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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.
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. 
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.
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.


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.
Cite this research | Open access | Issue: 28 | No. of pages: 1184-1186 | Language: English | Tags: COVID-19, obesity, vulnerable children | Topics: Health
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.
Cite this research | Open access | No. of pages: 2 | Tags: breastfeeding, child care, risk, COVID-19 | Topics: Health, Nutrition | Countries: United States
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.
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.
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.
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.
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.
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.
The Secondary Impacts of COVID-19 on Women and Girls in Sub-Saharan Africa

AUTHOR(S)
Tal Rafaeli; Geraldine Hutchinson

Published: June 2020   K4D Helpdesk Report
Based on emerging evidence and lessons from past health crises, there is strong evidence to suggest that women and girls in SSA will suffer from extreme and multifaceted negative secondary impact as a result of the COVID-19 crisis. Some of which may include higher poverty rates, increase in unplanned pregnancies, a surge in school dropout rates and child labour of adolescent girls, loss of income and reduced financial empowerment, increased household work, reduced access to healthcare and WASH alongside increased maternal deaths, and greater food insecurity and malnutrition.
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.
Migrant and displaced children in the age of COVID-19

AUTHOR(S)
Danzen You; Naomi Lindt; Rose Allen; et al.

Published: June 2020   Migration Policy Practice

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.  

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.
COVID-19 in 7780 pediatric patients: A systematic review

AUTHOR(S)
Ansel Hoang; Kevin Chorat; Axel Moreira; et al.

Published: June 2020   E Clinical Medicine
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.
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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.