In late 2021, as the COVID-19 pandemic wore on, the Berman Institute’s Annual Report asked a number of faculty members to look to the future and reflect not only on how Covid has impacted their areas of research expertise to date, but also share what they believe will be some of the lasting and perhaps permanent changes to the field.
In this excerpt pediatrician Rebecca Seltzer, MD, the Freeman Scholar for Clinical Ethics at the Berman Institute and an assistant professor at the Johns Hopkins School of Medicine, discuss the pandemic’s impact on children.
HOW HAVE THE NEEDS OF CHILDREN BEEN CONSIDERED BY POLICYMAKERS DURING THE PANDEMIC?
Because of my interest in child health policy even before the pandemic, I knew policies tend not to be driven by the needs of children. Kids don’t vote. But from an ethical perspective, children are an inherently vulnerable population. Their ability to survive and flourish is largely dependent on care from the adults and society that surround them. So, to say that during a pandemic, we don’t owe it to kids to protect them and put their needs at the forefront of policy decisions is a sad commentary on what we value. Why did we prioritize reopening bars before schools?
I still worry that this far into the pandemic, the narrative that Covid doesn’t impact children as much as adults doesn’t give enough attention to all the challenges they continue to face. While all children are vulnerable, there are pediatric populations that have been disproportionately impacted by the pandemic. Children of color have been more likely to be hospitalized or develop severe illness from Covid. Children in foster care missed visiting in-person with their biological parents or had adoptions put on hold due to court delays. And not only were children with medically complex conditions at greater risk of medical complications with Covid, but they faced challenges in all aspects of life. Access to and delivery of care was impacted by Covid policies, such as cancelling elective procedures. School based services, like speech and physical therapies, were abruptly stopped with school closures. Existing shortages in pediatric home nursing were exacerbated by illness and fears of exposure, leaving parents unable to sleep or work as they provided for their child’s 24/7 care needs without home nursing supports. It is morally problematic that the voices and experiences of these populations don’t seem to matter in discussions about Covid-related policies.
WHAT ETHICAL QUESTIONS HAS COVID HIGHLIGHTED IN YOUR WORK?
There were already problems with fragmented systems of care that didn’t properly promote optimal health and wellbeing for children with medical and/ or social complexities. Covid exacerbated these underlying challenges and disparities. It brought to light that some people are impacted differently, and more significantly. But through this pandemic we have seen one-size-fits-all policy decisions made by governments that don’t even talk about, let alone account for, these disparate impacts.
Ethics needs to be a part of policymaking. Ethics brings language and a framework for thinking through benefits and harms. Ethics professionals are good at recognizing that different people have different values, and at helping evaluate and prioritize competing interests and obligations, particularly when policies have different impacts on different populations.
I’m working with colleagues at the BI and Oxford on a project that looks at how policies impacted the families of children with chronic conditions. That’s grown into thinking about how the voices of these children and their families can be used in creating policies in the future. We’re trying to create a new methodology that will better include families’ lived experience in shaping the policies that will impact them directly
WHAT HAS BEEN THE PANDEMIC’S IMPACT ON YOU AS BOTH A PEDIATRICIAN AND THE PARENT OF YOUNG CHILDREN?
You mean other than exhaustion? It has made me feel even more of a need to advocate for vulnerable pediatric populations and remind decision-makers that kids matter. I feel strongly that in a lot of ways children have just been thrown to the side. Like I said before, I’ve seen just how inaccurate the belief is that children are spared or not impacted by Covid. While it is true that Covid causes severe illness and hospitalization in a small percentage of kids, there are now so many cases that even that small percentage is filling up our pediatric hospitals and ICUs—and it’s impossible to predict which kids are going to get very sick. As a primary care pediatrician, I see and feel the impact of COVID in every patient encounter—growth charts with weight trajectories skyrocketing since the start of the pandemic, teens with new onset depression and anxiety at alarming rates, kids falling behind in school, grief from the loss of loved ones to Covid, fears of contracting Covid, fears and uncertainty about the vaccine.
As a parent of two young children, I experience the frustrations and struggles that result from a lack of clear Covid policy guidance for early childcare centers. I recently called around several daycare centers to discuss Fall enrollment for my youngest and asked each of them about their Covid policies. No two were alike. It’s crazy that two years into this
pandemic there is still such confusion and no central guidance. Vaccination in small children is another similar area where young children have been left behind. For many, vaccination was the start of living a “normal” life again, but not for families with young children who are unprotected.
Considering the impact of this pandemic on kids, their exclusion from the discussion about policies has been quite eye-opening. As we begin thinking about the future, about establishing the policies that reflect our values and priorities, it’s important that a broader range of voices are heard, including those of the most vulnerable.