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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.
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.
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.
Behavioural and Emotional Disorders in Children During the COVID-19 Epidemic

AUTHOR(S)
Wen YanJiao; Lin Na Wang; Juan Liu; et al.

Published: June 2020   The Journal of Pediatrics

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.

COVID-19 in Children and Adolescents in Europe: A Multinational, Multicentre Cohort Study

AUTHOR(S)
Petra Prunk; Veronika Osterman; Uros Krivec; et al.

Published: June 2020   The Lancet Child & Adolescent Health
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.
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.
Maintaining safety and service provision in human milk banking: a call to action in response to the COVID-19 pandemic

AUTHOR(S)
Natalie Shenker

Published: June 2020   The Lancet Child & Adolescent Health
When a mother's own milk is not available, WHO recommends pasteurised donor human milk as the first alternative.  Human milk banks screen and recruit donors, and have wide-ranging precautions to ensure the safety of donor milk. Screened donor milk principally feeds babies of very low birthweight, protecting them from a range of complications, as well as babies with congenital anomalies or neurological conditions. The benefits of a human milk diet highlight the importance of providing these infants with donor milk for short periods—with appropriate use in the context of optimal support for lactation, such provision can support mothers to establish their milk supply without the need for supplementation with infant formula milk. The coronavirus disease 2019 (COVID-19) pandemic is presenting many challenges to human milk banks worldwide and highlights a range of vulnerabilities in service provision and emergency preparedness. 
Impact of COVID-19 on children: special focus on the psychosocial aspect

AUTHOR(S)
Ritwik GHOSH Ghosh; Mahua J. Dubey; Subhankar Chatterje; et al.

Published: June 2020   Minerva Pediatrica
Although medical literature shows that children are minimally susceptible to 2019-Corona virus disease (COVID-19), they are hit the hardest by psychosocial impact of this pandemic. Being quarantined in homes and institutions may impose greater psychological burden than the physical sufferings caused by the virus. School closure, lack of outdoor activity, aberrant dietary and sleeping habits are likely to disrupt children’s usual lifestyle and can potentially promote monoto- ny, distress, impatience, annoyance and varied neuropsychiatric manifestations. Incidences of domestic violence, child abuse, adulterated online contents are on the rise. Children of single parent and frontline workers suffer unique problems. The children from marginalized communities are particularly susceptible to the infection and may suffer from extended ill-consequences of this pandemic, such as child labor, child trafficking, child marriage, sexual exploitation and death etc. Parents, pediatricians, psychologists, social workers, hospital authorities, government and non-governmental organizations have important roles to play to mitigate the psychosocial ill-effects of COVID-19 on children and adolescents. To provide the basic amenities, social security, medical care, and to minimize the educational inequities among the children of the different strata of the society are foremost priorities.
Cite this research | Open access | Vol.: 72 | Issue: 3 | No. of pages: 12 | Language: English | Tags: child psychology, psychology, pandemic, COVID-19 response, COVID-19, impact | Topics: Mental Health, Health
Child poverty, food insecurity, and respiratory health during the COVID-19 pandemic

AUTHOR(S)
Ian P Sinha; Alice R Lee; Davara Bennett; et al.

Published: June 2020   Lancet Respir Med
The eradication of poverty and hunger are the top sustainable development goals, adopted by UN Member States in 2015. Yet the World Food Programme estimates that, in the wake of the COVID-19 pandemic, acute food insecurity could double from 135 to 265 million people worldwide. In the absence of mitigating policies, poverty leading to food insecurity will damage the respiratory health of a generation of children.
Impact of the COVID-19 virus outbreak on movement and play behaviours of Canadian children and youth: a national survey

AUTHOR(S)
Sarah A. Moore; Guy Faulkner; Ryan E. Rhodes

Published: June 2020   International Journal of Behavioral Nutrition and Physical Activity (IJBNPA)
Healthy childhood development is fostered through sufficient physical activity (PA; including time outdoors), limiting sedentary behaviours (SB), and adequate sleep; collectively known as movement behaviours. Though the COVID-19 virus outbreak has changed the daily lives of children and youth, it is unknown to what extent related restrictions may compromise the ability to play and meet movement behaviour recommendations. This secondary data analysis examined the immediate impacts of COVID-19 restrictions on movement and play behaviours in children and youth.
COVID-19 in Children: An Ample Review

AUTHOR(S)
Ioana M Ciuca

Published: June 2020   Risk management and healthcare policy
The aim of this review was to describe the current knowledge about coronavirus disease 2019 (COVID-19, which is caused by severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) in children, from epidemiological, clinical, and laboratory perspectives, including knowledge on the disease course, treatment, and prognosis. An extensive literature search was performed to identify papers on COVID-19 (SARS-CoV-2 infection) in children, published between January 1, 2020 and April 1, 2020. There were 44 relevant papers on COVID-19 in children. The results showed that COVID-19 occurs in 0.39–12.3% of children. Clinical signs and symptoms are comparable to those in adults, but milder forms and a large percentage of asymptomatic carriers are found among children. Elevated inflammatory markers are associated with complications and linked to various co-infections. Chest computed tomography (CT) scans in children revealed structural changes similar to those found in adults, with consolidations surrounded by halos being somewhat specific for children with COVID-19. The recommended treatment includes providing symptomatic therapy, with no specific drug recommendations for children. The prognosis is much better for children compared to adults. This review highlights that COVID-19 in children is similar to the disease in the adult population, but with particularities regarding clinical manifestations, laboratory test results, chest imaging, and treatment. The prognosis is much better for children compared to adults, but with the progression of the pandemic; the cases in children might change in the future.
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
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.
COVID-19 Risks to Children's Health and Nutrition
Published: May 2020  
The COVID-19 pandemic is putting millions of children at heightened risk, and jeopardising their immediate and long-term health and well-being. As countries around the world battle to prevent, contain and respond to COVID-19, it is critical that their efforts reach those most vulnerable and ensure primary health care  is continued and accessible to all. All stakeholders must take proactive measures to mitigate the impacts of COVID-19 on children’s health and nutrition, and response efforts should consider vulnerable children’s needs and rights. Based on extensive experience working with children, families and communities in emergencies, including epidemics, World Vision outlines a number of recommendations for Governments, UN Agencies, Donors, NGOS, Private Sector, and Faith Leaders. 
Hear it From the Girls – Asia and COVID-19
Published: May 2020  
The Asia Pacific region has seen significant progress in gender equality in recent years in a number of areas, such as education and political participation. From 2000-2016, the number of out-of-school girls in primary and secondary school dropped by 67 million. 1 The number of females in tertiary school rose by 41 million. From 1990 to 2018 the proportion of women in national parliaments has risen from 8 percent to18 percent. Unfortunately, in other areas, Asia and the Pacific have seen a decline in equality. According to UNESCAP, women’s economic empowerment has remained nearly stagnant and those who are young and in the informal labour market are expected to be hit the hardest. The East Asia Pacific Region is one of the only regions in the world where rates of teenage pregnancy are increasing in low-and-middle-income countries.Any emergency risks increasing existing discriminations and incidents of violence. It also risks losing progress so recently made for girls and young women. The COVID-19 Pandemic is an emergency on a scale not seen for nearly 100 years. 
Potential effectiveness and safety of antiviral agents in children with coronavirus disease 2019: a rapid review and meta-analysis

AUTHOR(S)
Qianling Shi; Qi Zhou; Xia Wang; et al.

Published: May 2020   Annals of Transnational Medicine
A novel coronavirus, later named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first detected on December 8, 2019, when several cases of pneumonia of unknown etiology were reported in China (1-3). As of April 12, a total of 1,696,588 confirmed cases had been reported in more than 200 countries, and the number of cases was still rapidly increasing, creating global alarm and concerns about the impact on health care and economy of the affected areas. As the COVID-19 outbreak presents a new, life-threatening disease. Our aim was to assess the potential effectiveness and safety of antiviral agents for COVID-19 in children.
Cite this research | Open access | Vol.: 8 | Issue: 10 | No. of pages: 16 | Language: English | Tags: children, pandemic, COVID-19 response, COVID-19 | Topics: Health, Child Protection
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