The COVID-19 pandemic has affected us all. However, children – the group with the lowest risk of the serious direct effects of the virus – have the highest risk of all age groups of experiencing the indirect adverse effects of the pandemic and efforts to contain it. This is the view of Prof Mark Tomlinson (Institute for Life Course Health Research), and Prof Linda Richter and Dr Wiedaad Slemming (both from the University of the Witwatersrand) in an opinion piece for News24 (17 February).
- Read the article below or click here for the piece as published.
Mark Tomlinson, Linda Richter, and Wiedaad Slemming*
In the course of 12 months we have swiftly progressed from a somewhat distant worry about a virus in a wet market in a city in China that most of us had never heard of, to 108,153,741 confirmed cases of COVID-19 (as of 14 February 2021), including 2,381,295 deaths; over 600 new variants of the virus; four vaccines fully approved and a further six in early or limited use, and another 87 vaccines in various stages of development.
We have all become conversant with much of the science and how age, co-morbidities and inequality all interact to create a toxic mix for some groups more than others. However, one age group – children (0-18 years of age) – the group with the lowest risk of the serious direct effects of the virus (illness and death) – is the same group with the highest risk of all age groups of experiencing the indirect adverse effects of the pandemic and efforts to contain it.
In a country like South Africa, still struggling to control two other epidemics – HIV and TB – that have resulted in many children losing parents, we now have a pandemic where over 20% of all deaths occur amongst people over 65 years of age. This means that children are losing grandparents who, in many cases, may be their primary caregiver and source of financial support. Illness, isolation and quarantine may result in newborns and young children being separated from their mothers, an experience that we know is devastating for infant and child development.
In South Africa's first hard lockdown, the impact on income and food security was catastrophic, exacerbated by hundreds of thousands of children not receiving school meals. The impact of food insecurity on child stunting and later development across the life course is well known, but it also resulted in fear and panic, anxiety and depression, and altered family and social relations.
Globally it is predicted that more than a million preventable child deaths will occur together with increasing rates of malnutrition and stunted growth. Approximately 1.5 billion children are not benefitting from continuous schooling due to rolling lockdowns across the world, with the likelihood that many children will never return to school. Globally and in South Africa large numbers of families and children are without digital devices or internet connections, and poor children are going to fall even further behind in the education because they can't access 'home schooling'.
We use the term nurturing care to refer to what children of all ages depend on from parents and families in terms of health care, nutritious food, protection from harm, opportunities to learn, and love and affection. For all families, but particularly poor families, their ability to provide nurturing care for their children is highly dependent on facilitating environments. A facilitating environment is one where there is available decent work, housing, health care, social security and laws that support them. As children get older, important sources of nurturing care extend to include the wider family network, child care workers, teachers, community members and, very importantly, friends and peers.
Nurturing care can break down when facilitating environments are disrupted, such as during a lockdown. Loss of income and interruption of health services threaten the health and wellbeing of children directly. Parents who are experiencing their own rising anxiety and mental health concerns will find it more difficult to protect children from the fear created by the media, conversations happening around their children, care for ill family and friends, and bereavements. Stressful situations affect people in different ways, with some withdrawing and becoming emotionally unavailable, which is especially damaging for young children. Others may become easily angered and lash out verbally and physically, including at children. Recurrent violence is especially harmful for young children.
Supportive adults beyond the household, such as extended family and educators are critically important for children. Isolation caused by lockdowns has disrupted the usual balancing of adverse and protective experiences that enable children to cope on a day-to-day basis. Even when children have access to digital resources and are learning 'at home', lockdown has interrupted the utterly vital informal learning that occurs in children's interactions with teachers, coaches, mentors and friends. Networks of friends are especially important for adolescents. When adolescents are 'trapped' at home with parents that have their own fears and worries, adolescents are increasingly likely to lash out or become withdrawn.
The century-old science of child development demonstrates the harmful effects of babies separated from mothers in their first months after birth; of children experiencing uncontrollable fear without the mediating reassurance of confident adults and of the physical, emotional and sexual abuse of children. Damage experienced in childhood, manifests itself throughout life in poor school achievement, lack of healthy and satisfying relationships, unstable mental health, lower levels of work productivity and less social stability.
But for everything, there is a flip side. When children experience the nurturing care of family and friends and live in environments that meet their basic needs, they can be massively resilient. Also to be borne in mind is that children and adolescents can be powerful health promoters, as demonstrated by child-to-child campaigns, and are often more eager than their parents and adults around them to adopt rules and guidelines to protect themselves and others. Some of the most active agents currently supporting public health approaches to dealing with the pandemic are children and adolescents.
The foundations of human well-being are laid down in childhood. If we do not create enabling environments and provide nurturing care for our children today and across the life course, the future well-being of the world will be in doubt. If we neglect the profound implications of this pandemic on children, South Africa will not thrive. We cannot afford to consign children and adolescents to a multitude of cumulative risks across their lifetime just because they carry the lowest risk of infection. We must act now and urgently.
*Prof Mark Tomlinson is co-director of the Institute for Life Course Health Research in the Department of Global Health at Stellenbosch University. Prof Linda Richter is director of the DSI-NRF Centre of Excellence in Human Development at the University of the Witwatersrand. Dr Wiedaad Slemming is a senior lecturer in the Division of Community Paediatrics in the Department of Paediatrics and Child Health at the University of the Witwatersrand. This article is closely based on their recent paper 'What the science of child and adolescent development contributes to understanding the impacts of COVID-19' in the South African Journal of Science.
