The Covid-19 pandemic has significantly impacted all of society, especially those in poverty or economically challenged. It has also stretched all support organisations and unmasked the failures in our systems to support marginalised individuals and families.
While we expect the pandemic “marathon” to last for another one to two years, even with an effective vaccine, there will be a prolonged post-pandemic recovery of another two to three years.
There is an underappreciation of the impact of Covid-19 on children. It is likely that we will continue to see psychological morbidity, demographic change and limited educational outcomes for many generations to come. This write-up summarises the key impacts on children and offers some suggestions to mitigate them.
Collateral health morbidity
While the majority of children are not generally affected by serious Covid-19 illness or death, however, there is collateral morbidity and mortality for other medical conditions. Data on this is currently anecdotal but the general impact is considered significant. We need to monitor delayed, incomplete and interrupted treatment for such cases using proxy disease indicators.
This will offer data that will allow us to mitigate such effects by re-engineering our child health services to become more accessible during the pandemic. Moving existing paediatric services to community centres, away from hospitals, is a useful possibility to explore.
Downward poverty spiral
Prior to Covid-19, 400,000 households lived in poverty, which is below our poverty line income of RM2,280. This translated into approximately 1.2 million Malaysian children. The worsening poverty due to Covid-19 is expected to push another 5% to 8% of the adult population, an additional two to three million children, into serious poverty (Merdeka Centre October 2020).
Covid-19 has in effect worsened and accelerated the rich-poor divide. Data from the Unicef October 2020 Families on the Edge Report (Part 2) states that 37% of inner-city families struggle to purchase food and 70% have difficulty meeting basic living expenses.
There is a need to have a mapping of all families at risk, the development of a comprehensive safety net that does not miss any, and sustained economic support to ensure food security. Effective measures to get resources to them require government agencies to work in partnership with civil society organisations.
The education pause button
The patchy education that many children of all ages have experienced this past year due to school closures has resulted in some children losing basic skills, regressing in learning abilities and having to relearn how to make friendships.
The education ministry’s survey in March-April 2020 showed that 37% of children did not possess any digital device and only 15% of students had personal computers. This digital divide outlines the disparity and unequal home environments for learning during school shutdowns.
Of more concern is the data from the aforementioned Unicef report where one in five inner-city parents reported that their children had lost interest in school. We urgently need a national and community initiative to bridge this digital divide by making chromebooks and internet access available to children of poorer families. As a community we could give away our preloved devices to poorer families. We need to keep schools and childcare centres open as much as possible, but following SOPs.
Worsening childhood malnutrition
The health ministry’s National Health and Morbidity Survey 2017 showed that 8% of all children were stunted. It said that 10% of children came to school without breakfast and another 60% had irregular breakfast. Covid-19 will worsen childhood malnutrition with long-term consequences for height growth.
The school-based Supplementary Food Programme was vital for some of these children with poor food security. We need to get schools open again safely and institute a universal school breakfast programme as means to ensure adequate nutrition. It should be noted that due to lockdowns with decreased physical activity, some children and adults in economic-able communities have become overweight or obese.
There is limited data for 2020 on child abuse but reports and data from NGOs suggest a rise in local domestic violence and child abuse during the various lockdowns, as seen in many countries. The women, family and community development ministry reported 1,929 domestic violence cases from March to October last year, while police data suggest a decline.
The ministry reported a decline in the number of child abuse cases reported in the first nine months of last year (3,875) while police in some states reported an almost 100% increase in incest cases during the movement control orders (MCO).
The confused data suggests grossly incomplete coverage and reporting. Sexual and physical abuse of children occurs primarily at home. It is important to realise that children are not able to tell others about the abuse as they are confined to their homes.
This may falsely reduce reported numbers. Anecdotal data suggests that response time for child abuse has also become slower. We urgently need to strengthen our Social Welfare Department and increase the number of personnel; utilising (deputising) NGO staff to help is an option.
Loss of focus and support for indigenous children
Covid-19 is a key distractor and many support services have been impaired or retarded in growth. In addition, lockdowns impair the ability of NGOs to visit vulnerable communities. There has been a loss of focus for our Orang Asli children and vital community feeding programmes have stuttered in their implementation.
The vast majority of Orang Asli children are malnourished and we cannot afford to ignore them. The authorities should proactively enlist the support of NGOs and the community to support the food security of Orang Asli in this time period. NGOs should be facilitated to visit Orang Asli villages regularly to ensure food distribution.
Trapped by the authorities
The home ministry reported in October that there were 756 children detained at immigration detention centres. Some 405 of these children were being held without their parents or guardians present. The only “crime” these children have committed is being undocumented.
With Covid-19 there has been a loss of advocacy for these children as NGOs have not been able to visit them. The United Nations High Commissioner for Refugees has been denied access to the detainees since August 2019.
As a signatory to the UN Convention on the Rights of the Child and in line with our Child Act, we have a legal responsibility to protect the rights of not just these but all children throughout the country, including those living on the streets. We urgently need to move these children out of detention centres into safe shelters where they can have access to meaningful education and healthcare.
Disabling the disabled
People with disabilities are marginalised in society and continually struggle with inclusion. Covid-19 has made that struggle even harder and disrupted their routine and lives, which is a risk to their health. Children with disabilities have a greater risk of severe Covid-19 illness and death.
They have been hardest hit by a loss of therapy and progress. Children newly identified to have disabilities now have a later diagnosis, later therapy and hence poorer outcomes. Some children with disabilities who are isolated at home (especially Autism) are not able to cope with the change in routine and parents struggle with behavioural problems.
People with disabilities also have problems receiving appropriate Covid-19 information due to vision, hearing and cognitive impairments. Many children with disabilities who are in special education classes have not been able to get back to school for much of 2020. This is a serious loss of education and progress for them.
Most Early Intervention Centres run by NGOs are struggling due to the loss of community funding. Some will close down and others lose staff. It is vital to keep them open as they are a lifeline to children with disabilities, as existing services are limited.
We suggest that the government budget to provide half their operating costs (staff pay and running fees) for the next two years as a means to keep vital services alive. We cannot afford to lose their services as the government ones for the disabled are extremely inadequate.
A generational scar/gap
On average, there is a 1.5% to 2.5% reduction in total births each year. The Statistics Department reported that births had decreased by 5.9% in the July to September 2020 quarter compared with the previous year. Due to Covid-19, many couples are delaying getting married and postponing having a child. There is also an associated increase in divorces.
The reduction in planned births will take its full effect in 2021 where we will see a major change in the number of births. The reduction in yearly birth volume may last much longer after Covid-19 due to increased poverty and the need to rebuild lives. The impact of this “lost generation” will be seen in the education system (reduction in students/classes), long-term manpower needs and health considerations (increased later age pregnancies).
Polluting our children’s future
The World Health Organization recognises that 25% of childhood deaths (children below five) and disease burden is due to environmental pollution. While we have had a transient improvement in air and water quality with lockdowns, the environment has been significantly affected by the worsening of deforestation and plastic pollution (from masks, PPEs and food takeaways).
Medical masks often contain plastics such as polypropylene with a lifespan of 450 years, an “ecological time bomb”. This, coupled with climate change will have far-reaching consequences for the children of today. We must mandate a national mask policy for the public that advocates for reusable masks.
Many nations have begun to use the Covid-19 pandemic as a catalyst to spur the economy using environmental change – dramatic changes in city environments to electrical-based-bus rapid transit, restricting cars severely, increased walking and cycling, and growing city green lungs using car parks.
Loss of the future
In the near future, the alphabet “C” in all preschool children’s books will be used to represent Coronavirus. It will signify a disease or condition that is tough/hard to beat. The pandemic with its fears and need for masks and vigilance is making our children grow up too fast. They are becoming a “fearful generation”.
In tandem with the Covid-19 pandemic is a mental health pandemic. We will only come to realise in the future the full impact of what this prolonged and fearful pandemic has on our children.
There are and will be increased long-term phobias and fears, post-traumatic stress disorders and suicides. It is vital that parents work to build a resilient family now, amid the pandemic. We must move from just survival to resilience and growth. We must stop waiting for Covid-19 to end, living our lives on a “pause button”, and move to living heartfully and meaningfully – being present to the moment and to our children.
Many of the gains we have made for child health under the Sustainable Development Goals may be lost or reversed. While we have expanded much of our energy thus far to “surviving” the threat of the Covid-19 pandemic, we must give our thought, energy and resources to building the system mechanisms that will allow our children to transcend the negative impacts of this crisis. A failure to do so will result in many generations of our children carrying the scars of Covid-19 even as adults.
Dr Amar-Singh HSS is a senior consultant paediatrician.
The views expressed are those of the author and do not necessarily reflect those of FMT.
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