Children and COVID-19 Research Library

As of 23 April 2020, there have been 104 confirmed paediatric cases of coronavirus disease 2019 (COVID-19) in Hong Kong. Fortunately, all cases were mild or asymptomatic with no fatalities. The proportion of patients with COVID-19 who are aged <19 years is 14.1% in Hong Kong, which is higher than other countries . This may be attributable to high numbers of overseas students returning to Hong Kong; even those who are asymptomatic are tested as part of the current border controls. Mortality for patients aged <19 years is very low, with less than 10 reported cases, mostly teenagers.

Evidence is mounting that healthy blood vessels protect children from serious effects of COVID-19, such as stroke.

Virtual consultations minimise the risk of COVID‐19 transmission, promote public protection and reduce the backlog of waiting lists during this time of testing. Although clinical confidence and appropriateness of use may vary in various aspects of clinical care, the author's experience in paediatric allergy is satisfactory.

Threatened by COVID-19, the world has been on lockdown. But within the walls of their own homes many women face an enemy more terrifying than COVID-19. The domestic abuse charity Refuge reported a 700% increase in calls in a single day.

Like most other Asian countries, India has also seen a gradual increase in the incidence and prevalence of myopia. Increased screen‑time, prolonged near work, reduced outdoor activities are some of the important risk factors for myopia according to various studies. Countries like China, where schools have replaced books with tablets and computers, evidently have a higher incidence of myopia.

This review characterizes clinical symptoms, laboratory, and imaging findings, as well as therapies provided to 7780 confirmed pediatric cases of COVID-19. Evidence shows that that children diagnosed with COVID-19 have an overall good prognosis. Future longitudinal studies are needed to confirm our findings and better understand which patients are at increased risk for developing severe inflammation and multiorgan failure.

The COVID-19 pandemic has resulted in governments implementing disease containment measures such as school closures, social distancing and home quarantine. Children and adolescents are experiencing a prolonged state of physical isolation from their peers, teachers, extended family and community networks. Quarantine in adults generally has negative psychological effects including confusion, anger, and post-traumatic distress. Duration of quarantine, infection fears, boredom, frustration, lack of necessary supplies, lack of information, financial loss, and stigma appear to increase the risk of negative psychological outcomes. Social distancing and school closures may, therefore, increase mental health problems in children and adolescents, already at higher risk of developing mental health problems compared to adults  at a time when they are also experiencing anxiety over a health threat and threats to family employment/income.

As the coronavirus pandemic extends to low and middle income countries (LMICs), there are growing concerns about the risk of coronavirus disease (COVID-19) in populations with high prevalence of comorbidities, the impact on health and economies more broadly and the capacity of existing health systems to manage the additional burden of COVID-19. The direct effects of COVID are less of a concern in children, who seem to be largely asymptomatic or to develop mild illness as occurs in high income countries; however children in LMICs constitute a high proportion of the population and may have a high prevalence of risk factors for severe lower respiratory infection such as HIV or malnutrition. Further diversion of resources from child health to address the pandemic among adults may further impact on care for children. Poor living conditions in LMICs including lack of sanitation, running water and overcrowding may facilitate transmission of SARS-CoV-2. The indirect effects of the pandemic on child health are of considerable concern, including increasing poverty levels, disrupted schooling, lack of access to school feeding schemes, reduced access to health facilities and interruptions in vaccination and other child health programs. Further challenges in LMICs include the inability to implement effective public health measures such as social distancing, hand hygiene, timely identification of infected people with self-isolation and universal use of masks. Lack of adequate personal protective equipment, especially N95 masks is a key concern for health care worker protection. While continued schooling is crucial for children in LMICs, provision of safe environments is especially challenging in overcrowded resource constrained schools. The current crisis is a harsh reminder of the global inequity in health in LMICs. The pandemic highlights key challenges to the provision of health in LMICs, but also provides opportunities to strengthen child health broadly in such settings.

This article examines the socioeconomic challenges that the COVID-19 pandemic poses for children on the move across four dimensions: poverty, survival and health, learning and protection and safety.  It also considers how new laws and regulations enacted in response to the pandemic are impacting these children. It then suggests the necessary policies and actions to protect this intensely vulnerable population. 
Many displaced children will see their family’s income shrink or disappear and, globally, poverty levels are expected to worsen. Vulnerable populations are predicted to disproportionately bear the brunt of this economic contraction. Poor health systems and disrupted health services – a reality for many migrant and displaced children – are likely to further weaken, placing children at risk of intensified hardship, both physical and psychological. The crowded conditions and poor access to proper water and sanitation common among families living in displacement pose obvious risks at a time when social distancing and hygiene are so critical.  
Migrant and displaced learners regularly encounter obstacles in accessing education, and the online materials and remote classrooms functioning around the world today may be far from their reach. They are at risk of falling further behind in school. And given that economic downturns typically lead to more children working, getting pregnant or married, and being trafficked or sexually exploited, migrant and displaced children – who already face great risks to their safety — stand to see their situation worsen. Domestic violence is on the rise globally, and accounts of stigma and discrimination against the displaced are also increasing. The increasing global death toll means some migrant and displaced children will be orphaned and become vulnerable to child protection abuses.  

Recent years have seen significant progress in the fight against child labour. The current COVID-19 pandemic, however, can potentially reverse the positive trends observed in several countries and further aggravate the problem in regions where child labour has been more resistant to policy and programme measures.
The level of global economic integration and the current crisis are likely to have a large and possibly lasting worldwide adverse socio-economic and financial impact. The pandemic is increasing economic insecurity causing disruptions in supply chains, falling commodity prices, in particular oil, and halting the manufacturing industry. The financial markets have been particularly affected, tightening liquidity conditions in many countries and creating unprecedented outflows of capital in many economies.
The paper discusses the main channels through which the current pandemic can influence child labour, including fall in living standards; deteriorating employment opportunities; rise in informality; reduction in remittances and migration; contraction of trade and foreign direct investment; temporary school closures; health shocks; pressure on public budgets and international aid flows.

Timely, disaggregated, and quality data on the situation of children can help identify where the most vulnerable live so that interventions to counteract the potential adverse effects of COVID-19 can be implemented to reach those most in need. UNICEF’s call to protect children, especially the most marginalized, is essential now more than ever and our global databases can inform that response by painting a picture of children around the world. In the face of this unprecedented crisis, where are children especially vulnerable to physical punishment? Are sufficient hygiene facilities available in schools? And is healthcare accessible for children with acute respiratory symptoms? How will the most vulnerable children, such as those living on the street or in refugee camps fare? Data like these can provide guidance for UNICEF and country programmes so that our efforts to mitigate and overcome the effects of the pandemic can be measured.

Since December 2019, health systems around the globe have struggled with an increasing number of cases of a viral respiratory syndrome that emerged in China. The cause is a new strain in the coronavirus family, provisionally named 2019 novel coronavirus (2019-nCoV)1, SARS-CoV-2 or COVID-19. The European Paediatric Association–Union of National European Paediatric Societies and Associations (EPA-UNEPSA) has established a collaborative working group with key Chinese academic institutions and medical centers with the purpose of facilitating the reciprocal exchange of information and sharing scientific knowledge. The aim of this commentary by the China-EPA-UNEPSA working group is to raise awareness regarding children's psychological needs during epidemics and report early data collected in the COVID-19–affected areas in China during the current outbreak, emphasizing the role of families and caregivers in the timely recognition and management of negative emotions.

To date, few data on paediatric COVID-19 have been published, and most reports originate from China. This study aimed to capture key data on children and adolescents with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across Europe to inform physicians and health-care service planning during the ongoing pandemic.

 

This rapid review collates and synthesizes evidence on the child protection impacts of COVID-19 and previous pandemics, epidemics and infectious disease outbreaks. It provides lessons for global and national responses to COVID19 and recommendations for future research priorities.

The evidence on the impacts of pandemics and epidemics on child protection outcomes is limited and skewed towards studies on the effects of HIV/AIDS on stigma. There is also some evidence on the effects of Ebola on outcomes such as orphanhood, sexual violence and exploitation, and  school enrolment, attendance and dropout. The evidence on other pandemics or epidemics, including COVID-19, is extremely limited.

There are various pathways through which infectious disease outbreaks can exacerbate vulnerabilities, generate new risks and result in negative outcomes for children. Outcomes are typically multi-layered, with immediate outcomes for children, families and communities - such as being orphaned, stigmatization and discrimination and reductions in household income - leading to further negative risks and outcomes for children in the intermediate term. These risks include child labour and domestic work, harmful practices (including early marriage), and early and adolescent pregnancy.

Lessons from previous pandemics and epidemics suggest that the following could mitigate the child protection risks:

• Responding to children in vulnerable circumstances, including orphans (e.g. throughpsychosocial interventions focused on improving mental health and community-based interventions that provide families with resources and access to services)
• Responding to stigmatization and discrimination (e.g. throughinformation and communication campaigns and support from public health systems, communities and schools)
• Investing in social protectionenable livelihoods during outbreaks and to counteract shocks
• Promoting access to health, protective and justice services, which may be restricted or suspending during infectious disease outbreaks
• Ensuring continued access to education, particularly for girls, who may be adversely affected

There is a high burden of proof for data collection during the current COVID-19 outbreak than there would be in normal circumstances. Evidence generation strategies during and after the COVID-19 crisis should consider rigorous retrospective reviews and building upon monitoring, evidence and learning functions of pre-existing programmes – particularly where there is ongoing longitudinal data collection. There should also be efforts to synthesize evidence from existing research on the effectiveness of interventions that respond to the key risk pathways identified in this review.

 

 

• The research brief can be found here.
• Access the Evidence Gap Map on child protection and violence outcomes here.
• Access the study protocol here.

 

As cases of coronavirus disease 2019 (COVID-19) spread globally and across the USA, reaching over 140,000 US cases by March 30, 2020 (a number that is almost certainly an under estimate, given the lack of testing across states), scientists and companies throughout the world are searching for a response, a treatment or vaccine. Multiple companies are currently working on developing vaccines for the disease. A vaccine will, by the most optimistic estimates, not be available for at least 12–18 months; but while there is no certainty, there are good chances one or more of variable efficacy will, eventually, be available. When it is, one potential question states will have to address is whether the vaccine should be mandated for school children and anyone else. This article examines this question; the answer, naturally, is ‘it depends’, but this article offers guidance about the ethical and legal considerations for making the decision. The article will address this in three parts: the ethical considerations that affect whether a COVID-19 vaccine mandate is appropriate, potential legal constraints, and practical and political considerations.