ANZPID submission to the Commonwealth Government COVID-19 Response Inquiry

The Australian and New Zealand Paediatric Infectious Diseases (ANZPID) Group of the Australasian Society for Infectious Diseases (ASID) calls for urgent consideration of the needs of children following the onset of the COVID-19 pandemic, and in planning for future pandemics. While ASID has provided a separate submission, this submission from ANZPID expands on lessons and priorities for children and young people.

During the COVID-19 pandemic, the interests of children and young people were compromised.

COVID-19 societal closures were influenced by pandemic disease modelling that at times used a narrow lens to assess disease impact. In the future, societal interventions should incorporate a holistic view of health outcomes across the life course, inclusive of children and the detrimental impacts of school and playground closures on their education, emotional, cognitive and physical development, as well as mental health, and the unequal effect these measures have on children from disadvantaged backgrounds (1,2). Professionals involved with child health and wellbeing have major concerns about the profound disruption the pandemic had on children during their formative years. As yet, it is unknown what impact this is having on individuals reaching their full developmental potential and how these detrimental impacts will affect society and the economy as a whole. Nevertheless, paediatricians now have waiting lists of up to 18 months for developmental, behavioural and mental health assessments, and there are insufficient services to address the increase in eating disorders, depression and social anxiety. https://kidscatchup.org.au/

Early child development and learning lays foundations for life and provides critical windows to ascertain developmental milestones. Through social relationships and play children learn how to think, understand, communicate, behave, express emotions and develop social skills. This ongoing development continues with brain remodelling occurring intensively during adolescence and ongoing until the mid-20s (3). How teenagers spend their time is crucial to brain development and being involved in a range of activities and experiences helps shape the brain. Exposure to toxic stress decreases the size and impairs functioning of regions of the brain responsible for learning, memory and executive functioning, posing a risk for learning and behaviour problems(4).

There is now emerging evidence demonstrating exposure to COVID-19 related school closures is associated with significant learning deficits that persisted overtime and increased among children from lower socio-economic backgrounds (5,6). Additionally, the silent effects the pandemic had on children included decreased physical activity and its impact on childhood obesity (7,8), increased screen time and its related effects (3,9,10), decreased child protection reporting despite increased risk of child neglect and abuse with social isolation, 11 as well as significant mental health impacts (12-14). These findings underscore the importance of better and more holistic consideration of children's interests and rights in policymaking and pandemic preparedness.

An Australian national mitigation and recovery plan is urgently needed to meet the gap in paediatric services in the aftermath of COVID-19 and ensure that in future outbreaks, equal health and education access is prioritised and that the detrimental effects to child physical and mental health is prevented. Early childhood education centres and schools need to be classified as essential services, with staff vaccinated as a priority group and remote learning only considered as a last resort. Access to disability and social welfare services and maternal-child health services should be classified as essential services and prioritised in future pandemic planning. In the future, it is necessary that adequate representation ensures the best interests of children, and that their advocates are included in decision-making processes.

The next pandemic is likely to be a respiratory infection and may substantially affect children. Australia must be prepared to collaborate with international agencies to advocate that children and young people are not forgotten in pandemic planning, with inclusion of these groups early in high quality vaccine and therapeutics trials. The World Health Organisation (WHO) is developing pre-approved pandemic-ready protocols for such purposes, as the COVID-19 pandemic has taught the world the value of preparation to facilitate for rapid pivot and deployment of resources. Research on the benefits and harms and specific needs of children must be similarly considered in deployment of non-pharmaceutical interventions.

ANZPID, along with others, including the Royal Australasian College of Physicians (RACP) and the Australian Children’s Commissioner, calls on the Commonwealth to establish the role of Chief Paediatrician, to ensure the needs of children and young people are included in all responses. This would include participation in the Australian CDC to respond and advocate in future pandemics. This should occur alongside creation of a national framework for child-rights informed ethical decision-making for pandemic and crisis scenarios where children and professional advocates are included to safeguard the United Nations Convention on the Rights of the Child (UNCRC) (15) - protected human rights. Child rights-based responses afford us opportunities to advance policies and practices to mitigate the direct and indirect threats of future pandemics.

Further reading

Research Brief: Mental health impacts of the COVID-19 pandemic for children and young people Insights from the Melbourne Children’s LifeCourse Initiative

Supporting every school to become a foundation for healthy lives. Lancet Child Adolesc Health. 2021.

Impacts of the COVID-19 Pandemic on Children Internationally: Papers from A Research Collaboration between the International Society for Social Pediatrics and Child Health(ISSOP) and the International Network for Research on Inequalities in Child Health (INRICH)

References

1. Basseal JM, Bennett CM, Collignon P, et al. Key lessons from the COVID-19 public health response in Australia. Lancet Reg Health West Pac 2023; 30: 100616.

2. Czeisler M, Wiley JF, Facer-Childs ER, et al. Mental health, substance use, and suicidal ideation during a prolonged COVID-19-related lockdown in a region with low SARS-CoV-2 prevalence. J Psychiatr Res 2021; 140: 533-44.

3. Olive LS, Sciberras E, Berkowitz TS, et al. Child and Parent Physical Activity, Sleep, and Screen Time During COVID-19 and Associations With Mental Health: Implications for Future Psycho-Cardiological Disease? Front Psychiatry 2021; 12: 774858.

4. McManus E, Haroon H, Duncan NW, Elliott R, Muhlert N. The effects of stress across the lifespan on the brain, cognition and mental health: A UK biobank study. Neurobiol Stress 2022; 18: 100447.

5. Hammerstein S, König C, Dreisörner T, Frey A. Effects of COVID-19-Related School Closures on Student Achievement-A Systematic Review. Front Psychol 2021; 12: 746289.

6. Sato K, Fukai T, Fujisawa KK, Nakamuro M. Association Between the COVID-19 Pandemic and Early Childhood Development. JAMA pediatrics 2023; 177(9): 930-8.

7. Yomoda K, Kurita S. Influence of social distancing during the COVID-19 pandemic on physical activity in children: A scoping review of the literature. J Exerc Sci Fit 2021; 19(3): 195-203.

8. Reece LJ, Owen K, Foley B, Rose C, Bellew B, Bauman A. Understanding the impact of COVID-19 on children's physical activity levels in NSW, Australia. Health Promot J Austr 2021; 32(2): 365-6.

9. Bergmann C, Dimitrova N, Alaslani K, et al. Young children’s screen time during the first COVID-19 lockdown in 12 countries. Scientific Reports 2022; 12(1): 2015.

10.  Yamamoto M, Mezawa H, Sakurai K, Mori C, Environment J, Group CsS. Screen Time and Developmental Performance Among Children at 1-3 Years of Age in the Japan Environment and Children’s Study. JAMA pediatrics 2023; 177(11): 1168-75.

11.  Katz I, Katz C, Andresen S, et al. Child maltreatment reports and Child Protection Service responses during COVID-19: Knowledge exchange among Australia, Brazil, Canada, Colombia, Germany, Israel, and South Africa. Child Abuse Negl 2021; 116(Pt 2): 105078.

12. Thomas HM, Runions KC, Lester L, et al. Western Australian adolescent emotional wellbeing during the COVID-19 pandemic in 2020. Child and Adolescent Psychiatry and Mental Health 2022; 16(1): 4.

13.  Springall G, Cheung M, Sawyer SM, Yeo M. Impact of the coronavirus pandemic on anorexia nervosa and atypical anorexia nervosa presentations to an Australian tertiary paediatric hospital. J Paediatr Child Health 2022; 58(3): 491-6.

14. Meyer D, Sumner PJ, Tan EJ, et al. Comparing the impact of high versus low lockdown severity on the mental health of young people in Australia during the COVID-19 pandemic. Psychiatry Res 2023; 322: 115121.

15.  Jörgensen E, Wood L, Lynch MA, Spencer N, Gunnlaugsson G. Child Rights during the COVID-19 Pandemic: Learning from Child Health-and-Rights Professionals across the World. Children (Basel) 2023; 10(10).

Date submitted: 15 December 2023

Media Contact: Alison Sweeney alison@asid.com.au or 0425 221 155.