Impacts of the COVID-19 pandemic on the physical and mental health of children

The total number of new cases of coronavirus disease 2019 (COVID-19) is decreasing in Hong Kong, but two recent paediatric cases have attracted immense public attention—a 4-month-old baby who contracted the viral infection from his family and a 4-year-old boy who was likely infected in the community several months before, possibly concurrently with roseola infantum, and tested positive despite the long interval between infection and testing. Since the outbreak of COVID-19 in Hong Kong in January 2020, there has been a great deal of research by local paediatricians on the clinical manifestations1 2 3 and scientific findings4 5 of the paediatric cases, including comparative studies with paediatric cases in South Korea,6 Wuhan,6 7 8 and other regions of mainland China,6 7 8 and with those of children infected with severe acute respiratory syndrome in 2003.9 Collaborations with local and overseas researchers have also contributed to a deeper understanding of COVID-19.10 11 12 13 The overt effects of COVID-19 on children are known: severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection generally causes mild illness in children and adolescents, with 99.2% of paediatric patients with COVID-19 experiencing mild symptoms8 and 26% to 38% asymptomatic.3 8 However, serious complications have occurred in children in Hong Kong, such as PIMS-TS (paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2), post-COVID-19 autoimmune haemolytic anaemia, and COVID toes.8 These patients required lengthy hospital management including intensive care and prolonged follow-up after recovery. In addition to providing a learning environment, schools serve to satisfy students' non-academic needs and school closures have serious consequences on the physical and mental wellbeing of students.15 Internationally, studies have found that obesity16 and myopia17 among school-age children have increased because of longer screen times, lack of physical activities, and the small living and learning spaces at home. The authors found that, amid the COVID-19 outbreak and the resulting related school closures and disease containment measures in Hong Kong, the risk of child psychosocial problems was higher in children with special educational needs, and/or acute or chronic disease, mothers with mental illness, single-parent families, and low-income families.