COVID-19 has exposed the need for health system assessments to be more child health-sensitive

Abstract

The COVID-19 pandemic is directly and indirectly impacting children’s health. Although the evidence base in this area is expanding, there is still much we do not know. Paediatric Multisystem Inflammatory Syndrome temporally associated with COVID-19 (MIS-C: Multisystem Inflammatory Syndrome – Children) and long COVID are the most notable direct effects of COVID-19 infection on children, though they are rare. Data suggest that children represent a very low proportion (between 1 and 3% of the total) among known COVID-19 infections, at least in the early stages of the COVID-19 pandemic. However, because children are likely to have a higher proportion of asymptomatic infection than adults, this might be an underestimation. The most significant population-level health harms for children from the pandemic are indirect, reflecting the impact of health system adaptations and policy changes such as elective care postponement and cancellation and possibly remote (instead of face-to-face) consultation which remains unevaluated. Evidence is emerging from a variety of different countries, illustrating the breadth of problems. In England, a large national longitudinal study found an increase in the rates of probable mental health disorders among children aged 5-16 before (10.8% in 2017) and after (16% in 2020) the pandemic. However, more than a fifth of children and 44.6% of 17-22-year-olds with a probable mental health disorder did not seek mental health service support due to the pandemic. Similarly, a very stark drop in accident and emergency attendances for mental health problems during and after the first COVID-19 policy measures and a steep rise in the first months of 2021 were reported in Scotland. Emergency Department contacts among children in England fell to 40% below usual levels during the peaks of the pandemic, affecting all types of presentation, ranges of acuity, and age groups. In Romania, hospitalization rates of children fell by 70% since the beginning of the pandemic and have not reached pre-pandemic levels. It is unknown if this drop is affected by limited access due to COVID restrictions or by other factors, such as a lower infection rate due to social distancing. The rapid and necessary scaling down of health care to redeploy paediatric and child health staff to adult services may have led to dangerous disruptions to the delivery of timely and high-quality health care for children, especially for those with chronic illness, disabilities and for those already experiencing barriers in access to care before COVID-19, such as minority ethnic groups including Roma and Travellers populations. Notably, there is no ethical framework for decision-making that considers children’s rights in such situations. Importantly, health system changes resulting from the pandemic also include creative innovations such as new ways of delivering outpatient services and the widespread adoption of technological solutions for delivering remote consultations which may enable families to access the health care they need. These innovations must be urgently evaluated for impact on health and equity of care, especially for specific populations with distinct needs such as neurodivergent children, vulnerable children, and children with communication needs.

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DOI

https://doi.org/10.7189/jogh.12.03048