This article is only available to Macro Hive subscribers. Sign-up to receive world-class macro analysis with a daily curated newsletter, podcast, original content from award-winning researchers, cross market strategy, equity insights, trade ideas, crypto flow frameworks, academic paper summaries, explanation and analysis of market-moving events, community investor chat room, and more.
Soon, the death rate from COVID-19 will breach 300,000. And though we may be getting to grips with its effect on adults, children present us with some confusion. Their symptoms appear lacking, and their ability to transmit the virus seems lower than adults. But recently, a group of researchers at Johns Hopkins Bloomberg School of Public Health presented startling new evidence on a potential rise in maternal and child mortality in low- and middle-income countries should essential health services be disrupted as a result of COVID-19.
Building on the lessons that previous outbreaks such as Ebola and SARS taught, the authors estimate a devastating increase in the numbers of maternal and child deaths resulting from reductions in routine health service coverage. Left unchecked, these reductions (due to, for example, disruptions in medical supply chains or the availability of human and financial resources) along with declines in the uptake of health services by communities fearful of infection will be more catastrophic for mothers and children than COVID-19 itself.
In fact, the authors alarmingly project an additional 1.2 million child deaths and 56,700 maternal deaths across 118 countries if coverage of essential services drops by around 45% for six months.
Children are at risk not only of infection, but also of losing or being separated from family members and caregivers. Both mothers and children are affected by the disruption of essential preventative and curative support and supplies resulting from suspensions in services and transportation systems, as well as by financial constraints. Constrained access to clinics, schools, social workers, water, and sanitation is a particular threat to the most vulnerable populations, and the lack of child protection and broader social services is particularly harmful to women and children in need of safety. Looming above all of these concerns is the economic impact of both the pandemic control measures that governments are taking and the predicted knock-on effects of the projected global recession.
Already before the crisis, UNICEF was working on an initiative to extend digital infrastructure to ensure all children can learn, no matter who and where they are, and this work needs to be brought quickly to scale.
Following the NHS England alert at the start of the month, there are infrequent but growing reports of an unusual vasculitis (inflammation of blood vessels) called Kawasaki Disease in children associated with COVID-19. Kawasaki Disease is extremely rare, tends to affect children of Asian descent (boys > girls) and is characterized by inflammation of mid-size arteries; coronary artery inflammation is most concerning (it presents a risk of aneurysms, which are burst vessels).
The treatment for Kawasaki Disease is high dose aspirin, intravenous immunoglobulins to prevent coronary aneurysms, and potentially immune modulators such as IL-1 or TNF antibodies.
Concerningly, there are also reports of a paediatric multi-system inflammation syndrome related with COVID – the disease’s classification vs Kawasaki is hazy. There have been up to 93 cases in New York; more than 130 across the US; and the UK has also seen about 12 children presenting symptoms. There are approx. 4.6mn children in New York. If 15% have had COVID-19, that’s 690,000 infections; 93 cases would be 0.01%, or an approx. 1:7500 rate in infected kids.
Why is This Emerging Now?
- It was previously unappreciated. Awareness of the COVID link is increasing reporting.
- It is extremely rare and only seen after large enough denominator of infections.
- It is a delayed reaction to infections weeks ago
- Possibly, it is a new strain.
It’s also unclear why this is occurring in children not adults. Maybe there’s a variant presentation of same thing happening in adults, or it could be due to children’s relatively immature immune system.
The Implications
- Causing concern for parents and schools. Until recently, kids were thought to be minimally affected.
- It raises questions about vaccines/children. Should children be vaccinated? Could Kawasaki/inflammation be a risk from vaccines as well as the virus? For which ages? There is no reason to think the risk with vaccination would be higher than with infection, but still it needs to be considered.
Justin Stebbing is a Professor of Cancer Medicine and Oncology, Consultant Oncologist, Imperial College and Imperial College Healthcare NHS Trust. He specialises in a range of malignancies, their treatment with immunotherapy (breast, GI and lung and clinical trials), having originally trained in medicine at Trinity College Oxford.
(The commentary contained in the above article does not constitute an offer or a solicitation, or a recommendation to implement or liquidate an investment or to carry out any other transaction. It should not be used as a basis for any investment decision or other decision. Any investment decision should be based on appropriate professional advice specific to your needs.)