Children could be collateral damage in COVID19 control

[Kokeshi123]

www.hsj.co.uk/acute-care/exclusive-children-may-be-covid-19-collateral-damage/7027315.article

"Children may have died from non-coronavirus illnesses because they are not coming to hospital quickly enough, amid concerns NHS 111 may be giving flawed advice to stay away, according to senior pediatricians."

There are also concerns that kids will wind up with spotty vaccination records which end up not being made up for later on. In terms of risk to kids themselves, I'm actually more concerned about future outbreaks of measles and diphtheria than about CV itself, I have to say.

I'm also concerned about the impact on little children's immune systems and eyesight development if lockdowns and other restrictions (esp being completely kept away from other children) are allowed to persist for months rather than weeks. The world's foremost leukemia expert has been pretty adamant that children should ideally be exposed to lots of other children and normal germs in their environments, because raising babies in an immunological bubble raises the risk of their developing autoimmune conditions later on.

As we try to decide how long the lockdown should persist, these factors need to be taken into account IMO.

[Pixxie7]

It’s a relatively short period of in the great scheme of things they will survive.

[SadlyMissTaken]

Re the Spanish Flu not hurting the economy, was there a lockdown then? Isn't the argument here that it's the lockdown that's inflicting the damage to the economy, rather than the virus itself? Or have I misunderstood?

[NotEverythingIsBlackandwhite]

Fgs, just over two weeks of a 'lockdown' where people can still go out every day for exercise and we can go out to get food and medicine, and so many people are whingeing.

As a nation our 'stiff upper lip' has often been referred to. I think that has long gone judging by the moaning on here. Thankfully in real life, my family and friends and neighbours are all complying without taking part in all the moaning and negativity.

Clearly the Govt have plans for relaxing the 'lockdown' at the appropriate time. This is a new virus and obviously plans have to evolve with it.

The Govt has many experts who they will be talking with and I'm sure they are well aware of all the concerns raised in this thread.

[Hearhoovesthinkzebras]

I just don't see how lockdown can be a viable tactic for 18 months /2 years until a vaccination is available.

I've seen an expert discussing the vaccine development and the view was it is very unlikely to be ready within 18 months. The fastest a vaccine has ever been made is four years, most take much longer.

I dont think the lockdown is intended to last for a year. It's to get us through this first phase. Once the cases are down to a certain level and providing that they implement strict testing, tracing and quarantine rules, hopefully we can continue as they ah e in South Korea and Singapore, though whether the public here will accept location tracking, temperature checking and quarantine, who knows.

[BoomBoomsCousin]

I dont think the lockdown is intended to last for a year. It's to get us through this first phase. Once the cases are down to a certain level and providing that they implement strict testing, tracing and quarantine rules,

That is what I would hope, but progress towards that seems to be exceedingly slow and I haven't heard anything from the government that this is their plan.

Frontline HCPs don't even have testing available yet and we're a couple of months into the crisis. There is huge global demand for the materials needed to make the tests, is it even clear that we can make enough over time?

TBH I don't see the British public being that concerned about location tracking. So many are blase about the access to data they give to companies through their phones and to the use of cameras on the street that I don't think it's that big a concern for most people in the UK. The prospect of getting out of lockdown will have many chomping at the bit to sign up from government tracking. Taking temperatures as people enter buildings, etc. might be harder.

[BoomBoomsCousin]

SadlyMissTaken

A pp was arguing that without a lockdown the economy would collapse because of everyone dying. I argued that the economy didn't collapse in 1918, despite the fact that pandemic hit the population harder and there wasn't a countrywide lockdown.

Although there wasn't a countrywide lockdown over the Spanish Flu, some areas took steps to minimize spread and data from the US suggests those places that did so had lower death rates than those that didn't. But I don't believe it shows the relative impacts on local economies (which would be hard to compare since lockdowns were more local and economic health depends on surrounding areas - which would not necessarily have locked down - too).

[MRex]

@BoomBoomsCousin - do you think there might be a reason why every NHS worker is encouraging people to stay at home? Any reason at all? Something about a virus? Or you think they all have a death wish?

[BoomBoomsCousin]

Yes Mrex I do. I think NHS workers want people to stay at home and flatten the curve so they can save as many lives as possible - even though that means they will be at risk for longer themselves.

[MeadowHay]

Boom is correct about the impact on HCPs. The longer this goes on for, the more exposure HCPs have, the greater their viral load, and the higher the rates of serious illness and death in HCPs. Nobody is saying that alone is a reason to end lockdown but it is factually accurate.

[mac12]

@BoomBoomsCousin Re impact of Spanish flu on economy. Those regions that took stronger action earlier saw better economic recovery in the following years.

news.mit.edu/2020/pandemic-health-response-economic-recovery-0401

[BoomBoomsCousin]

mac12 that was discussed on an economics forum I'm on a few days ago. You can get the actual paper here: papers.ssrn.com/sol3/papers.cfm?abstract_id=3561560

It runs against conventional wisdom and was criticised (on the forum I'm on) for selective choice of cities to include, ignoring conflating issues (i.e. that a city that was struggling economically anyway would be more likely to delay the start of shutdown measures or end them early as they would be more desperate to ensure businesses stayed, whereas cities already on the up could afford to take harsher measures). Also a question over the start point for economic growth (if you use, as a start point, the height of unemployment from the effect of interventions, then places that took harsher action are likely to see higher growth rates because they start from lower positions) and the big one of whether economic growth can be associated so closely with the areas that the lockdowns covered. These were the points made most strongly on the forum. They aren't my criticism because, although I was a student a few years ago and I maintain a strong interest, I don't pretend to be at a level to decide whether those criticisms are definitely right or wrong.

It's only a working paper, not even peer-reviewed, let alone subject robust debate after being published in a high-quality journal, though. So maybe they will find ways to address those issues or maybe they will decide they aren't reasonable criticisms and get published anyway and when other economists look at the data in light of their research they'll be proved right or maybe they'll have holes poked through the whole thing.

[MRex]

@MeadowHay - no, that isn't how viral load works. The infectious dose is the amount a person is exposed to at the start of their illness. The viral load responsible for infection isn't totting up on a daily basis for months, it's happening in a very short space of time. Social distancing reduces the potential level for everyone, giving them a less severe illness, meaning less cases in hospital. Once a person is infected they become ill and have to recover. If it's a HCP they go off sick and when they meet more patients some weeks later, at that stage they should be immune.

[tenlittlecygnets]

@BeijingBikini - My neighbour told me a similar story today about her colleague - the company got told to WFH the evening the lockdown was announced, she said yes that's fine I'll pick up the laptop etc. Next day no-one had heard anything from her; it turned out she'd killed herself.

Then she must have had a serious mental health problem in the first place. Coronavirus didn’t cause that.

[Breadandroses1]

There was a massive spike in measles infections post Ebola due to missed vaccinations. Measles ending up killing more people than Ebola (and DRC actually had a pretty good vaccination regime before anyone asks).

On a more personal note we will now be at least 6 months delayed progressing DDs ASD referral. Will probably be a year with the backlog. That's a lot of time lost.

[Xenia]

By the way those of us who had the BCG vaccination (the TB related one) as I am and my older children did as part of the state's normal programme which was then halted by the time my younger 2 came along might be inteereted in this - more likely to survive covid 19 if you have had it , I spent £400 privately on having the youngest 2 done as teenagers as I wanted them to have the same protection as older siblings particularly as we live in a bit of London with lots of people going to and fro between regions with TB.

www.medrxiv.org/content/10.1101/2020.04.07.20053272v1
www.irishtimes.com/news/health/coronavirus-more-striking-evidence-bcg-vaccine-might-protect-against-covid-19-1.4222110
www.telegraph.co.uk/news/2020/04/08/bcg-jabs-mean-six-times-less-likely-get-coronavirus-study-finds/

[MRex]

@Breadandroses1 - measles is very dangerous, but actually the death rate for ebola is much higher an average of 1 in every 2 people catching it were dying. Getting control over ebola to stop the spread would have saved many more lives, you just can't see the lives saved by those actions.

[Breadandroses1]

Yes, MRex, I worked on the Ebola response and am painfully familiar with the mortality rate (although it's not actually that easy to catch unless you are providing personal care). Clearly I'm not suggesting one doesn't respond to Ebola! Incidentally, it's not contained by any means, it's still bubbling away.

The broader point- which is important- are secondary impacts. So another statistic - maternal mortality increased by 75% in ebola hit areas, largely due to a decline in seeking help (understandable, right, but MM was already very high). At some point a public health response has to look more broadly at a wider range of costs than the immediate issue at hand and try and come up with a way of balancing those, and trying to make sure the impact is not so inequitable (ie worse for poor people, worse for women, worse for children). So schools, for example, were kept open during Ebola because a policy assessment was that they were protective.

There has been no equalities impact assessment (or gender analysis) done in the UK- a case in point is the poor structure of the furlough scheme which disadvantages pregnant women and parents who were on parental leave during the last year.

In poorer countries this is going to be beyond catastrophic- not because of COVID but because of the secondary impacts of the policies thrown out to deal with it. They will kill far more people.

You just have to build it into the policymaking (just!).