Protecting Children From COVID-19 Had Unintended Negative Consequences

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COVID-19 mitigation strategies were established in order to decrease viral transmission and to support health care delivery systems; however, these did not happen without consequences for both children and their caregivers. Many of these effects are ongoing.

Judy Guzman-Cottrill, DO, FSHEA, FAAP, professor of pediatrics and infectious diseases at Doernbecher Children’s Hospital, Oregon Health & Science University in Portland, Oregon, and colleagues discussed this topic in the opening plenary at the Society for Healthcare Epidemiology of America (SHEA) Spring conference, held April 12-14 in Colorado Springs, Colorado.

More than 167,000 children under 18 lost a parent or other in-home caregiver to COVID-19. When a national emergency was declared in the US on March 13, 2020, hospitals and clinics quickly implemented strict mitigation policies, including declaring that SARS-CoV-2 is a novel virus putting everyone at risk. The hospitals were overwhelmed with COVID-19 patients, so they limited visitors, employees, and staff, and telehealth rapidly increased. Outside those health care facilities, the personal protective equipment supply chained was overwhelmed. However, school closed and stayed closed, but not all students had home internet service, video devices, or space at home for instruction. Later, when the schools did re-open, not all districts opened the same with varying timing for returning to the classroom and masking, distancing, testing, extracurricular activities, and how those rules would be implemented.

For other health care facilities like ambulatory clinics and outpatient programs, strict screening processes and restrictions for staff, patients, family members, and visitors were implemented, so patients had decreased access to care. Because ambulatory care clinics turned to telehealth visits only, the quality of care diminished for some services via telehealth (eg, mental health), the lack of physical examinations led to delayed diagnoses, and the lack of in-person encounters lead to no in-person interventions.

A key situation affecting infection prevention and control included children who were not diagnosed with cancer or inoculated with everyday vaccines like MMR and then spreading the disease. Leading the problem to these situations, not all families have access to electronic devices or internet.

Pandemic-related mitigation strategies in K-12 schools did protect immunocompromised children and those with chronic conditions because they were safer with distance learning even though the severity of pediatric disease was unclear, and the pediatric contribution to viral transmission was unclear.

The mitigation strategies intended to protect children from COVID-19 and spreading it to their more-vulnerable parents and caregivers. However, the strategies led to delayed diagnoses of serious diseases and substantial decrease in routine pediatric immunization rates. Separating children from their schools and everyday lives increased anxiety and depression, too, often leading to higher suicide rates. Since not everyone has internet and device access, students and their families “became lost” in both our health care and education systems. The ramifications of these strategies on mental health, however, continue beyond the COVID-19 pandemic.

One of the highlights of the presentation concerned a young girl with mental illness.“There was this girl, Sophie, [who] was a 16 year-old teenager with depression. And she was telling how all of a sudden, she had to be without her parents for two weeks or more,” said a participant at the SHEA Spring Conference who also watched this presentation, Nicole Mongilardi, MD, University Hospitals, Cleveland, OH, and a fellow in Infectious Diseases at Case Western Reserve University, Cleveland, OH. “And then her parents were all her life and all her support and having had a suicidal attempt, and then not being able to be with them. [It] was the heartbreak and really moving.”

“One important message regarding suicide/suicide attempts is that rates have not increased significantly during the pandemic…instead, an already increasing rate before the pandemic has continued,” Kyle Johnson, MD, professor of child psychiatry, University of North Carolina, Chapel Hill, said during the presentation. “The pandemic has undoubtedly had an impact on youth mental health…This point is important though as we do not just want things ‘to go back to normal’ once the pandemic ends.”

Conversely, some benefits were profound despite the negatives. The mitigation strategies led to decreased risk of infection and transmission of COVID-19, including for the highest-risk children. While some children faltered and even failed with the lack of in-person learning, other children benefitted from distance learning.

“[The presenter] also showed the two spectrums [both positive and negative of the mitigation strategies]. this teenager, Miles, who actually did benefit,” Mongilardi told ICT®. He had a lot of peer pressure and bullies in school, so he did benefit from from the pandemic that allowed him not to be concerned with [bullying[ for the time he needed [to be virtual learning] and not being singled out… The majority [situation, however,] was so challenging.”

For the COVID-19 pandemic and any future pandemics, health care workers, parents, and educators cannot overlook the challenges that remain: the unacceptable disparities that exist when it comes to health care access and childhood education; susceptible children and adults will be at higher risk of developing vaccine-preventable disease; too many children and teens in our country were suffering before the pandemic; and the rates of anxiety and depression continue to increase. Finally, if the pandemic has shown anything more clearly, it is that the lack of access to mental health care continues to be a crisis in the US.