CC BY
16EFFECT OF COVID-19 ON CHILDREN
Ashutosh Vats
International Higher School of Medicine, Bishkek, Kyrgyzstan
Abstract
A systematic review notes that children with COVID-19 have milder effects and better prognoses than adults. However, as a vulnerable population, children and youth may be affected by the COVID-19 pandemic in many other domains, including education, mental health, safety, and socioeconomic stability; the infection of the virus may lead to separation or loss of their family. As with many other crises, the COVID-19 pandemic may compound existing vulnerabilities and inequalities experienced by children.
Keywords: Children, Covid-19, Infant, Newborn,Adult
Critical cases and mortality in children and infants -Even though most infected children have mild symptoms, SARS-CoV-2-infected children might sill become severely ill. The recent published and unpublished reports of critical children and infants are summarized. As shown, most of current published cases are from China, and infants and teenagers are common subjects in all published and unpublished critical cases.
In the end of March and the beginning of April 2020, there was a little unpublished data regarding the death or critical condition of a few children and infants. In the United States, one 6-week-old infant was brought unresponsive to a hospital and died after resuscitation.On April 2,2020, in Japan, one 8-month-old female infant was brought to hospital in out-of-hospital cardiac arrest (OHCA) status. Both of them were thereafter identified as SARS-CoV-2-positive cases according to the news. These cases remind first-line physicians to take strong precautions while resuscitating any children, especially those with sudden collapse or OCHA. Additionally, four other SARS-CoV-2-positive children's deaths appeared on the news, including those of three teenagers Official reports should be obtained soon to confirm this information.
SARS-COV-2-POSITIVE NEWBORNS -
During infectious disease outbreaks, fetuses and newborn infants are the most susceptible. Perinatal SARS-CoV-2 infection may induce fetal distress, premature labor, and neonatal illness, such as
respiratory distress, viral sepsis, multiorgan involvement, and even death. However, there is still no definite evidence of vertical transmission from a SARS-CoV-2-infected pregnant mother to her fetus or newborn infants to date.
Some investigators have reported on their experiences with SARS-CoV-2-positive pregnant mothers and their newborn infants. According to these publications, cesarean sections are usually the delivery method of choice when the mother has symptomatic COVID-19. Most of the reports regarding specimens collected from amniotic fluid, cord blood, neonatal throat swabs, or breastmilk samples revealed that nearly all were negative for SARS-CoV-2.
However, early-onset (<7 days) neonatal COVID-19 was found in a few neonates born to SARS-CoV-2-positive mothers. Zeng et al reported three SARS-CoV-2-positive neonates born to mothers with confirmed COVID-19. All three of these confirmed babies were symptomatic, including fever, lethargy, respiratory distress, and pneumonia on chest images. Their nasopharyngeal and anal swabs were positive for SARS-CoV-2 on days 2 and 4 and negative on day 6 or 7. Additionally, both Lu and Shi and Yu et al also reported a total of three infected neonates born from infected mothers, and they were positive for SARS-CoV-2 tests at the ages of 30 hours, 36 hours, and 5 days afterbirth. Therefore, the possibility of vertical transmission from an infected mother cannot be completely excluded.
Address for Correspondence: Ashutosh Vats, Email - ashutoshvatslO(a>,gmail. com. Mobile phone +919053450252
Additionally, late-onset (>7 days) neonatal COVID-19 was reported in three neonates between the ages of 15 and 19 days. The infectious sources included their infected mothers (n = 2) and a housemaid .Close contact with infected persons after birth is the most probable transmission route of these late-onset neonatal COVID-19 cases. All of these reported SARS-CoV-2-positive neonates recovered after management.
School closures -
By the end of March 2020, UNESCO estimated that over 89% of the world's student population was out of school or university due to closures aimed at mitigating the spread of COVID-19. This raised serious concerns regarding the social, economic, and educational impacts of protracted school closures on students. In addition, school closures disproportionately affect children from low-income or minority families, children with disabilities, and young women, due to disparities in access to distance education, unequal distribution of increased child-care and domestic responsibilities, and the fact that school subsidized meal programs and vaccinations are cornerstones of child healthcare for many families. For example, school closures during the 2014—2016 Ebola outbreak in West Africa increased school dropouts, rates of child labor, violence against children, and teen pregnancies.
Impact on most at-risk groups -
Child safety is at risk during the pandemic. Children who are living in unsanitary and crowded conditions are particularly at risk. Youth - especially young women, indigenous peoples, migrants, and refugees - face heightened socioeconomic and health impacts and an increased risk of gender-based violence due to social isolation, discrimination and increased financial stress. They are also more prone to child marriage as families seek ways to alleviate economic burdens.
Although reports of child abuse in the US declined by an average of 40.6% from April 2019 to April 2020, child welfare advocates suggest that this drop is an under-reporting artifact secondary to the closure of schools and daycare centers, where most reports of child abuse are made.
Unemployment -
Unemployment is a serious concern for young
people. Following the 2008 Economic Recession, youth unemployment rates were significantly higher than overall averages, and the recent expansion of the gig economy will likely heighten this disparity. Before the pandemic, there was already an upward trend in the number of young people not in employment, education, or training (NEET). 267 million young people globally are classified as NEET.
Impact on young migrants-
This global crisis is exacerbating existing vulnerabilities and inequalities experienced by young people, amplified in humanitarian contexts where fragility, conflict, and emergencies have undermined institutional capacity and where there is limited access to services. Particularly affected are: young migrants; young people who are internally displaced or refugees; young people living in poor, high-density urban areas; young people without a home; young people living with disabilities; and those living with HIV. Young people separated from, unaccompanied, or left behind by migrant working parents face higher risks of exploitation, violence, and mental health issues, as well as poor access to health services and protection.
FUTURE PROSPECTS TO FIGHT COVID-19 IN CHILDREN AND INFANTS -
Children are not free from COVID-19. Everybody has the possibility of getting the illness after coming into contact with someone carrying SARS-CoV-2, including children of any age. Although current published reports reveal that children develop less severe cases of COVID-19 than adults, critical deterioration or death did occur. Asymptomatic children are not tested usually for SARS-CoV-2 in many countries, so the prevalence of infected children is underestimated in the current reported data.
Usually, younger children take part in fewer daily social activities than teenagers, and their contact opportunities with carriers or patients should thus be lower, resulting in a lower risk of getting the COVID-19 illness. Although not as prevalent as those of 20- to 30-year-old adults, the social activities of teenagers, including international travelling, are still eventful. That may partly explain why the number of confirmed COVID-19 cases in teenagers is much higher than that in small children, according to data from the TCDC. In infanthood and
toddlerhood, the major contacts of small children are further narrowed to their family and caregivers, and thus their COVID-19 incidence seems to be the lowest. Nevertheless, we still need to monitor all children carefully when the COVID-19 pandemic is under today's explosive outbreak in many countries.
In comparison with adults, children with COVID-19 were deemed to have milder illness and a better prognosis. Although most of the originally healthy children with COVID-19 are mild, critical cases did occur. When children had a chronic underlying disease, the risk of critical illness, or even mortality, rose. Investigations into the susceptibility of children of different ages and the mechanisms of disease severity are necessary for future care of pediatric patients and disease prevention.
Smell and/or taste disturbance is a specific symptom in some COVID-19 patients, and that require further investigations. In a multicenter European study among 417 mild-to-moderate COVID-19 patients, 85.6% and 88.0% of patients had olfactory and/or gustatory dysfunctions, respectively. The authors suggest that olfactory and gustatory disorders are prevalent symptoms in European COVID-19 patients, and the sudden anosmia or ageusia need to be recognized as important symptoms of the COVID-19 infection. As, all three teenagers who lost smell and/or taste were diagnosed during late March 2020, and they all had a recent history of travel to Europe (Spain or the United Kingdom) in late March. Therefore, further researches on European COVID-19 for its special presentation and suspected higher CFR should be done.
Isolation of confirmed or suspected cases with mild illness is also an important way to block viral transmission. Therefore, developing accurate and rapid diagnostic techniques to identify SARS-CoV-2 patients or carriers is crucial. Although real-time reverse transcription polymerase chain reaction assays remain the molecular test of choice for COVID-19 etiologic diagnosis, many new antibody-based techniques are being investigated and tried. We hope and believe that new diagnostic ways to promote the diagnostic speed and accuracy and monitor SARS-CoV-2 viral viability will be applied in clinical situations soon and that they will help control the outbreak of COVID-19.
Prevention is always more important than treatment
in infectious diseases, especially for such a very contagious virus as COVID-19. Histories of travelling to COVID-19 epidemic regions or contact with infected subjects are more important than age when judging whether or not to perform further assessments. The well-known transmission routes of COVID-19 are droplet and contact transmission. Air-borne transmission is possible, but more evidence still required to prove it. Therefore, the precautionary measures for recommended for the general population should include hand washing; not touching the mouth, nose, and eyes; maintaining social distance; and wearing masks to cover the mouth and nose in public spaces. For medical personnel, different grades of advanced protective gowns and hats, N95 or surgical masks, goggles, and gloves should be employed liberally to protect these first-line medical providers and save more people from COVID-19.
Vaccine development for COVID-19 is the most important measure for future and long-term prevention. An effective vaccine to rapidly induce potent and long-lasting virus-specific immune responses against SARS-CoV-2 is one of the most urgently needed weapons to fight COVID-19. The characteristic structural component of the viral envelope, the virus spike (S) protein, is considered a good target for developing vaccines for COVID. There have been many investigators on the way to vaccine development; some have started their phase 1 trials. Evidence of their efficacy and safety in the near future to help save people's lives is eagerly awaited.
In conclusion, COVID-19, caused by SARS-CoV-2, has become a global health emergency since December 2019 and has increased explosively since March 2020. Although the proportion of children infected by SARS-CoV-2 seems relatively lower, and their symptoms are relatively less severe than those of adults, a few infected children could progress to critical illness. Vertical transmission from the mother to her fetus or neonate has yet to be proven, but case reports of sick neonates exist. Early identification and isolation, adequate management, prevention, and vaccine development are the keys to controlling disease spread. Further studies on the different faces of COVID-19 are required to fight this viral pandemic.
References
1. Ludvigsson JF (June 2020). "Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults". Acta Paedistr. 109(6): 1088-1095. doi: 10.1111/apa. 15270. PMC 7228328. PMD 32202343.
2. "COVID-19: Working with and for young people". www.unfpa.org. May 2020. Retrieved5 June2020
3. Harvard Health Publishing (15 May 2020). "Coronavirus outbreak and kids". Harvard Health. Retrieved 5 June 2020.
4. Armitage R, Nellums LB (May 2020). "Considering inequalities in the school closure response to COVID-19". Lancet Global Health. 8(5): e644. doi:10.1016/S2214-109X(20)30116-9. PMC 7195275. PMD 32222161.
5. "Covid-19 school closures around the world will hit girls hardest". UNESCO. 31 March 2020. Retrieved24 June 2020.
6. Loukas A, Roalson LA, Herrera DE (2010). "School connectedness buffers the effects ofnegative family relations and poor effortful control on early adolescent conduct problems". Journal of Research on Adolescence. 20 (1): 13-22. doi: 10.1111/j. 1532-7795.2009.00632.x.
7. Foster CE, Horwitz A, Thomas A, Opperman K, GipsonP, BurnsideA, etal. (October 2017). "Connectedness to family, school, peers, and community in socially vulnerable adolescents". Child and Youth Services Review. 81: 321-331. doi: 10.1016/j.childyouth.2017.08. Oil. PMC 6128354. PMD 30202142.
8. Psacharopoulos G, Patrinos HA (2018). "Returns to investment in education: a decennial review of theglobal literature". Education Economics. 26 (5): 445—458. doi:10.1080/09645292.2018.1484426. hdl:10986/30154. S2CID158496991.
9. Cooper H, Nye B, Charlton K, Lindsay J, Greathouse S (September 1996). "The Effects of Summer Vacation on Achievement Test Scores: A Narrative and Meta-Analytic Review". Review of Educational Research. 66 (3): 227—268. doi:10.3102/00346543066003227. S2CID145635039.
10. "UN Secretary-General's policy brief: The impact of COVID-19 on women \ Digital library: Publications". UN Women. Retrieved 24 June2020.
11. "Impact of Covid-19 on Children". 8 May 2020.
12. UN Women. (19 September 2019). Families in a changing world / UN Women. New York. ISBN 978-1-63214-156-9. OCLC1120137550.
13. Women, U.N. "How COVID-19 impacts women and girls", interactive, unwomen. org. Retrieved 24 June 2020.
14. Gender equality matters in COVID-19 response". UN Women. Retrieved 24 June 2020.
15. "Youth exclusion from jobs and training on the rise", www. ilo. org. 9 March 2020. Retrieved24 June 2020.
16. "Global Employment Trends for Youth 2020: Technology and thefuture of jobs ". 9 March 2020.
17. CDC (11 February 2020). "Coronavirus Disease 2019 (COVID-19) ". Centersfor Disease Control and Prevention. Retrieved 5 June 2020.
18. Journal of the Chinese Medical Association, J eng, Mei-Jya,b,c, *doi: 10.1097/JCMA.0000000000000323
19. Karimi-Zarchi M, Neamatzadeh H, Dastgheib SA, Abbasi H, Mirjalili SR, BehforouzA, et al. Vertical transmission of coronavirus disease 19 (COVID-19) from infected pregnant mothers to neonates: a review. Fetal Pediatr Pathol 2020. Doi: 10.1080/15513815.2020.1747120.
20. CISIONPR Newswire. INOVIO Initiates Phase 1 Clinical Trial Of Its COVID-19 Vaccine and Plans First Dose Today. Available at: http://ir.inovio.com/news-and-media/news/press-release-details/2020/INOVIO-Initiates-Phase-l-Clinical-Trial-Of-Its-COVID-19-Vaccine-and-Plans-First-Dose-Today/deiault.aspx. Accessed April 7,2020.
