Thread by @JonMarronMD

As a pediatrician & bioethicist, I find myself thinking a lot about the effects of #COVID19 on children, both currently and & in the future. These effects appear to influence nearly all aspects of kids' lives: their health, families, education, & everything between

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Early on in the pandemic, it appeared that children (for reasons that still are not totally clear) were less susceptible to the severe sequelae of #COVID19

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https://twitter.com/JonMarronMD/status/1243905074205614082?s=20

Data are still emerging, but recent work supports these early reports. Severe illness in children can be significant but occurs far less frequently than in adults, as reported via a large international collaboration in @JAMAPediatrics:
jamanetwork.com/journals/jamap…

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Even among children with cancer, COVID-related morbidity appears to be quite low, as reported in @JAMAOnc: jamanetwork.com/journals/jamao….

Notably, this has been the experience at my institution as well. #childhoodcancer #pedcsm

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Pediatric Blood & Cancer (the official journal of #PHODocs @ASPHO_hq & @WorldSIOP) recently published a "call for sharing experiences" given the limited data on #COVID19 in #ChildhoodCancer. Great list of online resources within this paper as well: onlinelibrary.wiley.com/doi/full/10.10…

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And then @TheLancetOncol published a report of the effect of #COVID19 on ped cancer care in Latin America: thelancet.com/journals/lanon…

TL;DR: limited effect on kids themselves but HUGE effect (not surprisingly) on care delivery systems

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In recent weeks, it's started to become clear that COVID is affecting the medical care of not just those with chronic disease or those actually infected with coronavirus.

@CDCgov @CDCMMWR reported HUGE drops in pedi vaccination rates since January dx.doi.org/10.15585/mmwr.…

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This led to the @AmerAcadPeds @AAPNews coming out strongly recommending "continued provision of health care for children" during #COVID19, including vaccinations, well visits, & sick (COVID & non-COVID) visits: services.aap.org/en/pages/2019-…

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But overall health & medical care arent only aspects of children's' lives affected by #COVID19. Remember that schools & daycares are closed, parents are losing jobs, & support structures are in shambles

Described beautifully but horrifyingly here: hrw.org/news/2020/04/0…

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Now, as we begin to take steps toward "re-opening," we must consider the potential impact on children as well

Remember the awful comments made by "Doctor" Oz about the potential loss of lives from schools re-opening. Misinterpreted or not, these comments remain horrifying

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But now discussions are really taking place about schools re-opening.

Great friend/colleague @DrMcollins2020 wrote about ethical challenges in schools reopening w @bermaninstitute @JHUeducation colleagues Ruth Faden & @ImpactGreater in @baltimoresun: baltimoresun.com/opinion/op-ed/…
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Similar concerns raised today in @JAMA_current by @drJoshS @educationdean (w/ assist by @DrMcollins2020), outlining a pathway for safe school opening, which I fear will be far more complicated than most expect: jamanetwork.com/journals/jama/…

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So to sum up, children have been *& will continue to be* hugely impacted by #COVID19

No matter what comes next & what direction things go, we mustnt lose sight of both obvious & hidden impacts of COVID on children around the world

We *MUST* consider them as we proceed!!

/fin

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