Protecting children in low-income and middle-income countries from COVID-19.

A saving grace of the COVID-19 pandemic in high-income and upper middle-income countries has been the relative sparing of children. As the disease spreads across low-income and middle-income countries (LMICs), long-standing system vulnerabilities may tragically manifest, and we worry that children will be increasingly impacted, both directly and indirectly. Drawing on our shared child pneumonia experience globally, we highlight these potential impacts on children in LMICs and propose actions for a collective response. Current data suggest children are susceptible to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection but are less likely than adults to become severely ill.1–4 Although at first glance these data appear reassuring, the child pneumonia, and broader global child health, experience provides a forewarning of what may be coming in LMICs. High-income countries (HICs) have an under-5 pneumonia mortality rate of 3 per 100 000.5 In contrast, the rate in LMICs is 200 per 100 000 population, with pneumonia the leading infectious cause of under-5 death globally.5 While yet unknown, COVID-19, a viral pneumonia syndrome, may impact children in LMICs more severely than what has been observed to date. The risk factors for poor outcomes in pneumonia …