The SARS-CoV-2 pandemic is a global emergency that has significantly altered healthcare systems and created understandable concern for those who deliver these services to children. At the same time the direct clinical impact of the SARS-COV-2 virus on children has been limited. While a potential SARS-COV-illness, tentatively called Paediatric Inflammatory Multisystem Syndrome, has resulted in deaths it remains a relatively rare consequence of the disease. Multiple studies have shown relatively little serious illness and there is growing evidence that children themselves are comparatively resistant to carriage and transmission [1]. For those keen to assist in improving the care of children this is a difficult dichotomy as it becomes apparent children are not going to have a significant role in determining our exit from the pandemic.
It is without doubt though that system change is impacting on children. Credible concerns regarding collateral damage to those without SARS-COV-2 infection and the rise in potential safeguarding cases need to be addressed [2]. One mechanism of improving healthcare delivery to vulnerable children would be to continue to safely re-open schools, admittedly something that has required covid-19 research in children to demonstrate. [3] However, there is now a real danger that research and academic efforts will concentrate on the virus itself, its recognition and its immediate impacts, rather than the systems needed to protect children. Sero-surveillance studies are already underway in the UK, as are studies to assess potential links to rare, childhood hyperinflammatory syndromes and covid-19. Do we need further evidence now or should efforts concentrate on the unintended consequences of health system reconfiguration and how we can best deliver care in an isolated, socially distanced world?
Some of the changes to clinical practice have probably been needed for some time. These include a complete review of the necessity of regular out-patient follow up and new mechanisms for educating at scale and at distance using technology. [4] Others, such as the ability to reach out to children at risk of abuse and aid those with severe chronic conditions need rapid solutions. These endeavours do not neatly fall under the National Institute for Health Research (NIHR) covid-19 priority themes, yet they are essential to deliver safe care in the future. The health of children and young people is clearly a priority to all paediatricians and those who work in child health. While we do not dispute that basic science and clinical research must still be undertaken we must now proactively turn our focus to ensuring research into optimising health systems and outcomes for children during and after the covid-19 era is prioritised.
Damian Roland, Honorary Associate Professor and Consultant in Paediatric Emergency Medicine, Children’s Emergency Department, Leicester Royal Infirmary.
Alasdair Munro, Clinical Research Fellow in Paediatric Infectious Diseases, NIHR Clinical Research Facility, University Hospital Southampton, NHS Foundation Trust, Southampton.
Competing Interests: none declared
References:
- Munro, A and Roland D. The missing link? Children and transmission of SARS-CoV-2, Don’t Forget the Bubbles, 2020. Available at: http://doi.org/10.31440/DFTB.25585
- Green P. Risks to children and young people during covid-19 pandemic BMJ 2020;369:m1669
- Munro APS, Faust SN Children are not COVID-19 super spreaders: time to go back to school Archives of Disease in Childhood Published Online First: 05 May 2020. doi: 10.1136/archdischild-2020-319474
- Roland D and Stansfield B Every Cloud: How the COVID-19 Pandemic may Benefit Child Health Accepted for Publication in Pediatric Research 2020