARS, a sharp decrease in T lymphocytes leads to the breakdown of the immune system. The cellular immune system of children differs from that of adults may be the keystone of atypical clinical manifestations or even covert infection. The frequent childhood vaccinations and repeated pathogens infections might be resulting in trained immunity of innate immune cells, immune fitness of adaptive immune cells or cross-protection of antibodies in the children. Therefore, due to lack of specific vaccine, some vaccines for tuberculosis, influenza and pneumonia may have certain application potential for the front-line health workers in the prevention and control of COVID-19. However, for high-risk susceptible populations, such as the elderly with basic diseases such as hypertension and diabetes, it is necessary to explore the remedial effect of the planned immune process on their immunity to achieve the trained immunity or immune fitness, so as to improve their own antiviral ability.

Journal article

From SARS to COVID-19: What we have learned about children infected with COVID-19

AUTHOR(S)
Meng Yao Zhou; Xiao-li Xie; Yong-gang Peng; et al.

Published: July 2020 International Journal of Infectious Diseases

Coronaviruses, both SARS-CoV and SARS-CoV-2, first appeared in China. They have certain biological, epidemiological and pathological similarities. To date, research has shown that their genes exhibit 79% of identical sequences and the receptor-binding domain structure is also very similar. There has been extensive research performed on SARS; however, the understanding of the pathophysiological impact of coronavirus disease 2019 (COVID-19) is still limited.

Commentaries and Think Pieces

COVID-19 and maternal and child food and nutrition insecurity: a complex syndemic

AUTHOR(S)
Rafael Perez-Escamilla; Kenda Cunningham; Victoria Hall Moran

Published: July 2020 Maternal & Child Nutrition

Globally, the COVID-19 pandemic has already led to major increases in unemployment and is expected to lead to unprecedented increases in poverty and food and nutrition insecurity, as well as poor health outcomes. Families where young children, youth, pregnant and lactating women live need to be protected against the ongoing protracted pandemic and the aftershocks that are very likely to follow for years to come. The future wellbeing of the vast majority of the world now depends on reconfiguring the current ineffective food, nutrition, health, and social protection systems to ensure food and nutrition security for all. Because food, nutrition, health, and socio-economic outcomes are intimately inter-linked, it is essential that we find out how to effectively address the need to reconfigure and to provide better intersecoral coordination among global and local food, health care, and social protection systems taking equity and sutainability principles into account. Implementation science research informed by complex adaptive sytems frameworks will be needed to fill in the major knowledge gaps. Not doing so will not only put the development of individuals at further risk, but also negatively impact on the development potential of entire nations and ultimately our planet.

Research brief

An investigation of mental health status of children and adolescents in China during the outbreak of COVID-19

AUTHOR(S)
Li Duan; Xiaojun Shao; Yuan Wang; et al.

Published: July 2020 Journal of Affective Disorders

This study investigates the psychological effects on children and adolescents associated with the epidemic in China. Findings indicate that the COVID-19 outbreak has had a significant psychosocial impact on children and adolescents. The presence of clinical depressive symptoms, resident in urban regions, implementation of the precaution and control measures, being female, having a family member or friend infected with coronavirus were associated with increased levels of anxiety.

Smartphone addiction, Internet addiction, family members or friends infected with coronavirus, graduation affected by the epidemic, levels of separation anxiety, physical injury fear, and tendency to adopt an emotion-focused coping style were associated with increased levels of respondents’ depressive symptoms.
Targeted intervention measures could be formulated based on the significant influencing factors on anxiety and clinical depressive symptoms.

Journal article

Zooming toward a telehealth solution for vulnerable children with obesity during coronavirus disease 2019

AUTHOR(S)
Woo Baidal; A. Jennifer; Jane Chang; et al.

Published: July 2020 Obesity

Health inequities exist throughout the life course, resulting in racial/ethnic and socioeconomic disparities in obesity and obesity- related health complications. Obesity and its comorbidities appear to be linked to coronavirus disease 2019 (COVID-19) mortality. Approaches to reduce obesity in the time of COVID-19 closures are urgently needed and should start early in life. In New York City, a telehealth pediatric weight-management collaborative spanning NewYork-Presbyterian, Columbia University Vagelos College of Physicians and Surgeons, and Weill Cornell Medicine was developed during COVID-19 with show rates from 76% to 89%. To stave off the impending exacerbation of health disparities related to obesity risk factors in the aftermath of the COVID-19 pandemic, effective interventions that can be delivered remotely are urgently needed among vulnerable children with obesity. Challenges in digital technology access, social and linguistic differences, privacy security, and reimbursement must be overcome to realize the full potential of telehealth for pediatric weight management among low-income and racial/ethnic-minority children.

Journal article

Spotlight on child abuse and neglect response in the time of COVID-19

AUTHOR(S)
Elizabeth York Thomas; Ashi Anurudran; Kathryn Robb; Thomas F. Burke

Published: July 2020 The Lancet Public Health

The article calls for adopting a public health approach toward pandemic-related increases in domestic violence ought to be heeded. Adoption of their framework for evaluating and addressing domestic violence and child abuse and neglect can create public health benefits that far outlast the current crisis. School systems and youth-serving organisations can and should play a vital role in addressing the increased abuse and neglect of children during the COVID-19 pandemic.

Research brief

The Role of Children in the Dynamics of Intra Family Coronavirus 2019 Spread in Densely Populated Areas

AUTHOR(S)
Eli Somekh; Alexandra Gleyzer; Eli Heller; et al.

Published: July 2020 The Pediatric Infectious Disease Journal

This brief examines the dynamics of coronavirus 2019 (COVID-19) transmission within families in the city of Bnei Brak, Israel, one of the most crowded cities in the world and the city with the highest rates of children per family in Israel. Analysis of family clusters in Bnei Brak shows lower rates of COVID-19 positivity in children compared with adults residing in the same household. Children 5–17 years of age were about 61% and children 0–4 years were 47% less likely to have positive PCR results compared with adults older than 18 years of age residing in the same household.

Commentaries and Think Pieces

Management of mother-newborn dyads in the COVID-19 era

AUTHOR(S)
Melissa M Medvedev

Published: July 2020 The Lancet Child & Adolescent Health

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has resulted in more than 11·6 million cases of COVID-19 and 538 000 deaths as of July 7, 2020.

The USA is the worst affected country, with more than 2·9 million cases. Evidence regarding transmission risk, clinical presentation, and consequences of SARS-CoV-2 among neonates of infected mothers is scarce. Risk of vertical transmission appears to be low, which is consistent with other coronaviruses.

Policy brief

Prioritising children's rights in the COVID-19 response

Published: July 2020 The Lancet Child & Adolescent Health

Although substantial progress has been made in many aspects of child health in the past two decades, the COVID-19 pandemic and its wide-ranging effects are threatening some of these hard-won gains. Public health measures such as lockdown, school closures, and restrictions in population movement—while necessary to halt virus transmission—are causing prolonged disruption to societal functioning and exacerbating inequalities worldwide. The global Human Development Index (HDI) is projected to decline this year for the first time since 1990, effectively erasing all progress in human development made in the past 6 years.With resources diverted to tackle the pandemic, many clinical and community health services for children have reduced in capacity. A modelling study by Timothy Roberton and colleagues in The Lancet Global Health estimated that a 9·8–18·5% reduction in coverage of essential maternal and child health services and a 10% increase in child wasting prevalence would lead to 42 240 additional child deaths per month across 118 low-income and middle-income countries.

Journal article

Mitigating the Impacts of the COVID-19 Pandemic Response on At-Risk Children

AUTHOR(S)
Charlene Wong; David Ming; Gary Maslow ; et al.

Published: July 2020 Pediatrics

This research focuses on risks and mitigation strategies for 3 at-risk subpopulations of children: (1) children with behavioral health needs, (2) children in foster care or at risk for maltreatment, and (3) children with medical complexity (CMC). Mitigation strategies delineated for these at-risk populations are also likely beneficial for any child and family. Importantly, children not already in these groups are at risk for facing new medical, behavioral, or social challenges that develop during the pandemic. In particular, children in households of low socioeconomic status are likely at the highest risk for new or worsening issues, underscoring the critical leadership role of Medicaid programs in these risk mitigation strategies.

Research Report

Beyond the Shadow Pandemic: Protecting a generation of girls from gender-based violence through COVID-19 to recovery

AUTHOR(S)
Archambeault Leslie

Published: July 2020 Save the Children International

COVID-19 is exposing and exacerbating the existing inequalities that put girls at increased risk of gender-based violence (GBV). This policy brief includes concrete recommendations for UN actors, donors, national governments, humanitarian actors, and the media to ensure that these risks are prevented, mitigated against, and responded to as an urgent priority through COVID-19 to recovery.

Cite this research | Open access | Tags: gender based violence, COVID-19 response | Topics: Child Protection | Publisher: Save the Children

Policy brief

Protecting Forcibly Displaced Women and Girls during the COVID-19 Pandemic

Published: July 2020 UNHCR Policy Brief

Forcibly displaced adolescent girls are facing increased risk of disrupted education and school drop-out as well as an extra caregiving burden during the pandemic. Refugee and internally displaced women and girls are more likely to hold precarious jobs in the informal sector and face disruptions in livelihoods and income generating activities as a result of the pandemic. The outbreak and subsequent movement restrictions have exacerbated existing risks of GBV, in particular intimate partner violence, as well as risks of sexual exploitation and abuse (SEA) while also hampering access to lifesaving services for survivors and other essential health services. Furthermore, limited access to information and decision-making spaces related to the COVID-19 response place women and girls at risk.
Despite these challenges, forcibly displaced women and girls are showing extreme resilience and are playing an important role in responding to the pandemic. This brief provides a snapshot of GBV and gender responsive interventions by UNHCR during the outbreak.

Cite this research | Open access | Tags: gender based violence, migration, protection from exploitation, violence against women, gender-responsive programmes, COVID-19 | Topics: Health, Child Protection, Migration, Social Protection, Well-being and Equity | Publisher: UNHCR - United Nations High Commissioner for Refugees

Commentaries and Think Pieces

Learning in times of lockdown: how Covid-19 is affecting education and food security in India

AUTHOR(S)
Muzna Alvi; Manavi Gupta

Published: July 2020 Food Security

This paper discusses the implications of lockdown-induced school and rural child-care center closures on education and health outcomes for the urban and rural poor. It focuses on food and nutritional security of children who depend on school feeding and supplementary nutrition programs. Authors argue that the impacts are likely to be much more severe for girls as well as for children from already disadvantaged ethnic and caste groups. They also discuss ways in which existing social security programs can be leveraged and strengthened to ameliorate these impacts.

Cite this research | Open access | Topics: Education, Nutrition, Social Protection, Well-being and Equity | Countries: India

Research Report

Gender Inequality and the COVID-19 Crisis: A Human Development Perspective

Published: July 2020 UNDP Report

Across several social, economic, and political dimensions, women and girls are disproportionately affected by the crisis simply because of their sex. The immediate effects of COVID-19 on gender inequality are already showing themselves in health and education, on the burden of unpaid care work and gender-based violence.
While the COVID-19 crisis affects everyone, women and girls face specific and often disproportionate economic, health, and social risks due to deeply entrenched inequalities, social norms, and unequal power relations. Understanding the gender-differentiated impacts of the COVID-19 crisis through sex-disaggregated data is fundamental to designing policy responses that reduce vulnerable conditions and strengthen women's agency, placing gender equality at their centre. This is not just about rectifying long-standing inequalities but also about building a more just and resilient world.

Cite this research | Open access | Tags: gender analysis, gender equality, multi-country | Topics: Education, Health, Child Poverty, Migration, Child Protection, Social Protection, Well-being and Equity, Nutrition, Water, Hygiene and Sanitation, Mental Health | Publisher: UNDP

Evidence and systematic reviews

Psychological burden of quarantine in children and adolescents: A rapid systematic review and proposed solutions

AUTHOR(S)
Nazish Imran; Irum Aamer; Muhammad Imran Sharif; et al.

Published: July 2020 Pakistan Journal of Medical Sciences

As COVID-19 grips the world, many people are quarantined or isolated resulting in adverse consequences for the mental health of youth. This rapid review takes into account the impact of quarantine on mental health of children and adolescents, and proposes measures to improve psychological outcomes of isolation. Three electronic databases including PubMed, Scopus, and ISI Web of Science were searched. Two independent reviewers performed title and abstract screening followed by full-text screening. This review article included 10 studies. The seven studies before onset of COVID 19 about psychological impact of quarantine in children have reported isolation, social exclusion stigma and fear among the children. The most common diagnoses were acute stress disorder, adjustment disorder, grief, and post-traumatic stress disorder. Three studies during the COVID-19 pandemic reported restlessness, irritability, anxiety, clinginess and inattention with increased screen time in children during quarantine. These adverse consequences can be tackled through carefully formulated multilevel interventions.

Research Report

Because We Matter: Addressing COVID-19 and violence against girls in Asia-Pacific

Published: July 2020

Asia is home to more than half of the world’s 1.1 billion girls. Gender inequality in many parts of the region means that girls are often systematically disadvantaged and oppressed by poverty, violence, exclusion, and discrimination. Emerging data shows that since the outbreak of COVID-19, violence against girls and women, particularly domestic violence, has intensified. Partly due to containment measures during COVID19, systems and services that are mandated to prevent, identify, and respond to violence against children are operating with limited or no capacity. Inadequate levels of government and donor investments in child protection, as well as gaps in the functionality of systems and effective enforcement of laws and policies have been pervasive. These existing challenges have been further exacerbated by the pandemic and are now affecting all children, while disproportionately impacting girls.

Cite this research | Open access | Tags: gender based violence, gender equality | Topics: Education, Child Protection, Social Protection, Well-being and Equity | Publisher: Save the Children, Plan International

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