Children are fortunately minimally affected by COVID-19. Despite early reports of a new inflammatory syndrome, children are much more likely to be severely unwell or die from illnesses that we consider ‘normal’, including influenza and pneumonia. This applies to most children with chronic medical conditions such as asthma and type I diabetes.1 This became clearer and clearer as the pandemic progressed, and calls for UK schools to reopen were made by experts as early as April 2020 based on data from around the world. School closures were based on the risk of transmission but current reviews and modelling have questioned the overall benefit.2
During lockdown there is clear evidence of massive reduction of children being brought for emergency medical treatment,3 child protection investigations have decreased in number despite the increased risk of abuse and neglect,4 health visiting services have reduced in many areas despite the importance of the earliest moments of a child’s life on their health and development,5 and vaccination services were stopped and have been slow to recover.6 This was coupled with the closure of playgroups, nurseries, breastfeeding support groups and numerous other child health and wellbeing organisations and activities.
The impact of these service closures has hit the poorest hardest. The COVID-19 crisis has been described as a ‘watershed moment for health inequalities’.7 The poorest and marginalised groups have the worst outcomes from COVID and are also likely to face further hardship in an ensuing recession. Crucial to health outcomes are the social determinants of health. Any future austerity measures will shrink already diminished services, reducing the capacity of both preventive and curative health and care services.7 Inequalities in educational attainment are also likely to widen, with long-term impact on health and wealth.8
Overall, it is reasonable to say that lockdown was a policy designed to protect adult lives, particularly the most elderly and vulnerable. Of course protecting adults is important for child wellbeing but the extent to which children should have been included in this broad-brush policy is debatable. The British Paediatric Surveillance Unit and Royal College of Paediatrics & Child Health have raised concerns that the benefits of ‘lockdown’ may be “overshadowed by the negative consequences of the lockdown”.9 With the possible exception of the discussion over schools, during this period children retreated from being an issue of public policy importance to being left only for parents and carers to deal with.
The political wrangling around COVID-19 responses has been a reminder of the low status of child health and rights. The UK government did not speak directly to children/young people until day 35 (19 April 2020) during their briefings where child needs went virtually undiscussed. But this is a moment to reflect on where we go next. We have seen what streets without cars feel like, and the safety enjoyed by children and young people during their daily walks, with the likely improvements in respiratory conditions. The government has signalled its intent to boost and fund walking and cycling, and this should include school-streets for every school. Given the increased risk of COVID-19 transmission indoors, children can be encouraged to spend as much time as possible outdoors – this will have myriad benefits for physical and mental health. Importantly, we must include the voices of children and adolescents to inform policy making10 and focused local public health responses are needed for future spikes in cases.2 Perhaps as we enter the next phase of the pandemic we can turn our thinking around, we can choose to put the needs and rights of children first – we can choose a different path.
Photo credit Robert Collins