Understanding Child Health in the Context of COVID-19

“The most significant threat to global child health from SARS-CoV-2 is unlikely to be related to COVID 19 in children, but rather the socio-economic consequences of a prolonged pandemic.”1

Photo of a woman with a baby on a hospital bed.
Photo credit: Kate Holt/MCSP

The Child Health Task Force is a global network of implementing organizations; NGOs; academic institutions; UN, multilateral, and bilateral agencies; in-country partners; and individuals working together to support the delivery of high quality child health services.

During the COVID-19 pandemic, we will continue to convene and coordinate stakeholders to share knowledge and innovative solutions to programmatic issues to stem the direct and indirect impact of the pandemic on children. We will collaborate with our partners to develop new tools and improve existing ones, and work with country partners to translate evidence about the pandemic into stronger child health programs, enabling children to survive and thrive during and after the pandemic.


What We Know

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Much of the published data and focus of the COVID-19 pandemic has been on adult patients, leaving behind a large knowledge gap for child health service providers and global partners assisting in the pandemic response. The body of information regarding clinical features of the coronavirus in children and adolescents is growing, but questions remain. 

  • Children of all ages are susceptible to COVID-19, with more cases being reported in younger children and infants.1
  • Children with COVID-19 express milder symptoms than adults, but the prevalence of COVID-19 in children is not well documented. This may be due to the fact that children are not as likely to be tested.4
  • While pediatric COVID-19 is often milder than that in adults, it can progress to severe disease in some cases.4
  • The majority of COVID-19 cases in children are transmitted through contact with adult patients, usually through household exposure. Numerous family clustering cases of COVID-19 have been reported in China, where one study estimated the secondary attack rate within a household to be 3-10%.4
  • Direct transmission from a child to an adult has not yet been reported, but children could be playing a role in the spread of the disease in the community and social distancing measures continue to be recommended for all ages.4,6
  • The climate of fear and economic uncertainty during the pandemic may contribute an even greater health impact on children, as parents or family members delay care-seeking for other childhood illnesses.1
  • Reports from Europe and North America in late April/early May 2020, have described clusters of children and adolescents requiring admission to intensive care units with a multisystem inflammatory condition with some features similar to those of Kawasaki disease and toxic shock syndrome. Initial hypotheses are that this syndrome may be temporally related to COVID-19 based on initial laboratory testing showing positive serology in a majority of patients.13

Points taken from featured journal articles here.


Additional Research Needs

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  • Understanding the differences in clinical features of COVID-19 by age.
  • Evaluating the role of children in community transmission.
  • Gathering data on predictors of mortality in children and the severity of the disease in children with malnutrition, rheumatic heart disease, or HIV positive children.
  • Monitoring the indirect impact of the COVID-19 pandemic on child health and development.

Featured Journal Articles

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  1. Coronavirus Disease (COVID-19) in Children - What We Know So Far and What We Do Not? 
  2. Novel Coronavirus 2019 (2019-nCoV) Infection: Part I - Preparedness and Management in the Pediatric Intensive Care Unit in Resource-limited Settings
  3. Novel Coronavirus 2019 (2019-nCoV) Infection: Part II - Respiratory Support in the Pediatric Intensive Care Unit in Resource-limited Settings
  4. Epidemiology and Clinical Features of Coronavirus disease 2019 in Children
  5. Novel coronavirus infection in children outside of Wuhan, China
  6. Coronavirus Disease 2019 in Children — United States, February 12–April 2, 2020
  7. Diagnosis, treatment, and prevention of 2019 novel coronavirus infection in children: experts' consensus statement
  8. Diagnosis and treatment recommendations for pediatric respiratory infection caused by the 2019 novel coronavirus
  9. Diagnosis and treatment of 2019 novel coronavirus infection in children: a pressing issue
  10. COVID-19 in Children: Initial Characterization of the Pediatric Disease
  11. Epidemiological Characteristics of 2143 Pediatric Patients With 2019 Coronavirus Disease in Chin
  12. Early Estimates of the Indirect Effects of the Coronavirus Pandemic on Maternal and Child Mortality in Low- and Middle-Income Countries
  13. Multisystem inflammatory syndrome in children and adolescents with COVID-19
  14. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study

COVID-19 Resources for Child Health Stakeholders

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We have identified key resources that child health stakeholders should be aware of in order to best support countries to continue providing life-saving child health services during the COVID-19 pandemic. Please email childhealthtaskforce@jsi.com with any additional resources to feature on this page.

Please note that the Child Health Task Force has not created these materials and all rights belong to the authoring organizations.

Operational Guidance

  • Operational Planning Guidelines to Support Country Preparedness and Response: WHO's overarching practical guide for UN Country Teams and partners to develop a COVID-19 strategic Preparedness and Response Plan to provide immediate support to national governments to prepare for and respond to COVID-19. 
  • COVID-19: Operational Guidance for Maintaining Essential Health Services During an Outbreak: This document expands on WHO's Strategic Preparedness and Response Plan. It provides guidance on a set of targeted immediate actions that countries should consider at national, regional, and local level to reorganize and maintain access to essential quality health services for all. Section 2, “Identify Context-Relevant Essential Services,” is particularly important to maintaining access to life-saving child health services during this time.
  • Interim Guidance - COVID-19 Prevention and Control in SchoolsThis UNICEF document provides clear and actionable guidance for safe operations through the prevention, early detection, and control of COVID-19 in schools and other educational facilities. It is also available in French, Spanish, and Arabic.

Clinical Guidance 

  • Clinical Care Guidance, Children with COVID-19: This guidance from the U.S. Center's for Disease Control and Prevention (CDC) provides healthcare providers with up to date information available on children with COVID-19 and current treatment practices for managing pediatric patients.
  • Clinical Care of Severe Acute Respiratory Infections (SARI): This toolkit is intended for clinicians working in acute care hospitals in low- and middle-income countries, managing adult and paediatric patients with acute respiratory infection, including severe pneumonia, acute respiratory distress syndrome, sepsis and septic shock.
  • Interim Guidance: Clinical Management of SARI when COVID-19 is Suspected: This WHO document is intended for clinicians taking care of hospitalized adult and pediatric patients with severe acute respiratory infection when COVID-19 infection is suspected. It is not meant to replace clinical judgment or specialist consultation but rather to strengthen clinical management of these patients and provide to up-to-date guidance. Best practices for SARI including IPC and optimized supportive care for severely ill patients are essential.
  • WHO Case Report Form and Scientific Brief: Multisystem inflammatory syndrome in children and adolescents temporally related to COVIDIn response to reports from Europe and North America describing clusters of children with a multisystem inflammatory condition potentially linked to COVID-19 and the urgent need for collection of standardized data describing clinical presentations, severity, outcomes, and epidemiology, WHO has developed a preliminary case definition and case report form for multisystem inflammatory disorder in children and adolescents and encourages pediatricians across the world to use this form to report these cases if seen. 

Community Care & CHWs

Commodities & the Supply Chain

Nutrition

  • FAQ & Decision Tree: Breastfeeding & COVID-19 for Healthcare Workers: This FAQ complements the WHO interim guidance: Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected and provides responses to questions that have arisen about the recommendations.
  • Infant and Young Child Feeding Recommendations When COVID-19 is Suspected or Confirmed: A new counselling package has been developed in collaboration between UNICEF and USAID Advancing Nutrition, with technical support from the Infant Feeding in Emergencies (IFE) Core Group, represented by Save the Children and Safely Fed Canada. The package includes 10 Counselling Cards and a Recommended Practices Booklet, reflecting global guidelines. The package provides both easy-to-understand recommended practices for counselors and user-friendly graphics that can be used with low-literacy communities in different contexts.

Private Sector Engagement

Country Documents

 
For a comprehensive suite of COVID-19 information,
check out the Johns Hopkins University Coronavirus Resource Center.

Webinar Series: Child Health & the COVID-19 Response

April 23, 2020 - Experiences from Bangladesh and Pakistan

May 7, 2020 - Community Response Efforts

May 21, 2020 - Partner Collaboration in the Response