Cesar Chelala
A physician and writer

 Children are the most vulnerable victims of COVID-19

The COVID-19 pandemic will continue to have serious effects worldwide long after the crisis has passed. Pediatricians and public health experts have been calling attention to an increasingly serious problem: the effects of the COVID-19 pandemic on children’s and adolescents’ physical and mental health.

Although COVID-19 is mostly benign in children, causing mild flu-like symptoms, it can also have effects beyond the disease itself. Children can develop multisystem inflammatory syndrome in children (MIS-C), a rare but serious condition.

MIS-C is characterized by inflammation of multiple areas in the body and, although its cause has not been yet determined, many children with this condition have had the virus that causes COVID-19, or have been exposed to someone with the infection. According to the Centers for Disease Control and Prevention (CDC) as of October 4, 2021, 5,217 cases of MIS-C had been reported in the U.S., including 46 deaths.

In addition to the risk of children contracting MIS-C, their mental health has been negatively impacted by COVID-19. From a young age, socialization is critical for children’s development. The isolation measures imposed by the pandemic have severely curtailed these activities resulting in a wide array of mental, emotional and behavioral health issues.

Particularly for older children, isolation measures to contain the pandemic have decreased opportunities to build crucial social-emotional peer relationships. Globally, 188 countries have imposed countrywide closures, affecting more than 1.5 billion children and youth.

Mental health issues in children have been aggravated by the pandemic in the form of school closures, which have made school-based mental health services unavailable for children. UNICEF estimates that, globally, schoolchildren have missed 1.8 trillion hours of in-person learning since the beginning of the COVID-19 pandemic and subsequent lockdowns. The children’s agency urges governments, local authorities and school administrations to reopen schools as soon as possible, taking all possible precautions to mitigate transmission of the virus in schools.

Anxiety and depression make up about 40 percent of the mental health problems children suffer which are aggravated by the pandemic. Studies show that symptoms of anxiety and depression have approximately doubled compared to pre-pandemic levels among children and adolescents. Children living in institutions and migrant children are particularly vulnerable.

The pandemic has also increased families’ economic strain. Poor families struggling to pay for rent and food face considerable difficulties in providing for their children’s most basic needs. At the same time, loss of income often provokes stress within the family, which may manifest as domestic violence between parents or against their children.

As the death toll of over 700,000 in the U.S. continues to climb, many children and adolescents have to confront the traumatic experience of losing a parent or a sibling. According to one estimate, 40,000 children have lost a parent to the coronavirus in the U.S. This leaves them at elevated risk for depression, anxiety and poor educational outcomes.

Stressful events, called Adverse Childhood Experiences (ACEs), have short and long-term consequences, including children’s impaired cognitive and emotional development. According to UNICEF, exposure to at least four ACEs is strongly associated with sexual risk-taking, mental health conditions and alcohol abuse later in life.

Mental health is not among governments’ priorities. At a global level, expenditure on mental health is only around 2.1 percent of the median government expenditure on health.

Chronic lack of investment in mental health means that health personnel are not properly trained to address mental health concerns. In addition, widespread stigma of mental health deters children’s parents and young people from seeking treatment, thus limiting their opportunities for emotional healing and social development.

The UN states, “What started as a public health emergency has snowballed into a formidable test for global development and for the prospects of today’s young generation.” The COVID-19 pandemic has created an opportunity for governments to properly address mental health issues for children and adolescents. And they must. The future of our youth depends on it.

Dr. César Chelala is an international public health consultant and the author of Adolescents’ health in the Americas, a publication of the Pan American Health Organization.

About the Author
César Chelala is a physician and writer born in Argentina and living in the U.S. He wrote for leading newspapers all over the world and for the main medical journals, among them The New York Times, The Washington Post, The Wall Street Journal, The Japan Times, The China Daily, The Moscow Times, The International Herald Tribune, Le Monde Diplomatique, Harvard International Review, The Journal of the American Medical Association, The Lancet, Annals of Internal Medicine, and The British Medical Journal. He is a co-winner of an Overseas Press Club of America award and two national journalism awards from Argentina.
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