While many have put COVID-19 in the rearview mirror, the effects of the pandemic continue to be felt by children, families and pediatricians.
As we mark the fifth anniversary of the public health emergency, AAP News asked several leaders of AAP committees, councils and sections to reflect on how the pandemic positively and negatively impacted patients, families and the practice of pediatrics, and the challenges that remain.
Mental health
The COVID-19 pandemic placed an inordinate amount of stress not only on children but also on those who care for them, said Jennifer K. Poon, M.D., FAAP, chair of the AAP Section on Developmental and Behavioral Pediatrics.
“There was already a mental health crisis when 2020 started, but it’s undeniable that the pandemic added a magnified layer to parents/caregivers and children at multiple levels in life,” Dr. Poon said. “We know that when children are stressed, they turn to adults for help. However, stressed adults, in dealing with their own challenges, may have decreased capacity to fully focus on helping a child cope.”
Gerri Mattson, M.D., FAAP, chair-elect of the AAP Council on Community Pediatrics, said social isolation and disruption in education and peer and social-emotional learning contributed to increased mental health concerns in children.
“I also think that we have not done a good job in recognizing the adverse experiences that happened due to loss of life, illness and the many social and economic drivers of health that were negatively impacted that also contributed to the stress and mental health for children in impacted families,” Dr. Mattson said.
Elizabeth M. Alderman, M.D., FAAP, chair of the AAP Council on Adolescents and Young Adults, said young people may have taken on new roles if a caregiver died or became seriously ill because of COVID. The change in family dynamic can continue to impact them into adulthood.
“It may have prevented kids that age from pursuing educational and vocational aspirations that they had or may have made them more responsible faster,” Dr. Alderman said.
She also noted that the rise in eating disorders has been connected to increased use of social media while teens were isolated.
Recognizing the pandemic’s toll on mental health, the AAP, American Academy of Child and Adolescent Psychiatry and Children’s Hospital Association declared a national emergency in child and adolescent mental health about 18 months into the pandemic.
Shift to telehealth
The explosion of telehealth and the way it increased access to care is one positive outcome of the pandemic era, Dr. Alderman said.
“For behavioral health, I’m not going to say it’s the norm, but it’s extremely prevalent in some places,” she said.
But the shift required innovation.
“We realized we had to go to telehealth pretty quickly, or kids were not going to be served — and pediatric practices would die,” said AAP President Susan J. Kressly, M.D., FAAP.
She said the Academy worked with pediatricians to enact changes to allow payment for remote visits.
“Members had to craft the solutions and the ideas and write the policies and notice the gaps,” she said.
Dr. Poon agreed that telehealth technology continues to be beneficial.
“This has … allowed a glimpse into our patients’ own natural settings, which helps pediatricians better understand a child’s environment,” she said.
Access to telemedicine and virtual visits also increased for newborns.
“Some units might have expedited installation of bedside cameras so caregivers, siblings and extended family could virtually visit with the newborn when visitor restrictions were in effect,” said Alexis S. Davis, M.D., M.S., FAAP, chair-elect of the AAP Section on Neonatal-Perinatal Medicine. “These cameras, once installed, are an adjunct for ongoing family-centered care in the neonatal intensive care unit so that families who may have challenges with visitation can still ‘see’ their baby.”
Despite the benefits, pediatricians mentioned several ongoing challenges with telehealth, including limited broadband capabilities in some parts of the country and lack of best practice guidelines to ensure the quality of health care is the same as the quality of in-person care.
Rise in misinformation and useful data
Dr. Mattson noted that the need to combat misinformation about health and public health has risen in the last five years.
“I do think this is a result of COVID and the beliefs that people had and have about how the virus came to be, the handling of the public health emergency, the development of vaccines and the lifting of precautions and social distancing,” she said.
On a positive note, there is more sophisticated use and communication of public health data available online and use of dashboards, tables and monitoring of trends related to respiratory diseases, she said.
Ongoing challenges
Many children and families continue to grapple with the effects of the pandemic.
“Research is needed to study long-term outcomes of child development and health following the pandemic, as well as potential interventions to improve outcomes,” Dr. Poon said.
Andrew C. Hsi, M.D., M.P.H., FAAP, a member of the AAP Committee on Native American Child Health, noted that “COVID and the response to it interrupted steady progress towards a healthier childhood and reduction of incidence of chronic health conditions advancing into adulthood.”
He also said resources have been lacking to address long COVID.
The pandemic also brought health care inequity to the forefront.
“I think more people are aware of the horrendous disparities that happened in the screening, care and access to COVID vaccines for people of color and to see that there were other factors such as lower economic status and living in rural areas,” Dr. Mattson said.
“The rich got richer, widening the equity gap,” Dr. Hsi added.
Silver linings
Dr. Hsi pointed to the development of COVID vaccines for all ages as among the positive effects of the pandemic.
“The development of the vaccines required international collaboration, and the science and manufacturing spheres worked together to make them, and the pharmaceutical companies got them into the public,” he said. “The production of vaccines continues, and the procedures to make new vaccines seems generalizable for other viral infections.”
Another positive: “We have seen how courageous health workers are given the rates of infection they experienced,” Dr. Hsi said.
Dr. Mattson pointed to how the government moved quickly to pass policies, approve funding and help deliver care to millions of people.
“I think there were many lessons learned, and not everything was done well,” she said. “I think we are more prepared for the next pandemic and there is a desire to recognize, review and learn from mistakes done with COVID and the public health emergency.”
