COVID-19: How The Health of Children Is at StakeHealth
Children may not be dying in the same number as adults or senior citizens due to COVID-19, but their health is at risk and so are the lives of their parents and grandparents. While children are often more susceptible to certain diseases and environmental toxins, they are also often more responsive to medical treatment and have a better ability to bounce back and heal from health issues.
The latter appears to be the case with COVID-19, but it should not lead to an utter dismissal of their unique health care needs or their special circumstances by politicians.
There is a reason we have experts in the care and treatment of children and the creation of the field of pediatric medicine that includes pediatricians, pediatric nurses, and children’s hospitals. Children have unique health care needs due to the fact that disease, stress and trauma, and health interventions are almost always different for kids than adults. In some ways, it can be far more complicated.
When you think about a child, they need protection. They’re not fully formed or fully mature. Their organs are not what they’re going to be. But at the same time, that immaturity allows so much bounce back and so much healing and so much ability. So you have to take both those things into mind as you take care of a child.Dr. Kurt Newman, President and CEO of Children’s National
Kids are hospitalized are lower rates than adults and so the majority of expenses are in adult care and medicine. Attention follows the money, but money also follows attention.
In his book Healing Children, Dr. Newman points out:
Adult diseases win more investment; adult doctors are better paid; adult medicine dominates the news cycle. As a society, we prioritize end-of-life and palliative care, while children’s medicine is painfully undervalued and underfunded. In the United States there are 35 independent children’s hospitals and more than 200 operating as part of a larger integrated health system, but nearly 5,000 hospitals focused primarily on adult care. This in a country with 75 million children under the age of eighteen.
Unfortunately, rather than addressing the unique needs of children, health care systems and policymakers often treat children as an afterthought.
We are seeing that again in the COVID-19 response. Other infectious diseases often more heavily impact children, but for reasons yet to be fully understood, children are less likely to die from this virus. That does not mean they do not have special concerns or needs at this moment in time. Every facet of the lives of children is being disrupted by both COVID-19 and the economic crisis. Children are, as UNICEF points out, the “hidden victims.”
Children Are Not Immune or Invincible
The impact on children from COVID-19 is immense. It is also variable and complicated. The impact is different based on age, gender, income, disability and health status, geography, and family circumstance.
In comparison to adults, children need different endotracheal tubs, resuscitation bags, laryngoscopes, suction catheters, intravenous catheters, needles, chest tubes, blood pressure cuffs, and medications. Children need more intensive and specialized pediatric nursing care, as children cannot be given instructions for self-care or left unattended in the same way adults are. Hospitals that care for kids must have expertise in child abuse and maltreatment. Children that have certain medical procedures, such as orthopedic and cardiology, sometimes have to repeat them as they grow and develop.
Unfortunately, in policy discussions, children are often ignored or invisible to policymakers so much of this nuance is ignored. Sometimes policymakers are downright clueless.
It is happening again. On April 8, Florida Gov. Ron DeSantis said he was considering the reopening of public schools in the midst of a statewide stay-at-home directive by claiming:
This particular epidemic is one where, I don’t think nationwide there’s been a single fatality under 25. For whatever reason it just doesn’t seem to threaten, you know, kids.
Gov. DeSantis needs to understand four critical issues related to COVID-19 and child health:
(1) Children and families are getting sick and dying from COVID-19 (recent data from the CDC and South Korea indicates that prior reports from China and Italy significantly understated the impact on children because the data was and still is predominately driven by who is getting tested, which have been older adults);
(2) Like anybody, young people also can carry the virus and infect teachers, coaches, bus drivers, counselors, teacher aides, janitors, school administrators, etc. and their own parents;
(3) Child health is heavily impacted by family and ensuring the protection of the health of parents and teachers is critical to children; and,
(4) More than 16,000 people in Florida have tested positive and tens of thousands of others likely have the virus and 354 people have already died in Florida.
Even though children are not dying at the same rate as senior citizens from coronavirus, it is wrong to assume that children are not being heavily impacted. Elon Musk also made a similar false leap when he tweeted that kids are “essentially immune” from COVID-19. Simply put, they are not.
The fact is that the coronavirus is impacting every aspect of the lives of children, including their health.
Children are neither immune nor invincible. The impact on them is just different. Again, children are not little adults.
According to the Centers for Disease Control and Prevention (CDC), 2,572 of laboratory-confirmed COVID-19 cases in the U.S. between February 12 and April 2 were in children. The median age for children infected in the U.S. for that period was 11 years. Although coronavirus cases in children tend to be less severe than in adults, there are some serious cases and even deaths among children. The CDC is finding that hospitalizations are more frequent for infants than other age groups of children. Data also indicated the underlying medical conditions among children that have been hospitalized are most reported for those with chronic lung disease (including asthma), cardiovascular disease, and immunosuppression.
The CDC concludes:
Whereas most COVID-19 cases in children are not severe, serious COVID-19 illness resulting in hospitalization still occurs in this age group. Social distancing and everyday preventive behaviors remain important for all age groups as patients with less serious illness and those without symptoms likely play an important role in disease transmission.
Children’s Physical and Mental Health Are Linked to Family Well-Being
Policymakers must also recognize the health of children is also greatly influenced by the overall health and well-being of their families. As Dr. Jack Shonkoff at Harvard University’s Center on the Developing Child explains:
The immediate effects and long-term impacts of this rapidly changing situation will not be evenly distributed. The stresses of caregiving (for children as well as for adults at greater risk) are rising for everyone.
Dr. Shonkoff adds:
For the millions of parents who were already struggling with low-wage work, lack of affordable childcare, and meeting their family’s basic needs from paycheck to paycheck, the stresses are increasing exponentially. When unstable housing, food insecurity, social isolation, limited access to medical care, the burdens of racism, and fears related to immigration status are added, the toxic overload of adversities can also lead to increasing rates of substance abuse, family violence, and untreated mental health problems. We cannot lose sight of the massive consequences of these threats to the health and development of our most vulnerable children and their families — now and for years to come.
Our failure to fully support families with children whose schools and child care centers have been closed could be catastrophic in the long-term. The education, housing, nutrition, and poverty of children will all, to varying degrees, be negatively impacted by the COVID-19 and economic crises. President Trump, Congress, the governors, state legislatures, and local governments must all do more to address these problems on a holistic basis.
For example, in the CARES Act that just passed Congress, the U.S. government will treat children as worth just 41.7 percent of that of adults ($500 for children and $1,200 for adults in the COVID/stimulus package). Consequently, a single mother caring for her two children will receive less support than two adults with no kids. That is one of a number of things that should be considered and fixed.
Cambridge University’s child and adolescent psychologist Paul Ramchandani points out that we should also be addressing the specific mental health needs of children and their caregivers. Ramchandani writes:
First, the very youngest children (including those yet to be born) are potentially the most vulnerable to family stress and anxiety. Effects on them may not be immediately apparent, but there is a large body of research showing that depression and anxiety in either parent is linked to a greater risk of mental health problems in children. This isn’t set in stone, so intervention and support now, such as psychological therapies for parents, would be transformative for many families.
Crisis Creates Expanded Threats to Maternal and Infant Mortality
In addition, at a time when people are being asked to shelter in place, maintain social distancing, and do not have child care, a whole array of problems are facing children. For example, mothers with newborns are being released from hospitals more quickly than normal, and parents are having trouble getting children to appointments for checkups, developmental screenings, and immunizations. This threatens the health and development of children.
We have an on-going crisis with respect to maternal and infant mortality across the world and we should take proactive steps to ensure that COVID-19 does not exacerbate those problems. Although we have made significant progress, The World Health Organization (WHO) points out that “[c]omplications during pregnancy and childbirth are the leading cause of death for 15–19-year-old girls globally.”
There are special circumstances and challenges related to the health of mothers and their babies when it comes to this health crisis, particularly as to how it impacts mothers and infants, the current uncertainty of how COVID-19 may or may not be transmitted, and how to keep mothers and babies safe and healthy.
Furthermore, with schools and child care centers closed, parents with health concerns are finding it difficult to address their own needs and problems while simultaneously attempting to care for their children. Pediatrician Dorothy Novack highlights the threat of “children “being stranded should their parents fall ill.” Novack explains:
For those who are single parenting, COVID-19 infection is already particularly harrowing. They are sick and quarantined away from anyone who can care for them. The only help they are able to receive comes in packages delivered to their stoops. They have no choice but to care for their children while they themselves are weak, feverish and exhausted. And the issue of child care adds insurmountable fear. They are constantly assessing their own breathing, wondering if they should call 911, hoping they can hold out and stay home, knowing their children have nowhere to go.
Beyond the enormous health challenges that COVID-19 has created, the stress it has on children and families must be addressed or there will be long-term consequences.
Crisis Will Create Other Threats to Child Health
The COVID-19 pandemic is also straining hospitals and health systems, leading to the reallocation of personnel and resources, and creating shortages of medical supplies and disruptions to routine health care services, such as pediatric developmental screenings and immunizations. Before this public health pandemic, through the crisis, related to the crisis (e.g., increases in emergencies caused by child abuse and unintentional poisonings), and well after, children have health concerns that must be addressed.
This is a critically important and on-going issue across the world. As UNICEF reports:
We are particularly concerned about countries that are battling measles, cholera or polio outbreaks while responding to COVID-19 cases, such as Afghanistan, the Democratic Republic of Congo, Somalia, the Philippines, Syria and South Sudan. Not only would such outbreaks tax already stretched health services, they could also lead to additional loss of lives and suffering. At a time like this, these countries can ill-afford to face additional outbreaks of vaccine-preventable diseases.
The message is clear: We must not allow lifesaving health interventions to fall victim to our efforts to address COVID-19.
In the U.S., immunization rates were already dropping before the coronavirus pandemic and communicable diseases like measles were on the rise in 2019 and have not gone away. We must ensure that steps are taken to maintain access to immunizations through this crisis and to take further action to improve immunization rates after the COVID-19 crisis passes, particularly among those that are behind on immunizations and the poorest and most vulnerable children.
In my last blog, the impact that the closing of schools is having on child nutrition was highlighted and there is a new story out emphasizing how Congress’s initial efforts on nutrition are not getting to children.
The Trump Administration and Congress must immediately address and fix this problem to ensure children are receiving the food and nutrition they need.
Policymakers must also consider ways to improve access to health care services for those children that rely upon school-based and school-linked services “for primary care and often mental health care, social services, oral health care, reproductive health, nutrition education, vision services, and health promotion.” Access to this health care is particularly important as students from poorer communities often have higher rates of asthma, substance use, poor nutrition, obesity, anxiety, and depression than other children.
There are also particular threats to the health of children in group home settings, homeless children, kids in the juvenile justice system, and those in immigration detention centers, who are in contact with workers that do not have the training, resources, or equipment to deal with this crisis. These children are far more susceptible to being exposed and contracting COVID-19 and are in settings without adequate medical services or resources.
Children are not little adults. They have special or unique health care needs across age, gender, disability, income, and circumstance. There are numerous challenges that children face when it comes to COVID-19. So again, kids are not “essentially immune.” Quite the contrary.
Furthermore, threats to the health and well-being of children go well beyond this health care crisis, as the economic downturn and recession will have long-lasting implications for children. Research on the impact that Hurricane Katrina and other natural, public health, and economic disasters highlight this challenge.
After Katrina, a National Commission on Children and Disasters was created to address the unique challenges facing children in crisis or disasters. According to a follow-up report by Save the Children five years later, only 21 percent of the recommendations had been fully implemented. Now is the time to pay full attention to the needs of children — both their health care challenges but also every aspect of their lives that is being disrupted.
Children in the U.S. need a coordinated and comprehensive approach to addressing the myriad of challenges impacted every aspect of the lives of children to deal with COVID-19 and the economic downturn. They need what children have in over 60 countries across the world: an independent Children’s Commissioner.
Our national and state leaders must pay special attention and focus to the needs of children and get it right. Our future depends on it.