COVID-19: Mental Health Crisis / Pediatric Guidance / 1918 Flu Pandemic

By Kelly Young

Edited by André Sofair, MD, MPH

Here are some of the most recent developments in COVID-19:

Mental health crisis: Over 40% of U.S. adults surveyed in late June reported at least one adverse mental or behavioral health problem. Of the 5500 respondents, 31% said they had symptoms of anxiety or depressive disorder, 26% had symptoms of trauma- and stressor-related disorder linked to the pandemic, and 13% had started or increased substance use as a coping mechanism. Roughly 11% said they had seriously considered suicide in the prior 30 days (the rate was 26% among people aged 18–24 and 31% among those who were unpaid caregivers for adults). In general, young adults, Hispanic and Black people, essential workers, unpaid caregivers for adults, and people with preexisting psychiatric conditions had the highest rates of mental and behavioral health symptoms. In MMWR, the researchers write: "Identification of populations at increased risk for psychological distress and unhealthy coping can inform policies to address health inequity, including increasing access to resources for clinical diagnoses and treatment options. Expanded use of telehealth, an effective means of delivering treatment for mental health conditions ... might reduce COVID-19-related mental health consequences."

Guidance for youth: The American Academy of Pediatrics (AAP) has released new guidelines regarding children and COVID-19. Among them:

• Cloth face coverings are recommended for nearly all children aged 2 years and up, including most of those with underlying health conditions. The AAP writes: "Plans for the safe return of children to school, child care, and other group settings must include the universal use of cloth face coverings." For households with vulnerable family members, mask wearing at home may be beneficial. Wearing a mask at home may also get a child used to wearing one at school.

• Common scenarios that should prompt testing in children include having COVID-19 symptoms, being in close contact with a confirmed case, and being scheduled for elective surgery.

• The AAP also offers strategies on using personal protective equipment (PPE) in ambulatory care settings.

Comparison with 1918 flu pandemic: In New York City, all-cause mortality during the early phase of the COVID-19 outbreak was comparable to the peak mortality seen during the 1918 influenza pandemic, a JAMA Network Open study suggests. The overall mortality rate from March 11 to May 11, 2020, was 202 deaths per 100,000 person-months, compared with 287 per 100,000 during October and November 1918. But mortality in 2020 was 4 times higher than a comparable nonpandemic period, while 1918 pandemic mortality was only 3 times higher than a nonpandemic period.