Sandra L. Fenwick, Chief Executive Officer of Boston Children’s Hospital

The Conversations We’re Not Having: Lessons from COVID-19’s Impact on Children from Sandra L. Fenwick

Much of the recent conversation surrounding children and COVID-19 has focused on school reopenings and whether children are responsible for transmitting SARS-CoV-2 to adults. But why have the media considered them only as vectors of disease? What about the effects of COVID-19 on children themselves? Speaking to the myriad health, economic, and social consequences of coronavirus on children and their families, Sandra L. Fenwick, CEO of Boston Children’s Hospital, shared her insight with the Voices in Leadership program on Tuesday, September 29, 2020.

The Pandemic’s Effect on Children

COVID-19 disproportionately affects people from historically and currently oppressed communities. Less often discussed is whether this effect is seen across all age groups. For example, COVID-19-associated hospitalization rates are 5 to 8 times higher in Black and Latinx children, respectively, compared to white children. In addition to the more familiar presentations of COVID-19, including cough, fever, and fatigue, some patients are also afflicted with multi-system inflammatory syndrome in children (MIS-C), a rare but serious complication of the SARS-CoV-2 virus.

Preparation for and Response to the Pandemic

Though Boston has been greatly impacted by COVID-19, Bostonians were uniquely prepared to face this challenge. Greater Boston has an extraordinarily high density of healthcare providers, facilities, and resources in proportion to its population (although whether healthcare provider density and population health outcomes are directly related is a subject of debate). In addition to being a national leader in pediatric care, Boston Children’s Hospital runs a huge research operation and constantly pushes the boundaries in new techniques taught to staff, which proved to be critical in responding quickly and decisively when signs of community transmission of SARS-CoV-2 appeared in Boston. The hospital’s primary concern during this first stage was safety, as knowledge on the transmissibility of the virus was limited, and the lack of testing made it difficult to know who had been infected. CEO Fenwick shared:

Sandra L. Fenwick, Chief Executive Officer of Boston Children’s Hospital (Right), was virtually interviewed by Dr. Robert J. Blendon, the Richard L. Menschel Professor of Public Health and Professor of Health Policy and Political Analysis, Emeritus at Harvard Chan (Left), for the Voices in Leadership web series for the Harvard T.H. Chan School of Public Health.

Dealing with the Unknown: Collaboration and Community

As uncertainties surfaced around the pathogenic effects of COVID-19 on children, researchers at Boston Children’s Hospital stepped forward to help answer these questions and support their community. One area of uncertainty faced by decision-makers at the hospital was whether to open their doors to adult COVID-19 patients during the surge. Although adult patients with congenital disease can receive care at Boston Children’s Hospital, adults with diseases acquired in adulthood typically could not. Would this need to change during a pandemic? Ultimately, CEO Fenwick and her team chose to focus on what they knew best and became a pediatric coordinating center that allowed other hospitals to divert pediatric care to Boston Children’s Hospital as they had to reallocate resources to adult COVID-19 patients. To understand more about the effects of SARS-CoV-2 infection in children, one clinician at Boston Children’s Hospital spearheaded the Pediatric International Collaboration on COVID-19 and MIS-C, with an aim to track the disease and its progression in children worldwide. As a result of this collaboration, clinicians worldwide have been debriefed on the types and frequency of symptoms exhibited by children with COVID-19 and MIS-C.

Future Directions and Preparations

Keeping in mind the approaching autumn season, the audience sought CEO Fenwick’s thoughts on the future of COVID-19 and Boston Children’s Hospital’s contributions, particularly in vaccine science. As children are not included in the early phases of clinical trials, the hospital’s researchers have been studying precision vaccines and the use of adjuvants to vaccines to try and boost immune system response. When questioned about a COVID-19 vaccine for children, CEO Fenwick reported that Dr. Richard Malley is already studying who should be vaccinated and what specific subpopulations the early vaccines should target. She also shared that Dr. Adrienne Randolph is collecting data for a registry to determine why children are being affected across different strata, including identifying which children would be most susceptible to COVID-19 and vulnerable to developing MIS-C after exposure. Other hospital researchers are studying the long-term effects of COVID-19 on health and development and why the immune response differs in children and adults.

Voices in Leadership webcast series enhances leadership, connecting high-profile leaders with the Harvard School of Public Health community. hsph.me/voices