COVID-19 among Children: The Unseen Facts beyond Its Direct Impact

TRANSCEND MEMBERS, 14 Sep 2020

Shree Prasad Devkota and Laxmi Paudyal – TRANSCEND Media Service

12 Sep 2020 – COVID-19 is a new disease caused by a new corona virus, which has not been previously identified in human. Corona viruses are a group of viruses which typically tend to affect human and other mammal’s respiratory tract and other guts (WHO 2020b). For the first time in 1937, corona viruses were first identified as an infectious bronchitis virus with which birds suffered that could ruin the poultry stocks. Till then other animals such as cats, dogs, horses, mice, pigs, rats, turkeys etc were infected with corona virus.

But human corona viruses were first characterized in 1965 when Tyrrel and Bynoe found it and named as B814 (Kahn, Jeffrey S, McIntosh and Kenneth, 2005). In the same time other various researchers such as Hame and Procknow (229E), McIntosh et al (OC), Almedia and Tyrell had found some or similar morphology of other species and they named those viruses as corona virus (corona denoting the crown like appearance on the surface projections) and was later officially accepted as a new genius of viruses. Human corona viruses are segregated into two broad groups’ alpha (229E and NL63) and beta (OC43 and HKU1) corona viruses (CDC, 2020). People around the world get infected with these corona viruses and shows symptoms like common cold, URTIs and Pneumonia.

But sometimes the corona viruses that infect animals can evolve and make people infected and become a new human corona virus. SARS-cov, MERS-cov and 2019-ncov (COVID-19) are the examples of such novel corona virus. Researchers studying the genetic sequence of the 2019-ncov virus found it states 88% of its genetic sequence with two corona virus originating in bats. Since 2003, at least 5 new human corona viruses have been identified, including SARS corona virus, MERS corona virus, NL63 (group I corona virus) and the New Heaven corona virus (Kahn, Jeffrey S, McIntosh and Kenneth, 2005).

SARS, which got outbreak in 2002-2003 from southern China and reported in 29 other countries of Europe, America and Asia. Overall 8098 infected individuals were identified with 774 SARS related fatalities. However these corona virus is believed to be animal origin human coronavirus, the animal reservoir is uncertain; perhaps, bats that spread to other animals (civet cats) has similar genetic characteristics (WHO, 2020c). In 2012, another outbreak from another species of human coronavirus identified with case firstly diagnosed in Saudi Arabia. They named it as Middle East Respiratory Syndrome (MERS-cov) and reported in 27 countries in which 12 countries from Eastern Mediterranean region. Overall 2519 cases were identified and 866 deaths noted due to SARS. Dromedary camels were found major reservoir host for MERS-cov and an animal source of infection in Human (WHO, 2019). While these two novel corona viruses are having epidemic and not yet any preventive vaccine or medicine for treatment available again another virus hit the world with health crisis.

Novel corona virus 2019-nCoV was first identified in December 2019 in Wuhan, China. It is named as Corona Virus Disease-19 (COVID-19) (WHO, 2020b). Since the outbreak due to its rapid human-human transmission it became global pandemic thus, World health organization [WHO] has declared the outbreak of Public Health Emergency of International Concern (PHIEC) on 30^th Jan 2020 and a pandemic on 11^th March 2020. Since 2009, this is the 6^th time WHO has declared PHIEC under International Health Regulations (IHR) (WHO, 2020d). This infection has spread so quickly that within 8 months period 213 countries get infected. Till 10^th September, 2020 globally total 27,688,740 confirmed cases with 899,315 COVID-19 related fatalities. In Nepal from the first confirmed case on January 23, 2020 to till 10^th September 26, 2020 there are 41,219 confirmed cases with 312 deaths from this infection (Worldmeter, 2020). Nearly 15% cases of COVID-19 are among children below 18 years in Nepal which seem to be higher than the global average as in US only 9% of confirmed cases are children said by Sameer Kumar Adhikari, joint spokeperson at Health Ministry (XINHUANET, 2020).

However, from a purely medical perspective, early evidence suggests that children are not the most affected by COVID-19 as children are not on the face of this pandemic. But they risk being among the biggest victims as children’s lives are nonetheless being changed in profound ways. All children, of all ages, and in all countries, are being affected, in particularly by the socioeconomic impacts and, in some cases by mitigation measures that may inadvertently do more harm than good. However this is a universal crisis but for some children the impact will be lifelong (UNICEF, 2020a). The direct impact of COVID-19 infection on children has to date been far milder than for other age groups.

Preliminary data from observed cases in China and the US suggest that hospitalization rates for symptomatic children are between 10-20 times lower than middle aged and 25 and 100 times lower than for elderly (United Nations, 2020). But Some vulnerable groups competed  harder more than direct effects of COVID-19 such as children living in poverty, children with disability, children in out-home care, children in detention and also refugee children and children at risk of child labour because as the COVID-19 crisis spreads around the world, it is transforming children’s day to day lives (OECD, 2020). COVID-19 has economic, health, educational, and child safety effects on child’s life.

Economic Impact

The COVID-19 recession also known as corona virus crash or recession is a major global recession that began as the economic consequences of ongoing COVID-19 pandemic. This recession will be much worse than the most severe global economic recession of 2008-2009 projected by International Monetary Fund (IMF). The Physical distancing and lockdown measures required to save lives and suppress the virus transmission have resulted in sharp decline in economic activity. It has been suspected to increase in extreme poverty (PPP $1.90 a day) this year of 84 to 132 million people, approximately half of whom are children (United Nations, 2020). The ongoing crisis could increase number of children living in the monetary poverty by upto 117 million by the end of 2020 (UNICEF, 2020a).

It is estimated that 86 million more children could pushed into household poverty across low and middle-income countries increasing by 15% and additional 42 to 66 million children will live in extreme poverty (Yoshikawa et al., 2020). In Nepal, it can be surmised that nearly 10 million children are estimated to be poor. The government has identified approximately 1.5 million households thus far as being vulnerable which suggests numbers of children are having effects of this pandemic.  According to UNICEF and Save the Children, children are at risk of child marriage, violence, exploitation and abuse as a result of this economic crisis, with immediate loss of income and inability to provide families with basic necessities such as food, water, health care and education. These effects threaten to reverse the hard-won progress countries have made in recent decades. Immediate health, nutrition, care and education risks exacerbate the deteriorating economic situation

Education Impact

Out of total population of students enrolled in education globally, UNESCO estimates that 89% are currently out of school due to school closures as a result of lockdown. Till now 188 countries imposed school closures affecting more than 1.5 billion children and youth (OECD, 2020; UNESCO, 2020a) among them nearly 743 million are girls. About one thirds of those students are from least developed countries where getting education is already a struggle will now find more difficult to get education (UNESCO, 2020a). Now with this pandemic, different safety measures taken to prevent transmission of this disease lead to economic hardship for many families which will eventually cost counter affect on children’s education as families will try to use those children for income generation purpose and forced them to drop out the school even after this pandemic (UNESCO, 2020b). It can be precedented with the education impact after Ebola epidemic.

During that epidemic, 5 million children were affected by school closures across cities across Africa and poverty level rose significantly as education was interrupted (UNESCO, 2020b). In all countries, this school closures are placing unprecedented challenges on governments to ensure learning continuity and on teachers, students and parents. Prolong school closures are significantly affecting the school calendar. Some countries have adjusted the academic calendar and some have rescheduled examinations. Teachers training, licensing and renewal of teacher license also affected (UNESCO, 2020c). The future is like unknown. Till when closure will continue, from when the regular classes will held, how academic year will start and complete, everything is like suspense till now. To cover up the academic year, various countries are introducing or scaling up existing distance education modalities based on different mixes of technology. More than two-thirds of countries have been introduced a national distance learning platform using internet but among low-income countries the share is only 30% (UNICEF, 2020a; UNESCO, 2020d). In some countries learning content is also delivered through TV and other media.

There is context of widespread digitalization for distance learning and for also for recreational and time spending purpose because of interrupted physical contact. But the poorest children have least likely to have access to online education and homely learning environment with internet connection. This results in education gap between children. In a developing country like Nepal the internet penetration rate is 72% out of which 55% have access to wireless services and 17% wire line internet. However if internet is available also it is difficult to conduct online classes because in some families have only one smart phone or laptop and there are up to 3 children talking classes simultaneously (The Kathmandu Post, 2020 May). At the same time children using more time on screen activity either for online classes or for spending time has negatively affect their health. The physical effects such as computer vision syndrome, eye strain, myopia, backache along with various psychological effects are seen due to prolong use of digital screen. Again with increased digitalization can also magnify risks such as sexual exploitation and cyber bullying if internet use is increasingly unsupervised (OECD, 2020).

Health Impact

In contrast to the direct impact of COVID-19, the broader effects of the pandemic on child health are significant. Multiple ways in which health services are being directly disrupted by the pandemic which includes reduced access to essential reproductive, maternal, newborn and child health interventions such as antenatal care, skill birth attendant at birth, treatment of diseases (United Nations, 2020). These indirect effects are stemming from strained health system, household income loss and disruption to care seeking and preventive interventions like vaccinations may be substantial and widespread (UNICEF, 2020a).

Increasing Childhood Mortality

Reduced household income will force poor families to cut back on essential health and food expenditure. Drawing again on the forecast for global economic growth from IMF and historical relationship between GDP and infant mortality rate in developing world, (United Nations, 2020) hundreds of thousands of additional child deaths could occur in 2020 compared to pre pandemic counter factual scenario. The economic shocks experienced by families because of the global economic downward would effectively reverse the last 2 to 3 years of progress in reducing IMR within a single year (United Nations, 2020).

Water sanitation and hygiene services are also at risk of disruption by lockdown measures, posing further threats to children’s health through water born diseases (UNICEF, 2020c). Other children with chronic illness such as TB, HIV are at risk of reduced access to medicines and care. New HIV infections among young children have decreased by half in the last decade; however service disruptions due to COVID-19 could reverse these gains. The number of new HIV infections is projected to nearly double if 100% of population loses access to treatment services over 6 months period and the pediatric deaths will be similarly soar (UNICEF, 2020a). Before the pandemic, 43% of all children less than 5 years of age in the world were estimated to be at risk of not achieving their developmental potential (United Nations, 2020),  which would double the rate if reduction in essential health services such as disruptions of medical supply chains, availability of human and financial resources occur.

From the previous outbreak of Ebola virus disease and SARS-cov it can be projection of an additional 1.2 million child deaths in 118 countries if coverage of essentials health services drops by around 45% for 6 months (Fore HH, 2020). It has shown that 15% decrease in coverage of life saving essential health interventions for 6 months in low and middle income countries is associated with 9.8% increase in mortality of under-five children. This can be estimated that an increase in child mortality in low and middle income countries as heath services for non-COVID related issues became scarce (Yoshikawa et al, 2020).

Increasing Malnutrition

More vulnerable children are becoming malnourished due to deteriorating quality of their diets and the multiple shocks created by pandemic and its mitigation measures to prevent transmissions of COVID-19 are disrupting food systems, upending health and nutrition services, deteriorating livelihood and threaten food security (UNICEF, 2020a). Hastily implemented lockdown measures risk disrupting food supply chains and food markets.  Families may lose wages and housing and have to bear the costs of increased health care and associated food insecurity.

One study shows that 370 million children among them 47% are female across 161 countries who normally rely on school meals for a reliable source of daily nutrition get hit harder for malnutrition (United Nations, 2020). Recent estimation indicates that in addition to the 690 million undernourished people in 2019, at least another 83 million to 132 million people may go hunger in 2020 (FAO, IFAD, UNICEF, WFP and WHO, 2020). These lead to at least 6.7 million children become malnourished during year 2020 which will be added to already wasted 47 million children and stunted 144 million children before this pandemic (World food programme, 2020). Malnourished children have weakened immune systems and may face a greater risk of dying from COVID-19 on the other hand it may be difficult for these children to access the treatment and care they need to survive and thrive (UNICEF, 2020b).

Deprived from Vaccines

Every year vaccines save an estimated 2-3 million lives, but COVID-19 threatens to roll back decades of progress made in reducing preventable child death by hindering access to these life saving vaccines. Nearly 14 million children did not receive any vaccines and 6 million children received some but not all vaccines in 2019. With addition of this approximately 80 million children under 1 are now at increased risk of vaccine preventable diseases in 68 countries as COVID-19 disrupts routine vaccination efforts (UNICEF, 2020c). Again with COVID-19 putting enormous pressure to already weak and over stretched health systems, the number of unvaccinated and under vaccinated children is expected to increase (UNICEF, 2020a).

The current pandemic situation and its containment measures is applying pressure on global manufacturer production capacities, supply availability and logistics. Polio immunization campaigns have resumed in Afganistan and Pakistan- the last two polio endemic countries in the world after COVID-19 outbreak which left 50 million child without their polio vaccine as a result, reported polio cases have reached 34 in Afganistan and 63 in Pakistan including in some previously polio-free parts of the country (UNICEF, 2020c).  In addition, more than 30 measles immunization campaigns which had cumulatively targeted more than 78 million children have been suspended in at least 23 countries including Nepal (United Nations, 2020; UNICEF, 2020d). Progress on immunization coverage was stalling before COVID-19 hit at 85% for nearly a decade which again will risk of reverse of this hard won progress due to the pandemic. Likelihood that a child born today will be fully vaccinated with all globally recommended vaccines by the time she reaches the age of 5 is less than 20% (WHO, 2020a).

Deteriorate Mental Health

Due to this pandemic 99% of children are living with movement restrictions and almost 60% children in countries where complete and partial lockdown is going on (WHO, 2020b). With physical distancing measures and movement restrictions there is effect on children’s mental health. Being quarantined in homes and institutions may impose greater psychological burden than physical sufferings by the disease. Younger children are of great risk as high levels of anxiety, stress, and extreme deprivation along with social isolation can affect their cognitive brain development which sometimes can trigger irreversible long term mental health challenges (Ghosh, Dubey, Chattarjee and Dubey,  2020).

Children today face anxiety about negative impact of the pandemic on their lives and their communities and uncertainty regarding the future.  Children are likely to be experiencing worry, anxiety and fears and this can include the type of fears that are very similar to those experienced by adults such as fear of dying oneself or their relatives, or fear of what it means and how to receive treatment, fear of society’s perception if one get infected by COVID-19 etc (WHO, 2020a). School closure, lack of outdoor activity, aberrant dietary and sleeping habits are likely to disrupt children’s usual lifestyle and can potentially promote monotony, distress, impatience, annoyance and varied neuropsychiatric manifestations (Ghosh, Dubey, Chattarjee and Dubey,  2020). On the other hand due to school closure not only the education is interrupted but also the children have loss the sense of structure and stimulation provided by school environment because schools are hubs of social activity and human interaction where children have opportunity to be with their friends and get the social support which is essential for good mental well being.

Impact on Child Safety

Crisis could lead to the first rise in child labour after 20 years of progress. Child labour decreased by 94 million since 2000 but that gain is now at risk. Due to COVID-19 and lockdown measures there is substantial rise in household poverty so to overcome this family will use every available measure to survive and eventually child labour will rise. A one percent of rise in poverty could lead to at least 0.7 percent increase in child labour (UNICEF, 2020a) Lockdown and shelter in place measures come with heightened risk of children witnessing or suffering violence and abuse and can expose children to new protection risks. Incidences of domestic violence, child abuse are on the rise (Ghosh, Dubey, Chattarjee and Dubey, 2020).

Being at home due to different mitigation measures to prevent disease transmission can place some children of increased risk of or increases exposure to child protection incidents or make them witness to interpersonal violence. This exacerbates the risks of poor nutrition, experiencing maltreatment and being exposed to violence at home (WHO, 2020a; UNICEF, 2020a; OECD, 2020). Moreover, the children from marginalized communities are particularly susceptible to the infection and may suffer from extended ill-consequences of this pandemic such as child labour, child trafficking, child marriage, sexual exploitation and death (Ghosh, Dubey, Chattarjee and Dubey,  2020). During Ebola disease crisis adolescence pregnancy increased by 65% in some communities (UNESCO, 2020c), so same prediction can be made here because of the girls’ dropout rate from school and child marriage can be the consequences of poverty after this pandemic.

Conclusion

The corona virus was first diagnosed in animals in 1937 and in humans in 1965. Now, the whole world is being affected by this virus and the Nobel Corona Virus 2019 (2019 – nCoV, or COVID-19) has became pandemic. Everyone knows about its direct effect on humans but the fact is that the effects of this disease and its mitigation measures among children are rarely noticed. In addition to getting infected with the virus, children may still be vulnerable to the effects of this pandemic. Government mitigation measures to control the disease, which prevent their parents from making a living, children, also get struggled. Children can lose a parent or adult caregiver to the disease. School closures, home quarantines, and psychological problems add to the negative impact on children’s emotional, social and physical well-being.

Although the morbidity and mortality rate due to the infection in children is relatively low, the unseen impact on children’s economic, educational, and health protection is significant. This effect is not only for present but it also has long term effects in the aftermath of this disease. Immediate and remote risk on health, nutrition, care and education will be exacerbating along with risky economic situation. All the children get affected directly and indirectly but the young children for health and lives, adolescents for child labor and abuse, girls for child marriage, adolescent’s pregnancy and school dropout and vulnerable groups for deteriorate psychological well being, child labor, poverty will have significant impact.

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Shree Prasad Devkota is a member of the TRANSCEND Network for Peace, Development and Environment. He is a Kathmandu University graduate, has a Master’s in Mathematics Education and M.phl in Development Studies. Currently he is chairperson of SDEF–Sustainable Development and Empowerment Forum, and has worked as a lecturer. He is researcher in the field development sectors in Nepal and has worked as consultant, monitoring and evaluation expert in different I/NGOs. Devkota has been working in the field of education of children, marginalized and socially excluded groups, especially on conflict management regarding the post-conflict situation in Nepal. He has published several research articles in national and international journals. Books: Teacher’s Lived Experiences and Contextualized Mathematics, LAP Lambert Academic Publishing, Germany, 2012. Education in Nepal from Dalit Perspective, LAP Lambert Academic Publishing, Germany, 2013. Conflict in School and Its Management, with Shiba  Bagale, Scholars’ Press, Germany, 2015. Life and Education of Children in Nepal (Pre and Post Peace Agreement a Comparative Study) Adroit Publishers , India,2017.

Ms Laxmi Paudyal is currently working as Lecturer at Gandaki Medical College Teaching Hospital and Research Center. She had completed her Masters in Nursing (Msc Nursing) in Pediatric Nursing from Rajiv Gandhi University of Health science in 2016 AD, Master in Sociology and Bachelor in Nursing (PBBN) from Tribhuwan university.She has teaching experience in different nursing colleges on different nursing subjects. She has clinical experience as staff nurse in different hospitals and she is also working as resource person in Sustainable development and empowerment Forum since 2013 AD. She has various publications of research articles in different journals and published books. She is editorial board member of Social Inquiry Journal of Social Science Research and also is a life member of Nursing Association of Nepal).

This article originally appeared on Transcend Media Service (TMS) on 14 Sep 2020.

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