COVID, Children and Housing Distress

Some high-risk groups for COVID have been focused upon but there has been little public, medical or policy attention focused on children. The burning question is Why?

It may be that children actually don’t get COVID-19 much. There are some data to support that conclusion. Yet the World Health Organization reminds us that every age group is potentially at risk of getting the virus. People with underlying health problems are more at risk, but these can be people of any age. Harvard researchers have identified a COVID complication observed in children that can be severe and dangerous. Called multisystem inflammatory syndrome in children (MIS-C), it can lead to life-threatening problems with the heart and other organs in the body. We know that children have gotten COVID and some have died.

However, it seems to me that it is more a result of a data problem. What we tend to know about COVID-19 comes from data about the incidence and prevalence of the disease, and its morbidity and mortality rates. All of these are dependent upon good data collection systems, which vary dramatically depending upon where you are. In general, despite valiant attempts, data on who gets the virus, its spread, and its outcomes aren’t as good as we need or want. It is a particular problem when it comes to housing distressed children, like those who are homeless or those seeking refuge when they come across the border into the US.

First is an identification problem. Young children are not able to verbalize when they are sick. Parents have to read the signs and interpret when their children are having routine ailments and when their condition is something more serious — or potentially life-threatening. Children may often have low-grade fevers, runny noses, or signs of a cold or flu. Usually, these kinds of problems are common to a variety of ailments and can be usually be adequately cared for at home, with rest, fluids, over-the-counter-medications, and time to recover. But we have seen that with some ailments and some children, they can “go south” quickly. Time is of the essence to get the children into the doctor or emergency room as soon as possible in these situations. Parents walk a tightrope, not knowing when to over-react or bide time. Some may not read the signs of serious illness and under-react to serious illnesses in their children as a result. When parents are overwhelmed with trying to manage complex housing problems and keep their families together, they have a lot to juggle, which makes the decision-making of when a child is truly sick extra challenging.

If parents decide that their child should be seen, they confront another problem. This is getting an appointment. Many physician offices have been closed as doctors have opted for teletherapy appointments. Unless people are pretty sure they have the virus, they have been told NOT to go to the ER, urgent care or doctor’s offices. Doctors encouraged very sick people to seek care at emergency rooms, but as most people know, going to the ER usually requires long wait times — and that was before hospitals became deluged by coronavirus patients.

Then there is the concern about whether they want to take their already sick child into an environment where there are many very seriously ill people there who are seeking help for life-and-death situations. Iatrogenic diseases aren’t uncommon. If they are not sure that the child is seriously ill to risk putting them into contact where there are others who feel they are deathly ill, not going to the ER or doctor’s office and exposing them to viruses, bacteria, and other germs may be a reasonable choice.

Let us not ignore the fact that for most parents, taking their child to the doctor or ER is costly. While some parents have good health insurance coverage and financial resources that enable them to pay for care, many don’t. Affording co-pays, prescriptions, or other medical resources may be beyond their ability. Knowing that they cannot afford care for their children puts them in a challenging situation, one that is fraught with moral, ethical, pragmatic, and financial issues.

Now, look at another data problem — lack of a COVID vaccine and lack of COVID testing of children. If tests aren’t conducted, there are no records of the illness. Therefore, because children aren’t being tested for the virus, it would seem that they aren’t being infected. “We have zero tests for children. We have zero swabs,” according to New York City pediatrician Dr. Dyan Hes. “I’ve had patients whose parents have COVID, the child has a 102.5 fever. At the beginning when we were doing this, we were sending them to the ER. They got turned away. They were not tested because we do not have enough tests and the kids are doing well.” Dr. Hes projects that 80% of the children have coronavirus. She reports that most of them are asymptomatic.

The Centers for Disease Control found that from February to April 2, 2020, there were 2,572 COVID-19 cases in children aged <18 years, the median age was 11 years (range 0–17 years). Nearly one-third of reported pediatric cases (813; 32%) occurred in children aged 15–17 years, followed by those in children aged 10–14 years (682; 27%). Among younger children, 398 (15%) occurred in children aged <1 year, 291 (11%) in children aged 1–4 years, and 388 (15%) in children aged 5–9 years. About 57% of the cases were found in male children, which is consistent with the findings that in the adult population males appear to be at higher risk of contracting COVID or dying from it. These findings are largely consistent with a report on pediatric COVID-19 patients aged <16 years in China, which found that only 41.5% of pediatric patients had a fever, 48.5% had a cough, and 1.8% were admitted to an ICU. There is concern that although pediatric COVID-19 patients infrequently have severe outcomes, the infection might be more severe among infants.

When it comes to the impact of coronavirus, children who are lucky enough to have parents with financial resources fare much better than those who are in poverty. A UNICEF report indicates that the economic repercussions of the coronavirus pandemic could push up to 86 million more children around the world into household poverty by the end of 2020. The virus has forced people to lose their jobs and with it their health insurance, housing, food, and ability to survive. In the US, homelessness is projected to increase by 45% by the end of the summer, with over 800,000 people being homeless.

Children who have stable housing fare much better than those who live in insecure housing, distressed housing situations, or homelessness. Families who are homeless had a hard enough time before the pandemic, and now it is regarded as “horror upon horror”. The meager places children could count on have been eradicated during the pandemic and children are desperate for safe places to go. Their parents may lose their housing. Schools close, as do libraries, daycare centers, and recreation centers, which have provided safe-havens for children, especially those whose parents have to work.

The Institute on Children, Poverty and Homelessness, reports that over 29.7 million children received free or reduced-price breakfast and lunch, and for students experiencing homelessness — who are over five times more likely to go hungry than their housed peers — school-provided meals are even more important. As workplaces close, parents lose their jobs and incomes, and food pantries struggle to keep up with demand and face a dwindling number of volunteers, meals offered by schools are even more vital.

They find that nationally, an estimated 14.5 million households do not have internet access, so when schools close and students are required to do remote learning, homeless and housing vulnerable children are at being unable to complete assignments and advance. Homeless parents may be unable to purchase resources that are required for their children’s successful achievement. Moreover, schools provide a source of stability, support, and encouragement for academic success that becomes compromised by the virus. A tremendous strain is placed on teachers and schools to ensure that all children can succeed.

Consider the challenges COVID infected children face. When homeless children get sick, they lack a safe place to sleep, a fridge for a cool drink, a stove to cook chicken soup, and a bath where they can warm and wash off their fever. Add to their stress the lack of testing, and their parents' inability to pay for prescriptions or visits to the doctor and housing distressed children face unfathomable health problems. COVID hits a person’s respiratory system, and homeless children have a much higher rate of asthma and other respiratory problems. If they are living doubled-up with others or living in a shelter, they are unable to maintain CDC recommended guidelines for social distancing. Some communities have put homeless people into hotel rooms where they are to stay-put, given them tents, or even in large collective living spaces to keep them from catching or spreading the virus. Lack of preventive care results in serious health conditions for children.

Using a broad definition of homelessness in children, children who are placed into institutions also remain at severe risk for getting exposed to the virus, and not having adequate housing and resources if they get sick. These children include those who are refugees, seeking asylum, or are immigrants who are removed from their families at the US-Mexico border, those who are put into shelters and congregate living arrangements, as well as those in juvenile detention facilities or residential cognitive, mental health or recovery institutions. These children are seldom talked about or considered by the public — or government officials or policymakers. There seems to be little funding to research them, support them or their providers, or prevent their exposure.

The Centers for Disease Control and Prevention and physicians nationwide, concerned that infectious respiratory illnesses were spreading in congested border facilities, recommended flu vaccinations be given to children 6 months or older.

Customs and Border Protection officials have refused to put a flu vaccination program into effect, arguing that most migrants spend less than 72 hours in Border Patrol facilities. The controversy came to a flashpoint in December when about 20 medical professionals hauling coolers with flu vaccines showed up at a migrant detention center near San Diego, announcing their plan to inoculate everyone inside the facility who consented, but were arrested by authorities. Because there is no vaccine for COVID-19, the children at the border certainly are at risk of a host of respiratory ailments that some children there have died from. Hundreds of migrant children and teenagers have been swiftly deported by American authorities amid the coronavirus pandemic without the opportunity to speak to a social worker or plea for asylum from the violence in their home countries — a reversal of years of established practice for dealing with young foreigners who arrive in the US.

Immigrant children who have been moved to other detainment shelters around the country have also come down with the coronavirus. So have children confined in detainment at juvenile justice facilities. Youth who are confined and can’t go home are at higher risk of contracting the virus, and when they are sick they lack the recovery supports and comforts to which housed children have access.

Having access to housing is a fundamental right for all children, one that is essential for their physical and emotional well-being. So is having access to preventive healthcare, and being provided the resources and supports that enable them to recover when they do get sick. Millions of children lack health insurance and their parents cannot pay for medical services. From 2016 to 2018, there was an increase of over 400,000 children who lacked health insurance, and that number has skyrocketed as parents have lost their jobs — and health insurance — due to the pandemic. The Children’s Health Fund estimates that, at minimum, 20.3 million children in the United States (28% of all children) face barriers to accessing essential health care.

Thus the COVD pandemic has exposed another pandemic — the lack of care for children in general, and the most vulnerable children in particular. The US is the only United Nations member country not to have ratified the world’s most supported human rights treaty — the Convention on the Rights of the Child. It is obvious that young lives matter — so where is the social outcry to support their access to housing, healthcare and education rights? Join me and the millions who are in support of children’s human rights.