Impact of the COVID-19 pandemic on children

A systematic review notes that children with COVID-19 have milder effects and better prognoses than adults. However, children are susceptible to "multisystem inflammatory syndrome in children" (MIS-C), a rare but life-threatening systemic illness involving persistent fever and extreme inflammation following exposure to the SARS-CoV-2 virus.
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.
Illness.
When a child is infected with COVID-19, they are more likely to have an asymptomatic case, or one that is mild to moderate in severity. They are less likely to become infected or hospitalized than adults.
Severe illness is possible, and in these instances respiratory support, such as a ventilator, may be required. Some children have experienced multiple organ failure. Such severe or critical cases were most common among children with certain underlying conditions, such as for example, asthma (and especially more severe cases of asthma) or those with weakened immune systems. Children are associated with lower mortality rates than other age groups, when infected with COVID-19. They are more likely to experience gastrointestinal symptoms than adults.
The most common symptoms among children include fever symptoms, followed by a dry cough. Other commonly reported symptoms among children include nasal congestion or runniness, fatigue, and headache. Some evidence suggests that many children who become ill develop "long COVID".
Early into the pandemic, dermatologists reported an increase in chilblains-like lesions in children, especially on their feet, fingers, and toes. It has been informally referred to as "COVID toes". This was presumed related to COVID-19 infection, however confirming that a child has been infected can be difficult.
Some children who become infected develop a rare condition known as MIS-C, short for "multisystem inflammatory syndrome in children". This causes a persistent fever and extreme inflammation. Other symptoms associated with MIS-C include severe abdominal pain and hypotension.
Education.
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 student life.
A comprehensive global study (Aristovnik et al., 2020) provides systematic meaningful insights into students’ satisfaction and perception of different aspects of their lives during the first wave of the pandemic, including their opinions on the immediate and distant future. The study found that teaching staff and universities’ public relations offered students the most important support at the university during the pandemic. On the other hand, the lack of computer skills and the perception of a relatively higher workload prevented students from perceiving a higher performance while adapting to the ‘new normal’; namely, education from a distance.
During the lockdown, students primarily raised concerns about their future professional career and study issues and were mainly bored, anxious, and frustrated. They also changed some of their hygienic behaviours such as regularly wearing masks and washing hands, and daily routine habits like leaving home and shaking hands.
While the role of both hospitals and universities appears to be positive, governments and banks did not meet the students’ expectations during the pandemic.
Socio-demographic (and geographic) factors also played an important role in the students’ perception of different aspects of academic work/life. The empirical results suggest that the transition from onsite to online lectures due to the COVID-19 crisis had a stronger effect on males, part-time students, undergraduate students, applied sciences students, students with a lower living standard, and students from less developed regions (in Africa and Asia), while the pandemic generally had a greater effect on students who were female, full-time, undergraduate and had financial problems with respect to their emotional life and personal circumstances. The results also demonstrate that more hopeful and less bored students, students who were more satisfied with their academic work/life, social science students, students with a better living standard (with a scholarship and/or the ability to pay the overall costs of study), and those who were studying in Europe showed greater satisfaction with the role and measures of their university during the COVID-19 crisis.
A Reuters national survey conducted in the US indicated serious mental health consequences resulting from school shutdowns and the pandemic. This affected both students and their teachers. 90% of school districts surveyed said that their district was experiecing higher "absenteeism or disengagement", and 74% of districts indicated increasing mental stress among students.
Mental health.
Drug and alcohol abuse among minors fell during the pandemic, as did arrests. Mental health visits saw a 24% increase for children ages 5 to 11, and 31% for older minors. Many children became more vulnerable to mental health conditions such as depression and anxiety due to the pandemic and its consequences, among which social isolation has been a contributing factor to a decline in mental health quality. Zanonia Chiu, a psychologist from Hong Kong, said about depressed children: "Now that schools are closed, some lock themselves up inside their rooms for weeks, refusing to take showers, eat, or leave their beds." Increased rates of domestic violence were reported during the pandemic, and this has included an elevated risk of child abuse internationally.
Health and development.
Increased stress for parents and caretakers, risk of infection, and social isolation threaten the health and development of children, and can contribute to adverse childhood experiences. Stressful pressures such as these can negatively impact a child's neurological development, especially in infancy or early childhood, including as a contributor to depression in adulthood.
A report in The Lancet indicated that the COVID-19 would indirectly result in elevated maternal deaths and infant mortality, due to disrupted access to healthcare and food. According to the report, "Our least severe scenario ... over 6 months would result in 253,500 additional child deaths and 12,200 additional maternal deaths." Children risk losing caregivers to COVID-19. The pandemic and its consequences can cause decreased access to resources such as water, social work or medical care for vulnerable populations. Poverty among children has increased. Long-term physical inactivity resulting from social distancing and lockdown measures result in less physical fitness for children, including higher childhood obesity and disruption of sleep patterns. Lack of physical access to school resources can also heighten food insecurity for poor students.
Additional millions of children worldwide are expected by UNICEF to experience food insecurity and malnourishment. Immunization efforts regarding diseases other than COVID-19 have been impacted, which will increase child deaths. According to UNICEF, over 94 million children were expected to miss measles shots, and an increase in HIV infections among children was expected if health services were disrupted. Stillbirths are expected to increase, due to disrupted access to health services.
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. The Rape, Abuse & Incest National Network reported in April 2020 that for the first time, over half of the victims calling their National Sexual Assault Hotline for help were minors.
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.
Vaccines.
As of September 22, 2020, no vaccine trials were being conducted on children under the age of 18 years. According to the CDC, adolescents ages 16 or 17 are eligible for the Pfizer COVID-19 vaccine, but not the Moderna or Janssen (Johnson & Johnson) vaccines. As of March 2021, Moderna and Pfizer/Biotech had begun conducting vaccine trials for children, and Johnson & Johnson planned to do so as well.