SARS pandemic exposure impaired early childhood development: A lesson for COVID-19

  1. Yunfei Fan
  2. Huiyu Wang
  3. Qiong Wu
  4. Xiang Zhou
  5. Yubo Zhou
  6. Bin Wang
  7. Yiqun Han
  8. Tao xue
  9. Tong Zhu

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Abstract

Social and mental stressors associated with the COVID-19 pandemic may promote long-term effects on child development. However, reports aimed at identifying the relationship between pandemics and child health are limited. We conducted a retrospective study to evaluate the severe acute respiratory syndrome (SARS) pandemic in 2003 and its relationship to child development indicators using a representative sample across China. Our study involved longitudinal measurements of 14,647 children, 36% of whom (n = 5216) were born before or during the SARS pandemic. Cox models were utilized to examine the effects of SARS on preterm birth and four milestones of development: age to (1) walk independently, (2) say a complete sentence, (3) count from 0 to 10, and (4) undress him/herself for urination. Mixed effect models were utilized to associate SARS with birthweight, body weight and height. Our results show that experiencing SARS during early childhood was significantly associated with delayed milestones, with adjusted hazard ratios of 3.17 [95% confidence intervals (CI): 2.71, 3.70], 3.98 (3.50, 4.53), 4.96 (4.48, 5.49), or 5.57 (5.00, 6.20) for walking independently, saying a complete sentence, counting from 0 to 10, and undressing him/herself for urination, respectively. Experiencing SARS was also associated with reduced body weight. This effect was strongest for preschool children [a weight reduction of 4.86 (0.36, 9.35) kg, 5.48 (-0.56, 11.53) kg or 5.09 (-2.12, 12.30) kg for 2, 3, 4 year-olds, respectively]. We did not identify a significant effect of maternal SARS exposure on birthweight or gestational length. Collectively, our results showed that the SARS pandemic was associated with delayed child development and provided epidemiological evidence to support the association between infectious disease epidemics and impaired child health. These results provide a useful framework to investigate and mitigate relevant impacts from the COVID-19 pandemic.

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    SciScore for 10.1101/2020.05.12.20099945: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The study has been approved by the institutional review board at Peking University (Approval IRB00001052-14010).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableA Cox model regression analysis was conducted to compare time to reach a milestone with exposure indicators (SARSchild or SARSmaternal) after adjusting for several covariates, including residence (urban or rural), sex (female or male), ethnicity, gestation length, birthweight, and breastfeeding status.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    There are three additional limitations of our study. First, because of the retrospective design, this study could not avoid survival bias or recall bias, which may have led to underestimation of SARS-related effects on child health. Second, the CFPS cohort was designed for a general purpose, not specifically for child health assessments. Although SARS-associated social stress could impact many dimensions of child development, we could only examine the available measures and may have neglected more important measures. Third, we evaluated the exposure to SARS using simple binary indicators. Since the severity of SARS varied spatially and temporally, our findings might also be biased due to exposure misclassifications. The above limitations could be addressed with a prospective study design. Therefore, a cohort focusing on child development under the COVID-19 pandemic should be urgently planned.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

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  2. Version published to 10.1101/2020.05.12.20099945v1 on medRxiv