IMAGINE being a child or teenager or parent at the moment. Your world has changed almost overnight. Everything you know has been turned upside down.
It begs the question: how will we know whether our kids are, and will be all right? To address the challenges posed by this once-in-a-lifetime event, we need a once-in-a-lifetime evidence-based response.
How do we rapidly and robustly gather the data and evidence to help us best support the needs of children and parents now and to inform future pandemic responses? Right now, we simply know that there is much we don’t know. This means that we need to try and estimate the considerable social and economic impacts on children and families.
To understand the impacts, good data are needed more than ever. These data will also allow us to adjust our health, social and economic strategies as we endure and then recover from coronavirus disease 2019 (COVID-19) and be better prepared for any future pandemic.
But we need to do more than put the right data in the hands of decision makers; we need to focus on potential solutions. These would include:
Immediately build a child and adolescent health and wellbeing observational and response system
We look to our infectious disease scientists to be on the front foot by innovating in the monitoring, treatment and prevention of COVID-19. We should look for that same innovation and frontier thinking from our public health and social scientists. We need to quickly establish community-level child and adolescent wellbeing observational platforms to monitor and respond to the viral and social impacts of COVID-19, especially in the most vulnerable groups, knowing that early data from the US is suggesting that poorer children and families are being most impacted.
For example, the Murdoch Children’s Research Institute (MCRI) has Australia’s largest number of ongoing longitudinal cohort studies for children and adolescents. These are ideally suited to be rapidly and responsively repurposed to monitor and report on child and family health, right now. These include both the immunological aspects of COVID-19 and the social wellbeing aspects, such as the widening inequity and financial impacts, poorer educational outcomes and family violence, to name a few.
We do know from looking at disasters locally – such as the 2009 bushfires – that there are significant mental health issues and trauma directly related to closing schools, and the related isolation translates into longer term effects.
Similarly, during the SARS epidemic in China in 2003, lack of transparency and poor risk communication resulted in panic buying of drugs and exposed serious information communication problems. The longer term psychological effects, including anxiety and depression in both recovered patients and family members, were notable.
Create a series of rapid response platforms
In response to these data, we must rapidly work out how to support children and families at a pace matching that of similar COVID-19-related changes, such as business shutdowns, industry bailouts and school closures. The response should not be to simply re-fund previously defunded services, but instead consider innovative service approaches that could “wrap around” and deliver truly equitable and quality care to what will be an increasing number of vulnerable children and families. This might involve teachers, health professionals, social workers, police and the courts, and will require careful planning and discussion.
These models have never been seen in Australia but will be crucial if we are to avoid a second wave of COVID-19 disasters related to the deep social and financial impacts. This will include innovative approaches across sectors, potentially delivered concurrently, such as expanding the use of telehealth for health, education and social interventions in regional and remote areas. Free childcare, finding more accessible models for specialist health care delivery, such as publicly funded paediatricians and psychiatrists who can also support GPs, can be considered. We could even address the social determinants of health head-on by considering a trial of non-conditional cash transfers.
Ensure we follow-up over the longer term
Maximise our learnings from this pandemic by following the impact on children and families into the future. Large birth cohorts have played a vital role in understanding the flow-on effects of whole-society shocks in the recent past. For example, the Growing Up in Ireland group documented the grim impacts of the 2008 Global Financial Crisis and recovery on Irish children’s and families’ wellbeing. Such studies are needed more than ever during crises.
MCRI and partners, including the Royal Children’s Hospital, Melbourne University and the Victorian Government, are already building our capacity to ensure we can maximise our learnings from this pandemic by following the impact on children and families into the future. This will be achieved through a project called Generation Victoria (GenV). GenV seeks to recruit all mothers giving birth across the state from 2021 for 2 years – approximately 170 000 newborns – into the world’s largest study of long-term health outcomes.
This will allow researchers to detect trends and patterns that we currently cannot see. GenV will help us be much better prepared for an unpredictable future and to test how we can effectively do things differently after the COVID-19 pandemic.
Governments, communities and parents are all making big decisions right now, and as we start to look at relaxing restrictions, about how to best look after our kids and their future. These are weighty decisions and we should heed and support the advice of the government. What is becoming increasingly clear though is that often we just don’t have the evidence we really need for our kids.
Solutions to unprecedented challenges are, by definition, also unprecedented. This doesn’t mean we shouldn’t seek to rise to them. When the next pandemic envelopes the globe, we want academics and policy makers to look back to 2020 and have the evidence we currently lack, to respond with confidence to protect all aspects of the health of children and their families.
Associate Professor Margie Danchin is a consultant paediatrician within the Department of Paediatrics, University of Melbourne and Murdoch Children’s Research Institute (MCRI). She is Group Leader, Vaccine acceptance, Uptake and Policy at MCRI, and is an immunisation expert with over 10 years’ experience in vaccine research and clinical work, both in Australia and in resource poor settings.
Professor Sharon Goldfeld is a paediatrician, public health physician, Theme Director of Population Health and Co-Group Leader of Policy and Equity at the Murdoch Children’s Research Institute and Director of the Centre for Community Child Health at MCRI and The Royal Children’s Hospital, Melbourne.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.