The Covid-19 pandemic is creating profound panic, fear and anxiety among the human race. The situation is undoubtedly tragic and heart-breaking. Covid19 has taken and is still taking huge numbers of lives. During writing ( 30.6.20), the number of the affected rose from 1.0 million to 10.50 million and lives lost rose from 50,000 to 0.50 million worldwide within last three months only while it is already 0.14 million affected and 1847 lives lost in Bangladesh.
Compared to adults, so far the direct effects of Covid-19 on child and adolescent appears not significant. But, the indirect effect could be horrifying. If we reimagine and try to foresee the indirect impact, we would visualise the horrific impact on child health in the post-pandemic era.
Apart from these huge numbers of death toll it already created a havoc on our daily lifestyles, work and job, businesses with a negative impact on earnings and overall economy.
The Covid-19 pandemic has changed, and will continue to change our way of life as well as the world scenarios in coming years. At the same time Covid-19 will surely be throwing a horrific impact on child health in very near future. Visits to health care centres are declining due to lockdowns, imposition of movement controls and transport disruptions, and on the top of those the community remains fearful of coronavirus infection along with frustration for the future.
Access to essential health services especially routine immunisation has already been hampered and threatens a significant increase in child mortality due to Vaccine Preventable Disease (VPD) in coming days.
All the achievements so far in child health and survival are dependent on the continued provision of essential health services to mothers and children around the world. Bangladesh was successful in achieving the MDG well ahead of scheduled target and proud for being able to lower the Neoborn, Infant and under-five mortality appreciably compared to the neighbourhood. This was possible because of our well structured and wonderfully functioning EPI and PHC service network for IMCI and Neonatal , Maternal Care right from the community level.
But in present pandemic situation the services have been disrupted. Routine vaccinations for children have fallen dramatically since the Covid-19 outbreak. Many children could die from preventable causes over the next six months . According to a UNICEF analysis, some 77 per cent of children under the age of 18 worldwide are living in one of 132 countries with movement restrictions and lockdown. These are creating the household income loss, poverty, hunger and disruptions to care-seeking.
This future challenge is now to be taken on as a priority to formulate child health policies in a new dimensional approach. It will be pragmatic now to ensure that the childbirth, child health and nutrition services remain continuously available during the pandemic.
In the past, world had faced many challenges, but the human race could overcome those with inventions of vaccines, adopting appropriate policies and timely interventions. Here again, we must be positive but at the same time we must formulate appropriate policies and take actions for timely implementation. Surely, one day the Covid19 challenges will end, but we must understand the fact that we have to face new challenges in the post-pandemic era. So, being panicked and overwhelmed by the present pandemic, we can't be just looking and waiting for a vaccine preventable disease (VPD) to emerge as a different pandemic.
Mathematical models published by Global Financing Facility of World Bank Group in "Country Brief: Preserve Essential Health Services during the Covid-19 Pandemic " indicate that large service disruptions in Bangladesh have the potential to leave 1,654,500 children without oral antibiotics for pneumonia, 3,673,600 children without DPT vaccinations, 386,500 women without access to facility-based deliveries, and 5,932,000 women receiving family planning services. In Bangladesh the result would be a 37 per cent increase in child mortality and a 19 per cent increase in maternal mortality over the next year. Evidence also suggests that the breakdown in primary care service provision during an epidemic can lead to longer-term increases in indirect mortality.
Experience from the past epidemics like the 2014 West Africa Ebola outbreak and SARS has shown that indirect effects of an outbreak -- e.g. medical supply including vaccination chain disruptions, declining health care service delivery and utilization as well as need of increased healthcare resource and personnel reallocation might be severe, sometimes outpacing the direct impact of the outbreak itself. Moreover, many of these indirect mortality effects may not be apparent for some time after the pandemic recedes and may even reverberate for an extended period following the pandemic. In parts of West Africa, for example, measles deaths among children increased dramatically following the Ebola outbreak as immunisations were curtailed amid the epidemic.
After lessons learned from the past, we must rethink strategies to adopt new outcomes, to restart the withheld services and enforce catch-up programmes for missed opportunities while responding to the present Covid19 crisis.
UNICEF Executive Director Henrietta Fore said, "Under a worst-case scenario, the global number of children dying before their fifth birthdays could increase for the first time in decades. We must not let mothers and children face collateral damage in the fight against the virus. And we must not let decades of progress on reducing preventable child and maternal deaths be lost." In the Lancet report, UNICEF warns these disruptions could result in potentially devastating increases in maternal and child deaths. An analysis by researchers from the Johns Hopkins Bloomberg School of Public Health, published in The Lancet Global Health Journal warned that considering the worst scenario in 118 low- and middle-income countries, an additional 1.2 million under-five deaths could occur in just six months, due to reductions in routine health service coverage levels and an increase in child wasting.
These potential child deaths will be in addition to the 2.5 million children who already die before their 5th birthday every six months in the 118 countries, threatening to reverse nearly a decade of progress on ending preventable under-five mortality. Some 56,700 more maternal deaths could also occur in just six months, in addition to the 144,000 deaths that already take place in the same countries over a six-month period.
The greatest number of additional child deaths will be due to an increase in wasting prevalence among children, which includes the potential impact beyond the health system, and reduction in treatment of neonatal sepsis and pneumonia.
We know that children are missing out on the routine vaccines. Vaccination campaigns have been postponed following social distancing measures, increasing the risk of disease outbreaks. Malaysia and the Philippines have had to postpone their mass polio vaccination campaigns. Not reaching these children with critical polio vaccines means that they will remain susceptible to polio and there is a danger of spread when movement restrictions ease. Similarly, Bangladesh postponed its MR Campaign schedules in the last week of March because of the Covid19 outbreak. The surveillance of measles dropped at the alarming level in April and May, 2020. The EPI routine immunization coverage is also decreasing, putting the countries including Bangladesh at risk of outbreaks of extremely contagious diseases like measles.
Reduction in routine immunization coverage, particularly if this continues, means that many children will be unvaccinated or under-vaccinated, putting their lives at risk of vaccine preventable diseases. In 2018, approximately 2.6 million children in East Asia and Pacific did not even receive their measles vaccination nor their third dose of Diphtheria, Tetanus and Pertussis (protecting children from debilitating and deadly illnesses) through routine immunization.
We must encourage that children receive their routine immunizations with preventive measures including physical distancing, handwashing, and use of face mask. We must make already panicked parents to understand that vaccines are safe, effective and life-saving tools to control and prevent outbreaks of infectious diseases. Disseminating accurate information and stopping the spread of misinformation is important to ensure that every child is protected with life-saving vaccines. Protection from VPD is a child's basic right.
Covid-19 is a terrible proof that outbreaks can happen in many countries at the same time. The global resurgence of measles is putting young children at risk.
Prof. (Dr.) Manzoor Hussain is President of Bangladesh Paediatric Association.
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