Review of literature:-

ROL-1Angelo Pietrobelli et al. Obesity (Silver Spring). 2020 Aug.

The aim of this study was to test the hypothesis that youths with obesity, when removed from
structured school activities and confined to their homes during the coronavirus disease 2019
pandemic, will display unfavorable trends in lifestyle behaviors. The sample included 41 children
and adolescents with obesity participating in a longitudinal observational study located in
Verona, Italy. Lifestyle information including diet, activity, and sleep behaviors was collected at
baseline and 3 weeks into the national lockdown during which home confinement was
mandatory. Changes in outcomes over the two study time points were evaluated for
significance using paired t tests. There were no changes in reported vegetable intake; fruit
intake increased (P = 0.055) during the lockdown. By contrast, potato chip, red meat, and sugary
drink intakes increased significantly during the lockdown (P value range, 0.005 to < 0.001). Time
spent in sports activities decreased by 2.30 (SD 4.60) h/wk (P = 0.003), and sleep time
increased by 0.65 (SD 1.29) h/d (P = 0.003). Screen time increased by 4.85 (SD 2.40) h/d (P <
0.001). Recognizing these adverse collateral effects of the coronavirus disease 2019 pandemic
lockdown is critical in avoiding depreciation of weight control efforts among youths afflicted
with excess adiposity. Depending on duration, these untoward lockdown effects may have a
lasting impact on a child's or adolescent's adult adiposity level.

ROL-2 Laura Di Renzo et al. J Transl Med. 2020.

On December 12th 2019, a new coronavirus (SARS-Cov2) emerged in Wuhan, China, sparking a
pandemic of acute respiratory syndrome in humans (COVID-19). On the 24th of April 2020, the
number of COVID-19 deaths in the world, according to the COVID-Case Tracker by Johns
Hopkins University, was 195,313, and the number of COVID-19 confirmed cases was 2,783,512.
The COVID-19 pandemic represents a massive impact on human health, causing sudden
lifestyle changes, through social distancing and isolation at home, with social and economic
consequences. Optimizing public health during this pandemic requires not only knowledge from
the medical and biological sciences, but also of all human sciences related to lifestyle, social
and behavioural studies, including dietary habits and lifestyle. Our study aimed to investigate
the immediate impact of the COVID-19 pandemic on eating habits and lifestyle changes among
the Italian population aged ≥ 12 years. The study comprised a structured questionnaire packet
that inquired demographic information (age, gender, place of residence, current employment);
anthropometric data (reported weight and height); dietary habits information (adherence to the
Mediterranean diet, daily intake of certain foods, food frequency, and number of meals/day);
lifestyle habits information (grocery shopping, habit of smoking, sleep quality and physical
activity). The survey was conducted from the 5th to the 24th of April 2020.  A total of 3533
respondents have been included in the study, aged between 12 and 86 years (76.1% females).
The perception of weight gain was observed in 48.6% of the population; 3.3% of smokers
decided to quit smoking; a slight increased physical activity has been reported, especially for
bodyweight training, in 38.3% of respondents; the population group aged 18-30 years resulted in
having a higher adherence to the Mediterranean diet when compared to the younger and the
elderly population (p < 0.001; p < 0.001, respectively); 15% of respondents turned to farmers or
organic, purchasing fruits and vegetables, especially in the North and Center of Italy, where BMI
values were lower. In this study, we have provided for the first time data on the Italian
population lifestyle, eating habits and adherence to the Mediterranean Diet pattern during the
COVID-19 lockdown. However, as the COVID-19 pandemic is ongoing, our data need to be
confirmed and investigated in future more extensive population studies.

ROL-3 Aleksandra Sidor et al. Nutrients. 2020.

The outbreak of coronavirus disease (COVID-19) in late December 2019 in China, which later
developed into a pandemic, has forced different countries to implement strict sanitary regimes
and social distancing measures. Globally, at least four billion people were under lockdown,
working remotely, homeschooling children, and facing challenges coping with quarantine and
the stressful events. The present cross-sectional online survey of adult Poles (n = 1097),
conducted during a nationwide quarantine, aimed to assess whether nutritional and consumer
habits have been affected under these conditions. Over 43.0% and nearly 52% reported eating
and snacking more, respectively, and these tendencies were more frequent in overweight and
obese individuals. Almost 30% and over 18% experienced weight gain (mean ± SD 3.0 ± 1.6 kg)
and loss (-2.9 ± 1.5 kg), respectively. Overweight, obese, and older subjects (aged 36-45 and
>45) tended to gain weight more frequently, whereas those with underweight tended to lose it
further. Increased BMI was associated with less frequent consumption of vegetables, fruit, and
legumes during quarantine, and higher adherence to meat, dairy, and fast-foods. An increase in
alcohol consumption was seen in 14.6%, with a higher tendency to drink more found among
alcohol addicts. Over 45% of smokers experienced a rise in smoking frequency during the
quarantine. The study highlights that lockdown imposed to contain an infectious agent may
affect eating behaviors and dietary habits, and advocates for organized nutritional support
during future epidemic-related quarantines, particularly for the most vulnerable groups,
including overweight and obese subjects.

ROL-4 Vilma Kriaucioniene et al. Nutrients. 2020.

The COVID-19 quarantine has caused significant changes in everyday life. This study aimed to
evaluate the effect of the quarantine on dietary, physical activity and alcohol consumption
habits of Lithuanians and the association between health behaviours and weight changes. An
online cross-sectional survey was carried out among individuals older than 18 years in April
2020. The self-administered questionnaire included health behaviour and weight change data.
Altogether 2447 subjects participated in the survey. Almost half of the respondents (49.4%) ate
more than usual, 45.1% increased snacking, and 62.1% cooked at home more often. Intake of
carbonated or sugary drinks, fast food and commercial pastries decreased, while consumption
of homemade pastries and fried food increased. A decrease in physical activity was reported by
60.6% of respondents. Every third (31.5%) respondent, more often those already with
overweight, gained weight. Multivariate logistic regression analysis showed that the higher odds
of weight gain were associated with females, older age, increased consumption of sugary
drinks, homemade pastries and fried food, eating more than usual, increased snacking,
decreased physical activity and increased alcohol consumption. Our data highlighted the need
for dietary and physical activity guidelines to prevent weight gain during the period of self-
isolation, especially targeting those with overweight and obesity.

ROL-5Celia Rodríguez-Pérez et al. Nutrients. 2020.

The aim of this study was to evaluate whether dietary behaviours of the Spanish adult
population were changed during the COVID-19 outbreak confinement. For that purpose, an
online questionnaire, based on 44 items including socio-demographic data, Mediterranean diet
(MedDiet) Adherence Screener (MEDAS) as a reference of a healthy diet, processed foods
intake, changes in their usual food choices and weight gain was distributed using social media
and snowball sampling. A total of 7514 participants (37% aged below 35 years, 70.6% female,
77.9% university-level education or higher) from all the Spanish territory completed the
questionnaire. Results outlined healthier dietary behaviours during the confinement when
compared to previous habits. Overall, the MEDAS score (ranging from 0 to 14, whereby higher a
scoring reflects greater adherence to the MedDiet) increased significantly from 6.53 ± 2 to 7.34
± 1.93 during the confinement. Multivariate logistic regression models, adjusted for age, gender,
region and other variables, showed a statistically significant higher likelihood of changing the
adherence to the MedDiet (towards an increase in adherence) in those persons who decreased
the intake of fried foods, snacks, fast foods, red meat, pastries or sweet beverages, but
increased MedDiet-related foods such as olive oil, vegetables, fruits or legumes during the
confinement. COVID-19 confinement in Spain has led to the adoption of healthier dietary
habits/behaviours in the studied population, as reflected by a higher adherence to the MedDiet.
This improvement, if sustained in the long-term, could have a positive impact on the prevention
of chronic diseases and COVID-19-related complications.

ROL-6 Maartje P Poelman et al. Appetite. 2020.

On March 15, 2020, the Dutch Government implemented COVID-19 lockdown measures.
Although self-quarantine and social-distancing measures were implemented, restrictions were
less severe compared to several other countries. The aim of this study was to assess changes
in eating behavior and food purchases among a representative adult sample in the Netherlands
(n = 1030), five weeks into lockdown. The results show that most participants did not change
their eating behaviors (83.0%) or food purchases (73.3%). However, socio-demographic
differences were observed among those that reported changes during lockdown. For example,
participants with overweight (OR = 2.26, 95%CI = 1.24-4.11) and obesity (OR = 4.21, 95%CI =
2.13-8.32) were more likely to indicate to eat unhealthier during lockdown compared to
participants with a healthy weight. Those with a high educational level (OR = 2.25, 95%-CI =
1.03-4.93) were also more likely to indicate to eat unhealthier during lockdown compared to
those with a low educational level. Older participants were more likely to indicate to experience
no differences in their eating behaviors compared to those of younger age, who were more likely
to indicate that they ate healthier (OR = 1.03, 95%CI = 1.01-1.04) as well as unhealthier (OR =
1.04, 95%CI = 1.02-1.06) during lockdown. Participants with obesity were more likely to indicate
to purchase more chips/snacks (OR = 2.79, 95%CI = 1.43-5.45) and more nonalcoholic
beverages (OR = 2.74, 95%CI = 1.36-5.50) during lockdown in comparison with those with a
healthy weight. Of those that used meal delivery services before, 174 (29.5%) indicated to use
meal delivery services more frequently during lockdown. Although the results confirm the
persistence of dietary routines, profound socio-demographic differences were observed for
those that did report changes. Especially for individuals with overweight and obesity, the
lockdown has taken its toll on healthy dietary choices. Further research should unravel
underlying mechanisms for these observations.

ROL-7Roberta Zupo et al. Int J Environ Res Public Health. 2020.

The world is currently struggling to face the coronavirus pandemic (COVID-19), and many
countries have imposed lockdowns and recommended quarantine to limit both the spread of
the virus and overwhelming demands for medical care. Direct implications include the
disruption of work routines, boredom, depression, increased calorie consumption, and other
similar harmful effects. The present narrative review article briefly analyzes the preliminary
effects of the quarantine lifestyle from the standpoint of dietary habits. In six different
databases, we searched for original articles up to 10 August 2020, assessing eating habits
among populations during the COVID-19 pandemic, and recorded any change in the intake of
major food categories, as well as changes in body weight. The research strategy yielded 364
articles, from which we selected 12 articles that fitted our goal. Our preliminary findings
revealed a sharp rise of carbohydrates sources consumption, especially those with a high
glycemic index (i.e., homemade pizza, bread, cake, and pastries), as well as more frequent
snacks. A high consumption of fruits and vegetables, and protein sources, particularly pulses,
was also recorded, although there was no clear peak of increase in the latter. Data concerning
the consumption of junk foods lacked consistency, while there was a decreased alcohol intake
and fresh fish/seafood consumption. As a possible connection, people gained body weight.
Therefore, in the realistic perspective of a continuing global health emergency situation, timely
preventive measures are needed to counteract obesity-related behaviors in the long-term, so as
to prevent further health complications.

ROL-8Marianna Pellegrini et al. Nutrients. 2020.

Our aim is evaluating the changes in weight and dietary habits in a sample of outpatients with
obesity after 1 month of enforced lockdown during the COVID-19 pandemic in Northern Italy. In
this observational retrospective study, the patients of our Obesity Unit were invited to answer to
a 12-question multiple-choice questionnaire relative to weight changes, working activity,
exercise, dietary habits, and conditions potentially impacting on nutritional choices. A
multivariate regression analysis was performed to evaluate the associations among weight/BMI
changes and the analyzed variables. A total of 150 subjects (91.5%) completed the
questionnaire. Mean self-reported weight gain was ≈1.5 kg (p < 0.001). Lower exercise, self-
reported boredom/solitude, anxiety/depression, enhanced eating, consumption of snacks,
unhealthy foods, cereals, and sweets were correlated with a significantly higher weight gain.
Multiple regression analyses showed that increased education (inversely, β = -1.15; 95%CI -2.13,
-0.17, p = 0.022), self-reported anxiety/depression (β = 1.61; 0.53, 2.69, p = 0.004), and not
consuming healthy foods (β = 1.48; 0.19, 2.77, p = 0.026) were significantly associated with
increased weight gain. The estimated direct effect of self-reported anxiety/depression on
weight was 2.07 kg (1.07, 3.07, p < 0.001). Individuals with obesity significantly gained weight 1
month after the beginning of the quarantine. The adverse mental burden linked to the COVID-19
pandemic was greatly associated with increased weight gain.

ROL-9Leila Cheikh Ismail et al. Nutrients. 2020.

The coronavirus disease is still spreading in the United Arab Emirates (UAE) with subsequent
lockdowns and social distancing measures being enforced by the government. The purpose of
this study was to assess the effect of the lockdown on eating habits and lifestyle behaviors
among residents of the UAE. A cross-sectional study among adults in the UAE was conducted
using an online questionnaire between April and May 2020. A total of 1012 subjects participated
in the study. During the pandemic, 31% reported weight gain and 72.2% had less than eight cups
of water per day. Furthermore, the dietary habits of the participants were distanced from the
Mediterranean diet principles and closer to "unhealthy" dietary patterns. Moreover, 38.5% did not
engage in physical activity and 36.2% spent over five hours per day on screens for
entertainment. A significantly higher percentage of participants reported physical exhaustion,
emotional exhaustion, irritability, and tension "all the time" during the pandemic compared to
before the pandemic (p < 0.001). Sleep disturbances were prevalent among 60.8% of the
participants during the pandemic. Although lockdowns are an important safety measure to
protect public health, results indicate that they might cause a variety of lifestyle changes,
physical inactivity, and psychological problems among adults in the UAE.

ROL-10Wafaa Husain et al. Environ Health Prev Med. 2020.

The coronavirus pandemic has transformed and continues to transform and affect the daily
lives of communities worldwide, particularly due to the lockdown restrictions. Therefore, this
study was designed to understand the changes in dietary and lifestyle behaviours that are major
determinants of health during the COVID-19 outbreak. A cross-sectional study was conducted
through an online questionnaire using a convenience sample of 415 adults living in Kuwait (age
range 18-73 years). The rate of skipping breakfast remained consistent, with a slight increase
during the pandemic. Lunch remained the main reported meal before and during COVID-19.
Compared to before COVID-19, people were much more likely have a late-night snack or meal
during COVID-19 (OR = 3.57 (95% CI 1.79-7.26), p < 0.001). Moreover, there was a drastic
decrease in the frequency of fast-food consumption during COVID-19, up to 82% reported not
consuming fast food (p < 0.001). There was a significant increase in the percentage of
participants who had their main meal freshly made (OR = 59.18 (95% CI 6.55-1400.76), p =
0.001). Regarding food group patterns, no significant differences were found before and during
the pandemic in terms of the weekly frequency of consumption, except in the case of fish and
seafood. There were no remarkable changes in beverage consumption habits among
participants before and during the pandemic, except for Americano coffee and fresh juice.
Furthermore, there was a great reduction in physical activity and an increase in the amount of
screen time and sedentary behaviours. A notable increase was detected in day-time sleep and a
decrease in night-time sleep among participants.  In general, this study indicates some changes
in daily life, including changes in some eating practices, physical activity and sleeping habits
during the pandemic. It is important that the government considers the need for nutrition
education programmes and campaigns, particularly during this critical period of the pandemic in
Kuwait.

ROL-11Jian Zhang et al. Nutrients. 2020.

Coronavirus disease 2019 (COVID-19) has imposed enormous challenges on people's lifestyles.
People in China have gradually returned to normal life; however, in the protracted pandemic,
people may still follow certain dietary behaviors to cope with COVID-19. This study was the
second stage of a longitudinal nutritional survey conducted in post-lockdown China that was
aimed at exploring post-lockdown dietary behaviors and their effects on dietary diversity. In line
with the first stage of the survey, the current dietary behaviors used to cope with COVID-19 and
ways of purchasing food were determined. In addition, changes in dietary behavior compared to
the same period in 2019 and those behaviors recommended to ensure food safety were also
investigated. The Household Dietary Diversity Score (HDDS) was used to assess dietary
diversity; this was also used in the first stage of the survey. Linear regression was used to
model the associations between the HDDS, participants' characteristics, and dietary behaviors.
The data of 1994 participants were included in the analysis. The overall mean HDDS was 9.2 ±
2.0. Compared to the same period in 2019, a substantial proportion of participants self-reported
that they had recently decreased eating in restaurants (61.6%) and reduced intakes of seafood
(53.1%), imported frozen food (57.1%), and raw food (60.5%), while 64.8% of participants
reported increased cooking at home. People with an increased consumption of seafood
(adjusted OR (95%CI) = 0.56 (0.07, 1.04)) and raw food (adjusted OR (95%CI) = 0.74 (0.27, 1.21))
had a significantly higher HDDS. Participants who changed their consumption of imported
frozen food (both increased and decreased) had a higher HDDS (adjusted OR (95%CI) = 0.56
(0.07, 1.04) and 0.27 (0.09, 0.44), respectively). People who depended more on purchasing food
online had a significantly higher HDDS (adjusted OR (95%CI) = 0.29 (0.02, 0.55)). Compared to
the data from stage 1, the proportion of people choosing healthy products to cope with COVID-
19 did not greatly change and those people had a higher HDDS (adjusted OR (95%CI) = 0.31
(0.19, 0.42)). Although this study found that the proportion of people who chose to use alcohol
or vinegar to prevent COVID-19 had decreased substantially compared to during lockdown,
there were still 5.3% and 9.8% who followed these irrational behaviors. Regarding the dietary
behavior regarding food safety, except for cooking food fully, fewer than half of participants
followed the recommended dietary behaviors, including individual food servings (44.2%), using
serving chopsticks and spoons (44.8%), and preparing raw and cooked food separately (43.3%).
People who followed these behaviors had a better dietary diversity. In conclusion, during the
post-lockdown period, people still followed certain dietary behaviors to cope with COVID-19.
While some dietary behaviors were adopted to help prevent infection, irrational dietary
behaviors were still followed. These behaviors were associated with the dietary diversity in
Chinese adults.

ROL-12Giovanni Castellini et al. Int J Eat Disord. 2020 Nov.

the aim of this longitudinal study was to evaluate the impact of COVID-19 epidemic on Eating
Disorders (EDs) patients, considering the role of pre-existing vulnerabilities. 74 patients with
Anorexia Nervosa (AN) or Bulimia Nervosa (BN) and 97 healthy controls (HCs) were evaluated
before lockdown (T1) and during lockdown (T2). Patients were also evaluated at the beginning
of treatment (T0). Questionnaires were collected to assess psychopathology, childhood trauma,
attachment style, and COVID-19-related post-traumatic symptoms. A different trend between
patients and HCs was observed only for pathological eating behaviors. Patients experienced
increased compensatory exercise during lockdown; BN patients also exacerbated binge eating.
Lockdown interfered with treatment outcomes: the descending trend of ED-specific
psychopathology was interrupted during the epidemic in BN patients. Previously remitted
patients showed re-exacerbation of binge eating after lockdown. Household arguments and fear
for the safety of loved ones predicted increased symptoms during the lockdown. BN patients
reported more severe COVID-19-related post-traumatic symptomatology than AN and HCs, and
these symptoms were predicted by childhood trauma and insecure attachment. COVID-19
epidemic significantly impacted on EDs, both in terms of post-traumatic symptomatology and
interference with the recovery process. Individuals with early trauma or insecure attachment
were particularly vulnerable.

ROL13 Valentin Flaudias et al. J Behav Addict. 2020.

 Since mid-March 2020, over 3 billion people have been confined as a result of the COVID-19
pandemic. Problematic eating behaviors are likely to be impacted by the pandemic through
multiple pathways. This study examined the relationships between stress related to lockdown
measures and binge eating and dietary restriction in a population of French students during the
first week of confinement. A sample of undergraduate students (N = 5,738) completed an online
questionnaire 7 days after lockdown measures were introduced. The survey comprised
variables related to lockdown measures and the COVID-19-pandemic, mood, stress, body image,
binge eating and dietary restriction during the past 7 days, as well as intent to binge eat and
restrict in the following 15 days. Stress related to the lockdown was associated with greater
likelihood of binge eating and dietary restriction over the past week and intentions to binge eat
and restrict over the next 15 days. Greater exposure to COVID-19-related media was associated
with increased eating restriction over the past week. Binge eating and restriction (past and
intentions) were associated with established risk factors, including female gender, low impulse
regulation, high body dissatisfaction, and having a concurrent probable eating disorder. The
higher the stress related to the first week of confinement, the higher the risk of problematic
eating behaviors among students, particularly those characterized by eating-related concerns.
Screening for risk factors and providing targeted interventions might help decrease problematic
eating behaviors among those who are most vulnerable.

ROL14 Angelo pietrobelli et al.30april2020

The aim of this study was to test the hypothesis that youths with obesity, when removed from
structured school activities and confined to their homes during the coronavirus disease 2019
pandemic, will display unfavorable trends in lifestyle behaviors. The sample included 41 children
and adolescents with obesity participating in a longitudinal observational study located in
Verona, Italy. Lifestyle information including diet, activity, and sleep behaviors was collected at
baseline and 3 weeks into the national lockdown during which home confinement was
mandatory. Changes in outcomes over the two study time points were evaluated for significance
using paired t tests. The sample included 41 children and adolescents with obesity participating
in a longitudinal observational study located in Verona, Italy. Lifestyle information including diet,
activity, and sleep behaviors was collected at baseline and 3 weeks into the national lockdown
during which home confinement was mandatory. Changes in outcomes over the two study time
points were evaluated for significance using paired t tests. There were no changes in reported
vegetable intake; fruit intake increased (P = 0.055) during the lockdown. By contrast, potato
chip, red meat, and sugary drink intakes increased significantly during the lockdown (P value
range, 0.005 to < 0.001). Time spent in sports activities decreased by 2.30 (SD 4.60) h/wk (P = 
0.003), and sleep time increased by 0.65 (SD 1.29) h/d (P = 0.003). Screen time increased by
4.85 (SD 2.40) h/d (P < 0.001). Recognizing these adverse collateral effects of the coronavirus
disease 2019 pandemic lockdown is critical in avoiding depreciation of weight control efforts
among youths afflicted with excess adiposity. Depending on duration, these untoward lockdown
effects may have a lasting impact on a child’s or adolescent’s adult adiposity level.
ROL15 koumi Dutta et al.16 jul 2020
Lockdown is an important measure that has been globally adopted to reduce the spread of the
contagious disease caused by SARS CoV-2. The imposed schedule and confinement led to
extensive use of digital media and rise in sedentary activity drastically. The escalated duration
of screen exposure causes disruption in sleep behavior. An online survey was conducted to
comprehend the effect of lockdown on sleep behavior and screen exposure time on school
children. Screen exposure time involved with various electronic gadgets was also analyzed. It
was observed that the social jet lag and sleep debt were significantly less during lockdown than
before it. Inertia during lockdown significantly increased. The difference between screen
exposure time on weekdays before lockdown and weekends during lockdown was identified to
be the highest. Three clusters based on sleep behavior and duration of screen time were
identified of which Cluster 2 revealed simultaneous existence of high sleep duration and screen
time. These baseline data on sleep parameters and duration of exposure to the screen will help
us in devising approaches to mitigate the evident disruption this unprecedented phase has
brought about.

ROL16 Am J omthalmol
To review the impact of increased digital device usage arising from lockdown measures instituted during
the COVID-19 pandemic on myopia, and make recommendations for mitigating potential detrimental
effects on myopia control. Review of studies focused on digital device usage, near work, and outdoor
time in relation to myopia onset and progression. Public health policies on myopia control,
recommendations on screen time and information pertaining to the impact of COVID-19 on increased
digital device use were presented. Recommendations to minimize the impact of the pandemic on
myopia onset and progression in children were made. Increased digital screen time, near work and
limited outdoor activities were found to be associated with the onset and progression of myopia, and
could potentially be aggravated during and beyond the COVID-19 pandemic outbreak period. While
school closures may be short-lived, increased access, adoption and dependence on digital devices could
have a long term negative impact on childhood development. Raising awareness among parents,
children and government agencies is key to mitigating myopigenic behaviours that may become
entrenched during this period. While it is important to adopt critical measures to slow or halt the spread
of COVID-19, close collaboration between parents, schools and ministries is necessary to assess and
mitigate the long term collateral impact of COVID-19 on myopia control policies.

ROL17 peadiatr Respir Rev.sep.2020

As the coronavirus pandemic extends to low and middle income countries (LMICs), there are growing
concerns about the risk of coronavirus disease (COVID-19) in populations with high prevalence of
comorbidities, the impact on health and economies more broadly and the capacity of existing health
systems to manage the additional burden of COVID-19. The direct effects of COVID are less of a concern
in children, who seem to be largely asymptomatic or to develop mild illness as occurs in high income
countries; however children in LMICs constitute a high proportion of the population and may have a
high prevalence of risk factors for severe lower respiratory infection such as HIV or malnutrition. Further
diversion of resources from child health to address the pandemic among adults may further impact on
care for children. Poor living conditions in LMICs including lack of sanitation, running water and
overcrowding may facilitate transmission of SARS-CoV-2. The indirect effects of the pandemic on child
health are of considerable concern, including increasing poverty levels, disrupted schooling, lack of
access to school feeding schemes, reduced access to health facilities and interruptions in vaccination
and other child health programs. Further challenges in LMICs include the inability to implement effective
public health measures such as social distancing, hand hygiene, timely identification of infected people
with self-isolation and universal use of masks. Lack of adequate personal protective equipment,
especially N95 masks is a key concern for health care worker protection. While continued schooling is
crucial for children in LMICs, provision of safe environments is especially challenging in overcrowded
resource constrained schools. The current crisis is a harsh reminder of the global inequity in health in
LMICs. The pandemic highlights key challenges to the provision of health in LMICs, but also provides
opportunities to strengthen child health broadly in such settings.

ROL18
Muzna Alvi, et al. Jul.2020

A vast majority of the relief and rehabilitation packages announced in the months following the
nationwide lockdown in India have focused on economic rehabilitation. However, the education sector
has remained absent from this effort, including in India’s central government’s 250 billion dollar stimulus
package. In this paper, we discuss the implications of lockdown-induced school and rural child-care
center closures on education and health outcomes for the urban and rural poor. We especially focus on
food and nutritional security of children who depend on school feeding and supplementary nutrition
programs. We argue that the impacts are likely to be much more severe for girls as well as for children
from already disadvantaged ethnic and caste groups. We also discuss ways in which existing social
security programs can be leveraged and strengthened to ameliorate these impacts.

ROL19 Anant Kumar, Department of Rural Management, Xavier Institute of Social Service, Dr. Camil
Bulcke Path, Ranchi, India 29 jun. 2020

The COVID‐19 pandemic impact on children is a growing concern. The United Nations and its agencies
(the World Health Organization and UNICEF), Indian Association For Child and Adolescent Mental Health
and National Institute of Mental Health and Neuroscience in India warn about the broader impacts on
children and call for urgent action to support the world’s children amidst the pandemic which may have
lasting consequences. The COVID‐19 pandemic and unprecedented control measures to prevent its
spread have disrupted nearly every aspect of children’s lives – their health, development, learning,
behaviour and their families’ economic security, including protection from violence and abuse. Given
this background, there is an urgent need for action through screening to minimize the mental health
issues of children in India who constitute a substantial proportion of the population.

ROL20 aAdditional Professor, Department of Psychiatry, KGMU Lucknow. India

COVID-19 pandemic and lockdown has brought about a sense of fear and anxiety around the globe. This
phenomenon has led to short term as well as long term psychosocial and mental health implications for
children and adolescents. The quality and magnitude of impact on minors is determined by many
vulnerability factors like developmental age, educational status, pre-existing mental health condition,
being economically underprivileged or being quarantined due to infection or fear of infection. This paper
is aimed at narratively reviewing various articles related to mental-health aspects of children and
adolescents impacted by COVID-19 pandemic and enforcement of nationwide or regional lockdowns to
prevent further spread of infection. We conducted a review and collected articles and advisories on
mental health aspects of children and adolescents during the COVID-19 pandemic. We selected articles
and thematically organized them. We put up their major findings under the thematic areas of impact on
young children, school and college going students, children and adolescents with mental health
challenges, economically underprivileged children, impact due to quarantine and
separation from parents and the advisories of international organizations. We have also provided
recommendations to the above. There is a pressing need for planning longitudinal and developmental
studies, and implementing evidence based elaborative plan of action to cater to the psycho social and
mental health needs of the vulnerable children and adolescents during pandemic as well as post
pandemic. There is a need to ameliorate children and adolescents’ access to mental health support
services geared towards providing measures for developing healthy coping mechanisms during the
current crisis. For this innovative child and adolescent mental health policies policies with direct and
digital collaborative networks of psychiatrists, psychologists, paediatricians, and community volunteers
are deemed necessary.

ROL 21E Bobo et al. Encephale. 2020 Jun.

During the COVID-19 pandemic, the French government has decided a general lockdown. This
unprecedented situation has raised concerns about children's and adolescent's mental health.
Children and adolescents diagnosed with attention deficit hyperactivity disorder (ADHD) may
find this context of restrained activity particularly tricky. The objectives of our study are to
gather information about the well-being and global life conditions of children and adolescents
with ADHD during the COVID-19 outbreak in France. We designed a survey including both open-
ended questions and questionnaire items for parents of children and adolescents with ADHD.
Parents responded to the following open-ended questions: 1) "How is your child doing since the
lockdown?" 2) "How is life at home since the lockdown?" 3) "If you had a remote service
provision with a mental health professional (e.g. by telephone or video technology), please
share your thoughts and any suggestions with us" 4) "Please share any other items that you
think are important about ADHD symptoms of your child and the lockdown situation". This
survey was posted on social media on the 6th of April and disseminated by French ADHD-parent
and patient organizations. The present article reports the descriptive, qualitative and
textometrical analyses of the survey. Between day 20 and 30 of lockdown, 538 parents
responded to the survey, and we included 533 responses in the final analysis. The vast majority
of responders were women 95 % (95 % CI 93,50; 97,18) with children whose mean age was 10,5
(95 % CI 7.58; 13.44). Since the lockdown, 34.71 % (95 % CI 30.70; 38.94) of children
experienced a worsening in well-being, 34.33 % (95 % CI 30.34; 38.56) showed no significant
changes and 30.96 % (95 % CI 27.09; 35.10) were doing better according to their parents. The
thematic analysis showed that an improvement of their children's anxiety was one of the main
topics addressed by parents. This improvement related to less school-related strain and flexible
schedules that respected their children's rhythm. Improved self-esteem was another topic that
parents linked with a lesser exposure of their children to negative feed-back. Parents repeatedly
reported both inattention and hyperactivity/impulsivity. However, optimal lockdown life
conditions seemed to compensate for the impact of ADHD symptoms (e.g. sufficient space at
home, presence of a garden). Some parents reported worsening of general well-being in their
children, and this manifested as oppositional/defiant attitudes and emotional outbursts.
Parents also cited sleep problems and anxiety in this context. As regards everyday life during
lock-down, at-home schooling was another major topic-parents described that their children
struggled to complete school-related tasks and that teachers seemed to have forgotten about
academic accommodations. The lockdown situation seems to have raised parents' awareness
of the role of inattention and ADHD symptoms in their children's learning difficulties. Due to
potential selection biases, the results of our survey may not be generalizable to all children and
adolescents with ADHD. The main strengths of this rapid survey-based study lies in the
reactivity of the participants and the quality and diversity of their responses to the open-ended
questions. According to their parents, most children and adolescents with ADHD experience
stability or improvement of their well-being. An improvement in school-related anxiety and the
flexible adjustment to the children's' rhythms as well as parents' increased awareness of the
difficulties their children experience are among the key topics in parents' descriptions.
ROL 22Peter Lachman Nov.2020

In 2005, Michael Marmot introduced the concept of the Social Determinants of Health (SDH) 1 in which
he proposed what was in plain sight, i.e., that health outcomes are determined by “the conditions in
which people are born, grow, live, work and age”. 2 For children, these social determinants influence life
opportunities, disease profiles, health outcomes, and life expectancy. Since the initial paper, there has
been little progress in addressing the social determinants of health. In a review in 2010, Marmot
concluded that social and economic status determines the health outcomes, and the lower the
socioeconomic status the worse the outcome. 3 In the USA, there have been similar reviews in which the
social determinants have been documented to have a severe adverse impact on children. In conclusion,
the challenge is great, but it is one that we need to grasp. A recent study has shown that African
American children have three fold worse outcomes in routine surgery when compared to their White
peers.53,54 We can assume that this could possibly apply to COVID-19, so further research is required. A
word of caution. We need to avoid the temptation to be judgemental as we explore the disparities
exposed by the SARS-CoV-2 infection.55 The impact of the COVID-19 pandemic goes far beyond
managing the disease. It has changed the way that we live, educate our children and interact in society.
We need to examine how healthcare is organized so that the underlying structural constraints are
addressed.56 And, while we manage the pandemic, we need to ensure that children are not
disadvantaged and that they have access to healthcare.57 The causes are deep-seated and complex, but
the body of evidence is growing. We now need research and to test interventions that will improve the
Social Determinants of Health—and ultimately health itself.

ROL 23Jennifer McIntosh et al. Lancet Child Adolesc Health. 2020 Nov.

Children's hospitals have long been advocates of a rights-based approach to health care and will be crucial
for ensuring that the rights of children are protected during future COVID-19 surges. The European
Children's Hospitals Organisation (ECHO) is a new organisation representing leading paediatric hospitals
across Europe, many of which helped to lead the COVID-19 response locally or regionally. ECHO
members provide acute and long-term disease management, caring for some of the most complex and
vulnerable patients in society. Using our collective voice, we call on children's hospitals and public health
systems to ensure that the rights of children are central in the new normal of COVID-19. According to
WHO, the COVID-19 pandemic is “one big wave”, and health systems should be ready for recurrent
surges in cases, regardless of the season. However, other respiratory viruses are seasonal, predictably
filling adult and paediatric intensive care unit (ICU) beds. With falling vaccination uptake further
exacerbated by the pandemic, fear has grown that an increase in vaccine-preventable diseases could
complicate the situation in hospitals this winter.
1

 Additionally, how the reopening of schools and more parents heading back to work will affect COVID-
19 infection rates remains unknown. Given the possibility of a future surge in COVID-19 cases and the
predictable increase in seasonal illness, preparation is imperative to ensure the safety of children and
young people.
ROL24 Dr. Kuldeep dole 10 April 2020
In today’s current scenario, it is fair to say that the COVID-19 reality is far different from our usual
routine. In our new routine, day-care and schools are cancelled, parents are working from home
and families are engaging in social distancing.

It is understandable that children will tend to use screens (television, devices, tablets, video
games) more than they typically would due to the restrictions of stepping out and dire need of
social distancing. In the current wired world, one typical way to occupy children is to use digital
media to engage the children while parents attend to their professional obligations.

However, the latest World Health Organization recommendation for screen time for children
under age 5 is one hour or less and for those under age 1 is no time at all on a daily basis.
Several other studies have also claimed that excessive screen time may damage the brain,
especially regions responsible for emotional processing, decision-making, attention and cognitive
control.

During this three-week lockdown, the children are now attending classes online and are restricted
to go outdoors which thus, increases their daily screen time. Considering that childhood is a
period of rapid development and a time when family lifestyle patterns can be adapted to boost
health gains, children should spend more time engaged in physical activity at home and getting
enough sleep. An improvement in the child’s physical activity and ensuring quality sleep will not
only improve their eye health but will also prevent childhood obesity and associated diseases
later in life.

The negative effects of increased screen time

There is no doubt about the fact that an increase in screen time leads to a high digital eyestrain.
Children are no different from adults when it comes to digital eyestrain. They can experience
adverse effects in their eye sight which can vary from dry eye to eye strain to blurry vision, as
well. A continuous increase in screen time can also increase the chance of developing Myopia,
which will eventually only progress further. While the symptoms are not permanent, they can be
frequent depending on the child’s screen time in the entire day. There are also other adverse
effects of increased screen time which includes Obesity, disturbances in sleep cycle and
challenges in one’s academic performance.

The lockdown is difficult for all age groups and every person across the world, but we have to
ensure that the children have a fruitful time at home which helps them grow and learn. The
caveat to ensure less screen time and healthy eyesight for your child is simply that, like all tools,
our digital tools have to be used with proper care, attention and responsibility.

ROL25 Snigdhendu Bhattacharya , Hindustan Times, Kolkata 13 may 2020

According to the survey 88% respondents said their children’s exposure to screens increased during the
lockdown, with 45% reporting the increase “to a great extent” and only 43% of the parents/ primary
caregivers said they always supervised when the child was online. The study found that around 54% of
parents reported that they sat and discussed the situation over Covid-19 and lockdown at length with
the child, whereas around 47% tried to divert the mind of the child. During
the survey, Rapid
Online Perception Study about the Effects of Covid-19 on Children, 1,102
respondents from 23 states and Union territories were interview. It was released on
Tuesday.

“Even though children have not been the face of this pandemic as they have largely
been spared of the direct health effects of Covid-19 so far, findings of the study
indicate that they have been among its biggest victims with multiple side-effects on
their physical and psycho-social well-being,” Puja Marwaha, the chief executive
officer of CRY, said.
ROL26 Srinidhi Gopalakrishnan jun,23,2020

Over the last three months, the nationwide lockdown imposed following the
coronavirus scare has made schools take the online route to help students continue
with their education. Children, as young as four years, have now gotten into the
groove of interacting with their teachers and classmates via video conference – a
change that arose out of necessity. And parents are concerned it’s affecting their
eyesight, above all else. What helped Delhi resident Priyanka Singh was to regulate
screen time of her son. “After the lockdown was imposed, children were not going out
and thus, had been using mobiles to play games. Once the classes started, this added
to the exposure. So, accordingly, I restricted Arav’s screen time by fixing time for
both games and studies. It is certain that it will affect the eyesight. More importantly,
continuous use of mobile phone will increase their dependence on it, so we need to
work out a solution to minimise exposure to electronic gadgets, as it can have
negative effects as well,” she shares With increasing concerns over screen time among
parents, Dr PS Narang, a Delhi-based paediatrician with around 40 years of
experience, feels productivity is what should be given priority, and not screen
exposure per se. “Excess of everything is bad. But a parent must understand the
difference between screen exposure for playing games and exposure for social
interaction, be it during online classes or with the child’s grandparents or cousins.
Even when it comes to games, there are many that are informative. Those are fine, but
games that promote violence should not be encouraged. These can lead to loss of
sleep or even cause bad dreams. Also, getting your child into a routine is necessary. If
the child is used to waking up at 7am and getting ready, it is important to maintain
that, rather than waking up the child just five minutes before classes begin,” he
recommends.
ROL 27 Shirlene D. Wang"'et al. Sep. 2020
COVID-19 restrictions such as the closure of schools and parks, and the
cancellation of youth sports and activity classes around the United States may
prevent children from achieving recommended levels of physical activity (PA).
This study examined the effects of the COVID-19 pandemic on PA and
sedentary behavior (SB) in U.S. children. Parents and legal guardians of U.S.
children (ages 5–13) were recruited through convenience sampling and
completed an online survey between April 25–May 16, 2020. Measures
included an assessment of their child’s previous day PA and SB by indicating
time spent in 11 common types of PA and 12 common types of SB for
children. Parents also reported perceived changes in levels of PA and SB
between the pre-COVID-19 (February 2020) and early-COVID-19 (April–May
2020) periods. Additionally, parents reported locations (e.g., home/garage,
parks/trails, gyms/fitness centers) where their children had performed PA and
their children’s use of remote/streaming services for PA. From parent reports,
children (N = 211) (53% female, 13% Hispanic, Mage = 8.73 [SD = 2.58] years)
represented 35 states and the District of Columbia. The most common
physical activities during the early-COVID-19 period were free
play/unstructured activity (e.g., running around, tag) (90% of children) and
going for a walk (55% of children). Children engaged in about 90 min of
school-related sitting and over 8 h of leisure-related sitting a day. Parents of
older children (ages 9–13) vs. younger children (ages 5–8) perceived greater
decreases in PA and greater increases in SB from the pre- to early-COVID-19
periods. Children were more likely to perform PA at home indoors or on
neighborhood streets during the early- vs. pre-COVID-19 periods. About a third
of children used remote/streaming services for activity classes and lessons
during the early-COVID-19 period. Short-term changes in PA and SB in reaction
to COVID-19 may become permanently entrenched, leading to increased risk
of obesity, diabetes, and cardiovascular disease in children. Programmatic
and policy strategies should be geared towards promoting PA and reducing
SB over the next 12 months.
ROL 28Sarah A. Moore"'et al.6july 2020
Healthy childhood development is fostered through sufficient physical activity
(PA; including time outdoors), limiting sedentary behaviours (SB), and
adequate sleep; collectively known as movement behaviours. Though the
COVID-19 virus outbreak has changed the daily lives of children and youth, it is
unknown to what extent related restrictions may compromise the ability to
play and meet movement behaviour recommendations. This secondary data
analysis examined the immediate impacts of COVID-19 restrictions on
movement and play behaviours in children and youth. A national sample of
Canadian parents (n = 1472) of children (5–11 years) or youth (12–17 years)
(54% girls) completed an online survey that assessed immediate changes in
child movement and play behaviours during the COVID-19 outbreak.
Behaviours included PA and play, SB, and sleep. Family demographics and
parental factors that may influence movement behaviours were assessed.
Correlations between behaviours and demographic and parental factors were
determined. For open-ended questions, word frequency distributions were
reported.
ROL 29 Myles faith June,9,2020

This study provides evidence of immediate collateral consequences of the

COVID-19 outbreak, demonstrating an adverse impact on the movement and
play behaviours of Canadian children and youth. These findings can guide
efforts to preserve and promote child health during the COVID-19 outbreak
and crisis recovery period, and to inform strategies to mitigate potential harm
during future pandemics. This study provides evidence of immediate
collateral consequences of the COVID-19 outbreak, demonstrating an adverse
impact on the movement and play behaviours of Canadian children and youth.
These findings can guide efforts to preserve and promote child health during
the COVID-19 outbreak and crisis recovery period, and to inform strategies to
mitigate potential harm during future pandemics. This study provides
evidence of immediate collateral consequences of the COVID-19 outbreak,
demonstrating an adverse impact on the movement and play behaviours of
Canadian children and youth. These findings can guide efforts to preserve and
promote child health during the COVID-19 outbreak and crisis recovery period,
and to inform strategies to mitigate potential harm during future pandemics.
ROL 30 Front. Psychol., 02 September 2020
The United Kingdom and Scottish governments instigated a societal lockdown in response to the
COVID-19 pandemic. Subsequently, many experienced substantial lifestyle changes alongside
the stresses of potentially catching the virus or experiencing bereavement. Stressful situations
and poorer health behaviors (e.g., higher alcohol consumption, unhealthy diet, poorer sleep
quality, physical inactivity) are frequently linked to poor mental health. Our objective was to
examine changes in health behaviors and their relationship with negative mood during COVID-
19 lockdown. We also considered associations between health behaviors and socio-demographic
differences and COVID-19-induced changes. 399 participants completed a questionnaire asking
about their personal situation and health behaviors during lockdown as well as a negative mood
scale. The significance threshold for all analyses was α = 0.05. Poorer diet was linked to more-
negative mood, and to changes to working status. Poorer sleep quality was linked with more-
negative mood, and with ‘shielding’ from the virus. Being less physically active was related to
more-negative mood and student status, whereas being more physically active was linked to
having or suspecting COVID-19 infection within the household. Increased alcohol consumption
was linked to living with children, but not to negative mood. Changes to diet, sleep quality, and
physical activity related to differences in negative mood during COVID-19 lockdown. This study
adds to reports on poor mental health during lockdown and identifies lifestyle restrictions and
changes to health behaviors which may, to some extent, be responsible for higher negative
mood. Our data suggests that it is advisable to maintain or improve health behaviors during
pandemic-associated restrictions.
ROL31 Genevieve F.Dunton at el. 4sep 2020

COVID-19 restrictions such as the closure of schools and parks, and the

cancellation of youth sports and activity classes around the United States may
prevent children from achieving recommended levels of physical activity (PA).
This study examined the effects of the COVID-19 pandemic on PA and
sedentary behavior (SB) in U.S. children. Parents and legal guardians of U.S.
children (ages 5–13) were recruited through convenience sampling and
completed an online survey between April 25–May 16, 2020. Measures
included an assessment of their child’s previous day PA and SB by indicating
time spent in 11 common types of PA and 12 common types of SB for children.
Parents also reported perceived changes in levels of PA and SB between the
pre-COVID-19 (February 2020) and early-COVID-19 (April–May 2020)
periods. Additionally, parents reported locations (e.g., home/garage,
parks/trails, gyms/fitness centers) where their children had performed PA and
their children’s use of remote/streaming services for PA. From parent reports,
children (N = 211) (53% female, 13% Hispanic, Mage = 8.73 [SD = 2.58] years)
represented 35 states and the District of Columbia. The most common
physical activities during the early-COVID-19 period were free
play/unstructured activity (e.g., running around, tag) (90% of children) and
going for a walk (55% of children). Children engaged in about 90 min of
school-related sitting and over 8 h of leisure-related sitting a day. Parents of
older children (ages 9–13) vs. younger children (ages 5–8) perceived greater
decreases in PA and greater increases in SB from the pre- to early-COVID-19
periods. Children were more likely to perform PA at home indoors or on
neighborhood streets during the early- vs. pre-COVID-19 periods. About a
third of children used remote/streaming services for activity classes and
lessons during the early-COVID-19 period. Short-term changes in PA and SB
in reaction to COVID-19 may become permanently entrenched, leading to
increased risk of obesity, diabetes, and cardiovascular disease in children.
Programmatic and policy strategies should be geared towards promoting PA
and reducing SB over the next 12 months.

ROL32 Shweta Singh at el. COVID-19 pandemic and lockdown has brought about a sense of fear and
anxiety around the globe. This phenomenon has led to short term as well as long term psychosocial and
mental health implications for children and adolescents. The quality and magnitude of impact on minors
is determined by many vulnerability factors like developmental age, educational status, pre-existing
mental health condition, being economically underprivileged or being quarantined due to infection or
fear of infection. We conducted a review and collected articles and advisories on mental health aspects
of children and adolescents during the COVID-19 pandemic. We selected articles and thematically
organized them. We put up their major findings under the thematic areas of impact on young children,
school and college going students, children and adolescents with mental health challenges, economically
underprivileged children, impact due to quarantine and separation from parents and the advisories of
international organizations. We have also provided recommendations to the above. There is a pressing
need for planning longitudinal and developmental studies, and implementing evidence based
elaborative plan of action to cater to the psycho social and mental health needs of the vulnerable
children and adolescents during pandemic as well as post pandemic. There is a need to ameliorate
children and adolescents’ access to mental health support services geared towards providing measures
for developing healthy coping mechanisms during the current crisis. For this innovative child and
adolescent mental health policies policies with direct and digital collaborative networks of psychiatrists,
psychologists, paediatricians, and community volunteers are deemed necessary.

ROL 33 Peter lachman 10 Nov. 2020

In 2005, Michael Marmot introduced the concept of the Social Determinants of Health (SDH)1 in
which he proposed what was in plain sight, i.e., that health outcomes are determined by “the
conditions in which people are born, grow, live, work and age”.2 For children, these social
determinants influence life opportunities, disease profiles, health outcomes, and life expectancy.
Since the initial paper, there has been little progress in addressing the social determinants of
health. In a review in 2010, Marmot concluded that social and economic status determines the
health outcomes, and the lower the socioeconomic status the worse the outcome.3 In the USA,
there have been similar reviews in which the social determinants have been documented to have
a severe adverse impact on children.4
In February 2020, just prior to the pandemic, Marmot published a progress report on health
inequalities and inequity in the United Kingdom. He demonstrated that inequity in the United
Kingdom has been exacerbated rather than decreased, despite intervention. More children are
living in poverty and more are experiencing food insecurity, with a negative consequence on
growth and development.5 These findings must raise questions for other societies. If the United
Kingdom, a relatively wealthy country with an established welfare system has deteriorating
conditions for children, the situation in other countries may be similar or worse. In 2016,
Pediatric Research published a review focused on the Social Determinants of Health, where it
was stated that social determinants were the “elephant in the room” in pediatric research and
there was a call for future research in this domain.6
Now 4 years later, in the midst of a pandemic, the importance of considering the SDH in
pediatric research has been highlighted once more by SARS-CoV-2. In societies affected by the
virus, those who suffer inequity and who are negatively influenced by the SDH have been most
severely affected. In this paper, I will cover the key areas that require attention as we move to the
post COVID era. It will not be possible to include all the papers that have been published.
Nevertheless, the potential for a new dimension in pediatric research will be highlighted and
references to reports will be provided.
The interaction of structural racism within the health system and the risk factors that are social
determinants of the outcome of those impacted by COVID have been emphasized.7 The COVID
pandemic has exposed underlying inequalities in society. For example, in the United States, the
CDC has estimated that people of Hispanic, Native American or Black American origin have an
approximately four to five times higher rate of infection.8,9 This is similar to the reported rates in
the United Kingdom, where the differential rate is of a similar magnitude.10 Currently it is not
certain why this is so, but the SDH plays a major role as the known risk factors and
comorbidities for poorer outcomes in COVID-19 infection, such as diabetes and obesity, and
other chronic diseases that are more prevalent in poorer communities and ethnic
minorities.11 Social determinants may result in higher rates of infection, due to overcrowding and
the inability to apply preventive measures, as well as the social consequences due to loss of
family income, loss of schooling, and loss of non-COVID public health interventions, thereby
perpetuating the cycle. It is clear that social background, socioeconomic status, and poverty,
along with ethnicity converge to produce worse outcomes.12,13 Knowledge of the infection and
preventive measures differ as to ethnicity and socioeconomic class.14
Therefore, the COVID-19 pandemic presents both a challenge and an opportunity for the
pediatric research community. While it is tempting to report the impact of the pandemic in terms
of the infection and its clinical sequelae alone, we can rather examine the impact of the pandemic
on children through the lens of inequity and the social determinants. The evidence in children has
yet to be reported in research studies, given that children have a lower incidence of severe
infections. As noted by Greenhalgh,15 evidence during the pandemic is being determined in a
different way to that of traditional research. Greenhalgh contends that in a complex adaptive
system such as the COVID-19 pandemic, we need to move to a “more fit-for-purpose scientific
paradigm”, where linear associations may not be possible, due to the complexity of the real
world. As the pandemic is one large natural experiment, reports of the impact of COVID-19 on
children are emerging in informal ways through correspondence to journals.
Although the evidence base is limited, these early communications point to the type of research
that is required in the coming months. There is also the opportunity to reconsider how we
undertake research into the consequences of the pandemic on child health and disease. If the
impact of the pandemic is to be understood, we will need to examine a wide range of issues on
how the pandemic has affected children, both now and over the years to come. Research must
address the disproportionate impact the pandemic has had on the social fabric of society in every
country it has affected. In this commentary, I will point to the key areas of research that are
required, in addition to the inevitable research for effective treatment modalities and for a
vaccine. The lessons from the study of the pandemic in the wider sense, can in turn be applied to
become a holistic research strategy.
Early in the pandemic, it was noted that data that would help to evaluate the relationship between
social determinants of health and COVID-19 were not being routinely recorded.16 This could
indicate a subconscious bias against the recording of essential data needed to identify the most
vulnerable groups in society that maybe affected by COVID-19, in favor of data focused on
interventions for the majority. The following areas of potential research are proposed:
ROL 34 Kunling Shen et al. World J Pediatr. 2020 Jun.

Since the outbreak of 2019 novel coronavirus infection (2019-nCoV) in Wuhan City,
China, by January 30, 2020, a total of 9692 confirmed cases and 15,238 suspected
cases have been reported around 31 provinces or cities in China. Among the confirmed
cases, 1527 were severe cases, 171 had recovered and been discharged at home, and
213 died. And among these cases, a total of 28 children aged from 1 month to 17 years
have been reported in China. For standardizing prevention and management of 2019-
nCoV infections in children, we called up an experts' committee to formulate this
experts' consensus statement. This statement is based on the Novel Coronavirus
Infection Pneumonia Diagnosis and Treatment Standards (the fourth edition) (National
Health Committee) and other previous diagnosis and treatment strategies for pediatric
virus infections. The present consensus statement summarizes current strategies on
diagnosis, treatment, and prevention of 2019-nCoV infection in children.

ROL 35Sonia Livingstone

Children’s digital access – or lack thereof – during the COVID-19 pandemic has significantly determined
whether children can continue their education, seek information, stay in touch with friends and family, and
enjoy digital entertainment. With over 1.5 billion children across 190 countries confined to their homes, active
video games or dance videos may also be their best chance to exercise. The rationale for closing digital divides
has never been starker or more urgent.
This data-driven research brief explores three research questions. 1) How much do we know about children’s
basic access to the internet across the globe? 2) Do children regularly use the internet to access health
information? 3) Are children able to verify the truth of online information?
The brief analyzes survey data from the ITU World Telecommunications/ICT Indicators database, as well as
household-survey data collected from approximately 22,000 children aged 12-16, generated by the collective
work of the EU Kids Online and Global Kids Online research networks. It concludes with recommendations on
how stakeholders can ensure that children’s health information needs are better supported during the COVID-
19 pandemic and beyond
ROL 36 Spogmai Akseer at et.
The COVID-19 pandemic has had an unprecedented impact on societies, globally. To help contain the spread
of the disease, schools around the world have closed, affecting 1.6 billion learners – approximately 91 per cent
of the world’s enrolled students. Governments and education stakeholders have responded swiftly to continue
children’s learning, using various delivery channels including digital tools, TV/radio-based teaching and take-
home packages for parent or carer-guided education.
However, the massive scale of school closures has laid bare the uneven distribution of the technology needed
to facilitate remote learning. It has also highlighted the lack of preparedness and low resilience of systems to
support teachers, facilitators and parents/caregivers in the successful and safe use of technology for learning.
Using data on access to technology from household surveys (MICS and DHS) and information on national
education responses to school closures gathered from UNICEF education staff in over 120 countries, this brief
explores potential promising practices for equitable remote learning.

ROL 37 kelsey M. Graber at el. 25 Nov. 2020

Amidst the COVID‐19 pandemic, there is uncertainty regarding potential lasting impacts
on children’s health and educational outcomes. Play, a fundamental part of childhood,
may be integral to children’s health during crises. We undertook a rapid review of the
impact of quarantine, isolation, and other restrictive environments on play and whether
play mitigates adverse effects of such restrictions. Fifteen peer‐reviewed studies were
identified, spanning hospitals, juvenile and immigration detention, and refugee camps.
We found evidence of changes in children’s access to play in crises and quarantine.
These studies indicated how play might support children enduring isolation, but lacked
robust investigations of play as an intervention in mitigating impacts of restriction.
Studies pertaining to children in isolation due to infectious disease outbreaks were
notably absent. It is important that the potential effects of changes to such a crucial
aspect of childhood are better understood to support children in this and future crises.

ROL 38 Giulia Segre

The COVID-19 outbreak has resulted in governments implementing disease
containment measures such as school closures, social distancing, and home
quarantine.
To date, only a few studies  have drawn attention to the psychological impact of
lockdown on Italian children’s mental health. The present study aimed to investigate
the psychological distress (anxiety and mood symptoms) and changes in routine
among Italian primary and middle school students during the COVID-19 quarantine.
This qualitative interview study was performed between the 18th of May and 7th of June
2020: it involved a sample of 82 children and adolescents living in Milan (Italy), attending
primary and middle school (aged 6 to 14 years), and their parents. Almost 30% of the
subjects reported having struggled to adjust to home learning. 36 responders completely
changed their dietary habits during the lockdown: they were not eating the same amount of
food and were consuming more junk food. Sleep habits were also affected by the lockdown
measures: 28% of the sample had difficulties sleeping and wished to sleep in their parents’
bed. Concerning psychological distress, 64 (78%) children and adolescents had anxiety
symptoms; 43.9% of the students reported significant mood symptoms. Children are not
indifferent to the dramatic impact of the COVID-19 epidemic: our data confirm their
difficulties in adapting to the quarantine measures. The effects of stress exposure may not
manifest later on during the children’s development, and, for this reason, it would be
interesting to follow up on these participants to improve our understanding of how long
these outcomes may last.

Rol 39 Ruibei Bai,   at et.

The purpose of this study was to explore the impact of the COVID-19 outbreak on children’s
behavior and their parents’ mental health in China. A total of 30861 children’s parents were
selected from throughout China to complete the self-made Child behavior Questionnaire
and Child Parents Mental Health Questionnaire. The results showed that there were
significant differences in children’s behavior scores in variables such as age, whether or
not an only child and place of residence; There were significant differences in physical,
emotional and cognitive scores of parents in variables such as gender, age, education,
occupation, place of residence, whether there are medical staff in family, the relationship
with children, and children’s age. The correlation analysis showed that children’s behavior
and parents’ physical, emotion and cognition were significantly correlated with epidemic-
related factors. The stepwise multiple linear regression analysis showed that epidemic-
related factors can significantly predict children’s behavior and parents’ physical, emotion,
and cognition. These results can provide theoretical basis for the behavior management of
children at home and the psychological adjustment of parents during the epidemic.