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Children and COVID-19 Research Library

UNDER DEVELOPMENT UNICEF Innocenti's curated library of COVID-19 + Children research

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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.
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.
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.
Cite this research | Open access | No. of pages: 102 | Tags: children, education, COVID-19 | Topics: Education | Publisher: Save the Children
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.
Cite this research | Open access | Vol.: 143 | No. of pages: 6 | Tags: adolescents, children, immunization, COVID-19 response, COVID-19 | Topics: Health, Child Protection | Countries: China
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.
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.


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.
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.
Cite this research | Open access | Vol.: 35 | Issue: 5 | No. of pages: 10 | Language: English | Tags: child mental health, children, mental health, psychological distress, COVID-19 response, COVID-19 | Topics: Mental Health, Child Protection
Coronavirus disease 2019 (COVID-19) in children and/or adolescents: a meta-analysis

AUTHOR(S)
Alessandro Mantovani; Elisabetta Rinaldi; Chiara Zusi; et al.

Published: June 2020   Nature Paediatric Research
This review systematically researched in PubMed, Scopus and Web of Science databases observational studies describing COVID-19 in children and/or adolescents until April 11, 2020. Data regarding clinical and radiological features were extracted from eligible studies and meta-analysis was performed using random-effects modeling. The study finds that children and/or adolescents tend to have a mild COVID-19 course with a good prognosis.
Compared to adults, children and/or adolescents tend to have a mild COVID-19 course with a good prognosis.
Soro Sali, a 39 years old woman is practicing Kangaroo, at the Regional Hospital of Korhogo, in the North of Côte d'Ivoire.
Data to inform the COVID-19 response
Published: June 2020 UNICEF Publication
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.
Challenges of COVID-19 in children in low- and middle-income countries

AUTHOR(S)
Heather J. Zar; Jeanette Dawa; Gilberto B. Fischer

Published: June 2020   Paediatric Respiratory Reviews
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.
Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19

AUTHOR(S)
Maria Elizabeth Loades DClinPsy; Eleanor Chatburn; Nina Higson-Sweeney

Published: June 2020   Journal of the American Academy of Child & Adolescent Psychiatry
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.
Coronavirus disease 2019 (COVID-19) in children: a systematic review of imaging findings

AUTHOR(S)
Susan C. Shelmerdine; Jovan Lovrenski; Pablo Caro-Domínguez; et al.

Published: June 2020   Pediatric radiology
COVID-19 is a novel coronavirus infection that can cause a severe respiratory illness and has been declared a pandemic by the World Health Organization (WHO). Because children appear to be less severely affected than adults, their imaging appearances have not been extensively reported.
Asthma and COVID‐19 in children: A systematic review and call for data

AUTHOR(S)
Jose A. Castro‐Rodriguez; Eric Forno

Published: June 2020   Pediatric Pulmonology
Whether asthma constitutes a risk factor for coronavirus disease‐2019 (COVID‐19) is unclear. Here, we aimed to assess whether asthma, the most common chronic disease in children, is associated with higher COVID‐19 risk or severity in pediatric populations.
Changes in contact patterns shape the dynamics of the COVID-19 outbreak in China

AUTHOR(S)
Juanjuan Zhang; Maria Litvinova; Yuxia Liang; et al.

Published: June 2020   Science
Intense nonpharmaceutical interventions were put in place in China to stop transmission of the novel coronavirus disease 2019 (COVID-19). As transmission intensifies in other countries, the interplay between age, contact patterns, social distancing, susceptibility to infection, and COVID-19 dynamics remains unclear. To answer these questions, we analyze contact survey data for Wuhan and Shanghai before and during the outbreak and contact-tracing information from Hunan province. Daily contacts were reduced seven- to eightfold during the COVID-19 social distancing period, with most interactions restricted to the household. We find that children 0 to 14 years of age are less susceptible to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection than adults 15 to 64 years of age (odds ratio 0.34, 95% confidence interval 0.24 to 0.49), whereas individuals more than 65 years of age are more susceptible to infection (odds ratio 1.47, 95% confidence interval 1.12 to 1.92). Based on these data, we built a transmission model to study the impact of social distancing and school closure on transmission. We find that social distancing alone, as implemented in China during the outbreak, is sufficient to control COVID-19. Although proactive school closures cannot interrupt transmission on their own, they can reduce peak incidence by 40 to 60% and delay the epidemic.
Cite this research | Open access | Vol.: 368 | Issue: 6498 | No. of pages: 6 | Language: English | Tags: children, pandemic, COVID-19 response, COVID-19 | Topics: Health, Child Protection | Countries: China
Resistance of children to Covid-19. How?

AUTHOR(S)
Alain Fischer

Published: May 2020   Nature Mucosal Immunology
Both resistance to infection and resistance to disease appear to be much stronger in children than in adults. The apparent resistance to infection might actually reflect a more rapid clearance of the virus so that the chance to detect cases is diminished. Future studies on seropositivity prevalence should help to distinguish between these possibilities. Of note the increased male to female ratio as observed in adult Covid-19 patients (6 to 4) is also observed in children. Finally, children below the age of 1 year are over-represented in pediatric Covid-19 cohorts with a higher risk of fatality compared with children above the age of 1.
Impacts of COVID-19 on Vulnerable Children in Temporary Accommodation in the UK

AUTHOR(S)
Diana Margo Rosenthal; Marcella Ucci; Michelle Heys; et al.

Published: May 2020   The Lancet Public Health
There is no doubt that coronavirus disease 2019 (COVID-19) has huge economic implications as highlighted by the media, but there are also a myriad of considerable direct and indirect health, social, and educational consequences for children and families experiencing homelessness, while living in temporary or insecure accommodation (eg, staying with friends or family, sofa surfing, shelters, bed and breakfast lodging). In particular, young children (aged ≤5 years) living in temporary accommodation have an invisible plight that might not seem obvious to many people because they are not on the streets as homeless (eg, rough sleepers), but are perhaps the most susceptible to viral infection because of pre-existing conditions (eg, diabetes, asthma, epilepsy, anxiety, depression).1 Additionally, these children rarely have the ability to self-isolate and adhere to social distancing, with previous extreme inequalities and inequities in accessing health care becoming exacerbated.
COVID-19 & Disruptions to Education
Published: May 2020  
The COVID-19 pandemic is wreaking unprecedented havoc on the lives of millions, creating devastating impacts on children, families and communities around the world. This brief focuses on the pandemic’s impact on children’s education, which cannot be overstated. COVID-19 related school and university closures have disrupted the education of more than 1.5 billion learners—over 90% of the world’s student population.
School Closure and Management Practices During Coronavirus Outbreaks Including COVID-19: A Rapid Systematic Review

AUTHOR(S)
Russel Viner; Simon Russel; Helen Croker; et al.

Published: May 2020   The Lancet Child & Adolescent Health
In response to the coronavirus disease 2019 (COVID-19) pandemic, 107 countries had implemented national school closures by March 18, 2020. It is unknown whether school measures are effective in coronavirus outbreaks (eg, due to severe acute respiratory syndrome [SARS], Middle East respiratory syndrome, or COVID-19). This systematic review seeks to identify what is known about the effectiveness of school closures and other school social distancing practices during coronavirus outbreaks. Data from the SARS outbreak in mainland China, Hong Kong, and Singapore suggest that school closures did not contribute to the control of the epidemic. Modelling studies of SARS produced conflicting results. Recent modelling studies of COVID-19 predict that school closures alone would prevent only 2–4% of deaths, much less than other social distancing interventions. Policy makers need to be aware of the equivocal evidence when considering school closures for COVID-19, and that combinations of social distancing measures should be considered. Other less disruptive social distancing interventions in schools require further consideration if restrictive social distancing policies are implemented for long periods.
Cite this research | Open access | Vol.: 4 | Issue: 5 | No. of pages: 5 | Language: English | Tags: children, school attendance, schools, COVID-19 | Topics: Education
Children are unlikely to be the main drivers of the COVID‐19 pandemic – A systematic review

AUTHOR(S)
Jonas Ludvigsson

Published: May 2020   Acta Paediatrica
Many countries have closed schools and kindergartens to minimise COVID‐19, but the role that children play in disease transmission is unclear. This systematic literature review from the MEDLINE and EMBASE databases and medRxiv/bioRxiv preprint servers to 11 May 2020 identified 700 published and unpublished papers on COVID‐19 transmission by children. Children accounted for a small fraction of COVID‐19 cases and mostly had social contacts with peers or parents, rather than older people at risk of severe disease. Data on viral loads were scarce, but indicated that children may have lower levels than adults, partly because they often have fewer symptoms, and this should decrease the transmission risk. Household transmission studies showed that children were rarely the index case and case studies suggested that children with COVID‐19 seldom caused outbreaks. However, it is highly likely that children can transmit the SARS‐COV‐2 virus, which causes COVID‐19, and even asymptomatic children can have viral loads.

Conclusion
Children are unlikely to be the main drivers of the pandemic. Opening up schools and kindergartens is unlikely to impact COVID‐19 mortality rates in older people.
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UNICEF Innocenti's Children and COVID-19 Library is a database collecting research from around the world on COVID-19 and its impacts on children and adolescents. Learn more.

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COVID-19 & Children: Rapid Research Response

UNICEF Innocenti is mobilizing a rapid research response in line with UNICEF’s global response to the COVID-19 crisis. The initiatives we’ve begun will provide the broad range of evidence needed to inform our work to scale up rapid assessment, develop urgent mitigating strategies in programming and advocacy, and preparation of interventions to respond to the medium and longer-term consequences of the COVID-19 crisis. The research projects cover a rapid review of evidence, education analysis, and social and economic policies.