Interesting that a thread specifically about vulnerable children, usually cited as the reason for all the schools to be back immediately, has sunk like a stone. The BMJ today (should be added that any stoppage to current non-school related family support and so on, is in addition to 10 years of underfunding):
They must not be left behind in its aftermath
When the Titanic sank there was a linear relation between the social class of passengers and their risk of drowning.1 During the bubonic plague, the upper classes fled Italian cities for safer country residences, heeding the public health advice, “cito, longe, tarde” (flee early, flee far, return late)2; the less wealthy were left behind and died disproportionately as a result. A similar pattern was seen in New Orleans during Hurricane Katrina.3 History tells us that, during times of crisis, vulnerable groups lose out most. The covid-19 pandemic is no different. Emerging data show the pandemic tracking along social fault lines.4 And although children are not the face of this pandemic, they are deeply affected. The UN warns of “unprecedented risks to the rights and safety and development of the world’s children.”5
During childhood, we are especially vulnerable to the main determinants of health: living conditions, family income, employment, education, access to health services. The pandemic can be conceived as an additional systemic shock to these determinants. In the shorter term, with the focus squarely on adults with covid-19, child health and social care services are being sidelined. These include acute services for life threatening illnesses, outpatient services for chronic conditions, child protection services guarding against abuse and neglect, and preventive services that support early years development, routine checks, and immunisations. Global modelling predicts a stark increase in child mortality as a result of diversion of care.6 As soon and as seamlessly as possible, we must restore these services to full, and greater, capacity.5
Within family homes, the unintended consequences of the lockdown will affect poor children the most. Greater “toxic stress” for many families will increase the risk of neglect and domestic violence.7 Exposure to these adversities can have lifelong health impacts. Many children are going hungry as foodbanks scramble to reconfigure services to meet the rising tide of food insecurity.8 Lockdown in poor quality and overcrowded housing, with inequitable access to safe green space, will disrupt children’s lives, some more than others.9
Social distancing measures and school closures are interrupting educational trajectories. Teachers must be commended for developing online resources, under huge pressure and in difficult circumstances, but for some children the lack of internet, electronic devices, and quiet space at home will further exacerbate inequalities in educational outcomes. Despite plans for the phased reopening of schools, an increasing dependence on supplementary online learning seems assured.