The Covid-19 pandemic has been a head-on challenge to even the most solid health systems in the world. In South Africa its onset collided with the already existing quadruple burden of disease. The country faces epidemics of HIV and tuberculosis (TB); non-communicable diseases such as hypertension and diabetes; suboptimal maternal and child health; as well as violence and injuries.

To deal with Covid-19 the government re-organised the health system. Medical and laboratory capacity was increased and field hospitals were built – all in anticipation of a rapid rise in adult Covid-19 patients.

Children have made many sacrifices because of the country’s Covid-19 response. These include social isolation, and lack of education opportunities and access to nutrition intervention programmes.

The impact of Covid-19 itself on children has been comparatively small. The burden of paediatric Covid-19 disease has been low, in line with reports from countries ahead of South Africa in the epidemic wave. Hospitalisations and death rates have been low among children.

For South African children other risks are much greater. The potential for severe collateral damage caused by Covid-19 on the usual causes of childhood death and illness is huge. This is because of severe impacts on important child health interventions such as the immunisation programme, the nutrition programme, and the HIV and TB prevention and treatment programmes. Children are not the face of the Covid-19 pandemic. But they risk being among its biggest victims.

Child mortality

Childhood is a period of increased vulnerability in terms of health and nutrition. An estimated 43,000 children under five died in South Africa in 2018 alone, and of these, 12,717 were newborns. Some of the key drivers of child deaths were underlying malnutrition, HIV and TB. The overlap between the HIV and Covid-19 epidemics in countries like South Africa is of particular concern due to great risks to the hard-won milestones in controlling the HIV epidemic. In addition, violence and injury, congenital disorders and non-communicable disorders have been emerging as important causes of childhood deaths.

Providing continuity of health services in an already stretched health system is no small ask during a pandemic. The Covid-19 lockdown phases have affected the availability and accessibility of essential health services, especially for women and children. Travel restrictions, staff shortages at health facilities and disrupted community health worker routines have all reduced access to healthcare.

International research has highlighted the risk for marked increases in the prevalence of childhood wasting as well as increased child and maternal mortality in the months to come, due to the reduction in coverage of essential maternal and child health care services.

In South Africa, childhood malnutrition remains a reality. The District Health Information System recorded 11,280 hospital admissions for severe acute malnutrition in children below five years of age within one year (2018/9), including 806 deaths. The trends in hospital admissions and deaths associated with child malnutrition have been improving over the past few years, but could potentially deteriorate rapidly due to an increase in child hunger.

Planning ahead

Child nutrition, growth and health are intimately intertwined and will be jointly affected if mitigation strategies are not urgently put in place. Otherwise the adverse impact on child morbidity and mortality is a real possibility – this is a second wave that now urgently needs to be flattened.

South Africa isn’t experiencing a famine, but a lack of access to food. It is time to set new goals, while being vigilant in maintaining the Covid-19 response. Children and young people should be a priority, while continuing to shield the old and sick.

Combating hunger will cost money, but just as importantly, it will be about having a vision and a plan.

This plan needs to be in sync with the rebuilding of the economy, and requires coordination of all the relevant role players. These include various government departments, businesses, non-governmental and faith-based organisations and donors. The plan should also harness the goodwill of ordinary South Africans. Constructively contributing towards the rebuilding of the country may be an effective antidote to Covid-19 fatigue.

• Ute Feucht: Associate Professor in Paediatrics, University of Pretoria
• This article was first published in The Conversation