Expert forum Covid-19 interview: Heather Haq

Heather Haq, Chief Medical Officer at Baylor College of Medicine in Houston, Texas, highlighted the impact of COVID-19 on children


Swiss Re Institute: Dr. Haq , thank you for joining us. Your insights as a hospitalist pediatrician shine an important light on children's health, an area that's been neglected in the past year as we've rushed to contain the pandemic.
Dr. Haq (find her on LinkedIn): Glad to be with you to share some of what we've learned over the course of the past year as frontline workers at Texas Children's Hospital. We all know that COVID-19 rarely leads to severe outcomes in children and teens – most infected children experience only mild to moderate symptoms. For this reason, both the physical and psychological impact on children is often overlooked. The numbers, however, are telling us that there needs to be a far greater focus on children. In the beginning of the pandemic it was estimated that around 2% of diagnosed cases were children and teens. But as testing has expanded the estimate has risen to 8-10%. While there are few deaths, we do see a number of worrying trends.

Swiss Re Institute: Before we look at the longer-term impacts of COVID-19 on children, can you tell us a bit more about children's symptoms as they come to your hospital?
Dr. Haq: There's neonatal fever, fever, vomiting, diarrhea, dehydration. We see cases of kidney injury and pneumonia, but not as much as in adults. And then there's MIS-C, the multi-system inflammatory syndrome in children. We find that one in three children requires critical care.

Swiss Re Institute: Can you elaborate on MIS-C?
Dr. Haq: It's basically a combination of fever, lab evidence of inflammation, and multiple organ systems involved – and a history of recent or current COVID infection. We have seen a large number of these cases here in Texas. These tend to happen in adolescents, previously healthy. And we've found that cases of MIS-C usually lag behind COVID surges by about three to four weeks.

Swiss Re Institute: What are the long-term sequelae of both acute COVID and MIS-C in children?
Dr Haq: We have set up a post-COVID clinic, focused on examining heart function of children who were diagnosed with either acute COVID disease or MIS-C. A lot of these kids have structural changes in their hearts, or heart function, that need to be observed closely over time. We are concerned that these children could have lifelong impacts.

With regard to psychological impacts, we see an alarming trend, you might call it a pediatric mental health tsunami. Many children experience heightened levels of anxiety. These are children who have lost family members or have family members impacted by COVID-19 and so require care long after a diagnosis. Children, in their developmental stages, also struggle with disrupted schooling, loss of peer interactions, loss of routine, economic changes at both the family and community level. In the United States we've found that emergency room visits for mental health crises among 12 to 17-year olds is up more than 30% compared to the prior year. Children are presenting to the ER with suicidal ideation, following suicide attempts and both intentional and unintentional overdoses. We see another disturbing trend in that the pre-teen age group also presents these types of issues.

Swiss Re Institute: Are the rise of suicide ideation and attempts tied to pandemic waves?
Dr. Haq: That's what we see. At the beginning of last year, the data was comparable to 2019. But already in February and March we saw a rise in suicidal ideation rates, as well as an increase of children presenting for suicide attempts to pediatric emergency departments. We saw a next surge in the summer. As far as actual suicide attempts, there's been an increase, compared to the prior year, throughout the pandemic. These trends in our teenage and pre-teen populations indicate a widespread mental health impact of the pandemic on this age group.

Swiss Re Institute: Are mental health institutions ready to cope with the increase?
Dr. Haq: We see shortages of community mental health resources. With psychiatric institutions overflowing because of increased demand, patients are sent to medical hospitals, such as Texas Children's. Across the US we seen an increase in number of mental health admissions into hospitals. These are children without medical issues but suffering from severe depression and suicidal thoughts.

It is difficult to predict the long-term sequelae of the mental health challenges in this age group. But I think we're going to be seeing reverberations of this mental health pandemic amongst children for a long time to come. Finally, allow me to add one more area of concern that requires attention, study and care: orphans, left in the wake of the pandemic. The many adult deaths due to COVID-19 leave behind an even greater number of single or double orphans. It must be expected that these millions of bereaved teens and pre-teens will add to the increasing demands put on our care institutions.