WE may not be keeping count, but children continue to die on a daily basis. Let’s take tuberculosis for example. World Tuberculosis Day, which passed us by without much fanfare on March 24, was supposed to highlight the fact that tuberculosis caused 1.1 million

children to fall ill in 2018. Out of this, 205,000 died worldwide.

As the world’s attention is focused on the Covid-19 pandemic, the other bacteria and viruses have not stopped wreaking their own devastation on our species. In recent months, paediatric services have been overwhelmed with children suspected of or having Covid-19. Fortunately, the vast majority will have only mild illness. Only 0.6% developed critical illness, according to the largest study to date by Dong et al in Pediatrics , February 2020.

However, children can be affected in other ways. Displacement of patients due to Covid-19 means a longer waiting list for surgeries, delayed diagnoses of other diseases and lack of critical care beds, an already chronic shortage is exacerbated by the need to convert some beds for adult use.

Our Orang Asli population is particularly affected. Severely malnourished children from remote areas have difficulty accessing healthcare and much-needed aid. Even in ordinary times, it can take these families many hours and considerable resources to travel to the nearest healthcare facility. The movement control order (MCO) and reduction of public transport services make this even more challenging.

Another area of concern is child safety. The Wuhan experience has clearly demonstrated that forced quarantine measures and social distancing have an adverse impact on mental health. Fear for their health, financial security and lack of community support can quickly turn to anger in susceptible adults. With the ongoing crisis and movement control measures, stressed adults who are

forced to remain in cramped quarters may lash out against spouses or children.

Victims face great difficulty in distancing themselves from abusers, and obviously small children will be completely unable to seek safety and shelter. To make matters worse, most if not all of our Welfare Department Child Protection Officers are required to limit their movements and work from home whenever possible, significantly reducing their ability to watch over and protect children at risk.

The MCO will also be particularly devastating for those living in poverty. In 2014,18% of children in Malaysia were in low income households, a likely underestimated figure. With restrictions on the ability to receive their daily income, children will be the first to suffer from inadequate nutrition, water, shelter and education. This leads to a drop in future health and productivity, and further entrenches these children in poverty.

Malaysians need to stand together (metaphorically) to overcome the direct and indirect impact of Covid-19 on our society. The powers that be and the men and women on the ground need to be sympathetic to the less fortunate, more vulnerable and oft-times without a voice to highlight their needs.

Key professionals must be engaged in the planning of food and medicine provision for our most vulnerable children and families in mandated isolation. We must maintain and strengthen public health measures, communicable disease surveillance, and keep in touch with our citizens with chronic healthcare needs.

We need more urgent and meaningful collaboration among doctors, police and the military. The military may be best equipped to distribute food to the Orang Asli communities, the poor and hungry throughout Malaysia.

The Women and Family Development Ministry must strengthen mechanisms for the reporting of crimes of hate and suspected domestic and child abuse. Welfare Officers should employ teleconferencing and videoconferencing to systematically monitor all children and families at risk who are known to them. In the longer term, a nationwide online child abuse register would contribute immensely to this effort.

The ministry can engage both the Malaysia Digital Economy Corporation and the Communications and Multimedia Ministry in using digital technology to facilitate these measures.

Above all, we need to realise that we are ALL in this together, and we must work towards the safety and health of the most vulnerable in our society. Each of us must play our role, whether it is running a critical care service, cleaning the floor of a public space, donating online or staying at home.

DR PRAVIN VASANTHAN (Paediatric intensivist) and DR HELMY HAJA MYDIN (Respiratory physician) , Kuala Lumpur

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