By Tom Davis, World Vision Int, lead for health and nutrition
When my daughter was six weeks old, we almost lost her to a respiratory virus, so I understand the panic that some parents may be feeling right now as COVID-19 spreads to more and more communities. Surviving close calls is part of being a parent -- who doesn't have a story? But, we become informed and we learn things along the way, including how to live with a certain amount of anxiety and to trust our ability to protect our precious children from more serious future harms. Amidst the cacophony of coronavirus conversations, many are wondering just how dangerous the infection is to children.
The good news is that so far children seem to be remarkably resilient to the virus. Researchers at Johns Hopkins Bloomberg School of Public Health and in China looked at 72,000 COVID-19 cases from China and found that only 1 in 500 (0.2%) of children aged younger than 19 years died from the virus and there was not a single child death among children 0-9 years. (Feeling better?) Very few hospitalisations were also recorded. However, it is still early days and the picture could change as more research is done and as this health emergency unfolds, so we cannot let our guard down. The medical community is still unsure about why children seem to fare better when they have the virus. They may simply be fitter and more able to fight infection and recover.
Still, this good news is no reason to be complacent about children as this threat unfolds. The impact of the virus on children - especially in poorer parts of the world - has yet to be factored in simply because -- for the most part -- COVID-19 has so far mercifully not spread to much of sub-Saharan Africa, countries in other parts of the world with weak health systems or to regions of the world with high refugee numbers. And, even if the mortality rate for children remains low for this virus, we can expect major impacts when young children lose their caregivers. We learned valuable lessons from the HIV/AIDS crisis about the substantial risks that children face when they are orphaned by a killer disease.
Another reason not to be complacent is that grandparents, elderly neighbours, family members with other severe illnesses, and those with low immunity to disease are at higher risk of dying. The same research that reported zero deaths among children also found that nearly 15% of those aged over 80 died following COVID-19 infection. Those with asthma, diabetes and heart disease are also at greater risk of succumbing to the virus. We do not fully understand the degree to which children may be transmitting COVID-19 to their caregivers and others, but we must act with limited data: Parents and caregivers must be vigilant about encouraging children to develop habits that will reduce the chance that they will get the virus or pass it on to these other groups who may be at much higher risk of serious disease.
Children should be regularly and thoroughly washing their hands with soap or sanitizer many times a day, and applying good respiratory hygiene: coughing or sneezing into their elbow or even better into a tissue that then immediately gets safely thrown away. Caregivers can help by not sending children to school or public events when they are ill and doing the same themselves.
COVID-19 appears to be more than twice as infectious as the typical seasonal flu. Schools can be hotspots for viral transmission, since there are often lots of boys and girls sitting and playing in close proximity to each other, engaging in rough and tumble play in the playground and touching classroom door handles that scores of others have handled. While it may seem scary to both children and parents to shut down schools, the main reason some countries like Italy and China have closed them down is because children might carry the virus home or into the community where those who are much more susceptible to the disease live.
As more and more hospitals and intensive care units become overwhelmed, children will also be put at higher risk. With fewer beds to go around and medical staff under severe strain, there will be less capacity to treat patients with other medical conditions and children may be among them.
While these additional risks to children may be mild in higher-income countries, they will be greatly magnified in poorer countries. Public health experts are watching COVID-19’s spread into additional countries in sub-Saharan Africa and fear what may happen when it reaches refugee camps and dense urban settlements since a shortage of hospitals and ICU facilities could mean life or death in those places. The mortality rate for COVID-19 in these countries could be much greater than what we have already witnessed simply because advanced and even basic medical care is much less available. The prevalence of other diseases such as malaria, pneumonia, HIV/AIDS, and TB will also mean that many people -- including children -- will be trying to fight COVID-19 with compromised immune systems and complicating factors.
When children in these places lose their mums and dads, grandparents, other caregivers and elderly loved ones in much greater numbers, they will also experience much more vulnerability. In the poorest places, some children will simply not be able to survive and may choose to resort to desperate measures that include having to beg on the streets, leaving school to work or even having to sell themselves. We have seen it before with HIV/AIDS, Ebola and other killer diseases, and we must act now to avoid this loss of life.
As always, World Vision is hard at work trying to keep children and their caregivers safe. In Asia, we have been working for weeks to promote prevention behaviours and to educate communities on how to keep themselves safe, providing protective equipment to health workers, engaging with government health authorities and planning next steps on how to respond. And, our workers in countries with weaker health systems are taking steps to reduce the impact that COVID-19 will have when it arrives at their doors. This is not a time to panic. The containment efforts to date have bought us some time and we need to use it wisely to prepare every country and every family. We are all survivors. We can do this.