Psychosocial and financial well-being mediated the effects of COVID-19 distress on suicidality: a serial mediation model among Hong Kong young adults.

PURPOSE: The COVID-19 pandemic has brought significant distress on not only the physical health but also mental health of individuals. The present study investigated the direct and indirect effects from COVID-19 distress to suicidality via psychosocial and financial well-being among young people. METHODS: This cross-sectional survey recruited 1472 Hong Kong young people via random sampling in 2021. The respondents completed a phone survey on COVID-19 distress, the four-item Patient Health Questionnaire and items on social well-being, financial well-being, and suicidality. Structural equation modeling (SEM) was conducted to examine the direct and indirect effects of COVID-19 distress on suicidality via psychosocial and financial well-being. RESULTS: The direct effect of COVID-19 distress on suicidality was not significant (ß = 0.022, 95% CI - 0.097-0.156). The total indirect effect from COVID-19 distress to suicidality was significant and positive (αßγ = 0.150, 95% CI = 0.085-0.245) and accounted for 87% of the total effect (B = 0.172, 95% CI = 0.043-0.341). There were significant specific indirect effects via social well-being and psychological distress, and financial well-being and psychological distress. CONCLUSION: The present findings support different pathways from COVID-19 distress to suicidality via functioning in different domains among young people in Hong Kong. Measures are needed to ameliorate the impact on their social and financial well-being to reduce their psychological distress and suicidality.

Concluding Remarks: European Narratives About the Effects of the COVID-19 Pandemic on Coworking

This book is a collection of narrations about the effects of the COVID-19 pandemic from different countries collected within the Workgroup 2ATLAS of the COST action CA18214 ‘The Geography of New Working Spaces and the Impact on the Periphery'. This conclusive chapter comprehends the previous chapters and offers a comparative view regarding the effects on Coworking Spaces (CS), Governmental Measurements to curb the Pandemic, Effects on Work, Remote/Telework Work, Working-From-Home (WFH), Effects on Commuting, Transportation Mods and Services, Effects on the Housing, Place of Residence, Office and Real Estate Market, Effects on Tourism, Effects on Urban Planning. The final section of this chapter draws attention to the direct and indirect effects of coworking spaces. Direct effects on individuals and indirect effects as living-, work- and build-environment, taking into account space and economy, environment (energy) and urban planning. This book contributes to a fast-growing amount of literature on new working spaces, especially coworking spaces. Further empirical studies should be conducted to create evidence as a solid foundation for policies at the EU, national and subnational levels. © 2023, The Author(s).

COVID-19–related stressors, family functioning and mental health in Canada: Test of indirect effects

Objective: The purpose of this study was to examine how family relationships relate to stress and mental health during the COVID-19 pandemic response in Ontario, Canada. Background: Generally, families are pillars of strength during times of stress and burden. However, enduring stressors, such as the COVID-19 pandemic, may challenge the cohesion and caregiving functions of families. Researchers are just beginning to explore stressors associated with the COVID-19 pandemic, family functioning, and mental health in the general population. Rooted in stress process theory, the current study disentangles the complex pathways through which COVID-19-pandemic-related stressors and family cohesion and family conflict are associated with the mental health of the general population in Ontario, Canada. Method: Data were collected using an online survey from April 22, 2020, to May 22, 2020. Through convenience sampling, 933 individuals were recruited from the general population in Ontario, Canada. Results: Findings suggest that COVID-19-pandemic- related stressors are associated with anxiety directly and indirectly through eroding family cohesion and exacerbating family conflicts. Conclusion: By looking into family cohesion and family conflicts simultaneously, this investigation has taken a nuanced approach to studying the influence of COVID-19-pandemic-related stressors on family functioning. Implications: These findings suggest that efforts to assist families in bolstering cohesiveness may be helpful. Further, diminishing family conflicts, especially during community or global disasters, such as epidemics, pandemics, or natural disasters, should be a focus in both practice and future research.

COVID-19-related fears, stress and depression in adolescents: The role of loneliness and relational closeness to online friends

Research shows that the various waves of COVID-19 have generated increased fears, loneliness, and negative feelings in many adolescents. In this context, social media use may fulfill the pivotal function of connection, thereby supporting a sense of relational and emotional closeness to others via online interactions. However, there is no agreement as to the risks or buffering effects of social media usage among adolescents during the pandemic. The current study aims to explore the direct and indirect effects of COVID-19-related fears on adolescents' perceived stress and depression, evaluating the mediating effect of their sense of loneliness and the moderating effect of relational closeness to online friends. A sample of 544 Italian adolescents participated in an online survey during the third wave of COVID-19 (71.9% females;mean age = 16.22 years). The survey comprised the Multidimensional Assessment of COVID-19-Related Fears, the Italian Loneliness Scale, the Depression and Stress subscales of the Depression-Anxiety-Stress Scale-21, and the Relational Closeness. The findings show a mediating effect of loneliness in the predictive relationship between COVID-19-related fears and both depression and stress, and they also indicate that relational closeness to online friends has a moderating effect, buffering the effect of loneliness on adolescents' stress and depression. The positive role of relational closeness to online friends suggests the need to consider the quality of the specific use of social media among adolescents, which may serve precise functions and needs.

Pandemic-Related Stress and Other Emotional Difficulties in a Sample of Men and Women Living in Romantic Relationships during the COVID-19 Pandemic.

This study examined the extent to which relationship quality affects variability in perceived stress and other emotional difficulties associated with the pandemic. The study was conducted 2-17 March 2022 using a self-administered online survey. The sample size consisted of 1405 individuals who were in a romantic relationship. The scales used in the study included the PSS-4, ECR-RS, SLS-12 and the standardized Pandemic-ED scale (RMSEA = 0.032). Increased stress levels (U = -5.741), pandemic-related emotional difficulties (U = -8.720), worse romantic relationship quality (U = -2.564) and more frequent anxiety-related attachment (U = -3.371) were characteristic of women. A hierarchical regression model for stress showed that age (b = -0.143), financial situation (b = 0.024), the ECR-RS scores (b = 0.219) and pandemic-related emotional difficulties (b = 0.358) proved to be statistically significant predictors of stress. The hierarchical regression model for pandemic-related emotional difficulties indicated five predictors: gender (b = 0.166), education (b = 0.071), financial situation (b = 0.203), scores on the ECR-RS scale (b = 0.048) and stress (b = 0.367). The SEM model used has satisfactory fit indices (RMSEA = 0.051), romantic relationship quality scores and attachment styles interact with the variability of perceived pandemic-related stress and burdens. The determined model offers conclusions relevant to clinicians working with individuals and couples during periods of intense stress.

Impact of COVID-19 measures on the health and healthcare of children in East-Africa: Scoping review.

BACKGROUND: The COVID-19 pandemic is of grave concern. As scientific data is being collected about the nature of COVID-19, government leaders and policy makers are challenged. They might feel pressured to take strong measures to stop virus spread. However, decisions could cause more harm than do good. This study maps all existing literature regarding the impact of COVID-19 containment measures on the health and healthcare of children in East-Africa. METHODS: This scoping review follows Population Concept Context guidelines of Arksey and O'Malley and PRISMA 2020 checklist. PubMed, Web of Science, and Embase were searched. All peer-reviewed literature published in English between January 2020 and October 2022 was considered. Initial screening of titles and abstracts was undertaken independently by two reviewers, with a third available in case of doubt. This was followed by full-text screening involving two independent reviewers. RESULTS: In total, 70 studies were included. Eight containment measures affecting children's health and healthcare were distinguished: lockdowns, school closures, physical distancing, travel restrictions, business closures, stay-at-home orders, curfews, quarantine measures with contact tracing. The consensus in the studies is that containment measures could minimise COVID-19 spread but have adverse indirect effects on children in East-Africa. Seven indirect effects were distinguished: economic damage, limited education access, food insecurity, child abuse, limited healthcare access, disrupted health-programs, and mental health challenges. CONCLUSION: Government leaders and policy makers should take adverse indirect effects of COVID-19 measures into account, particularly in resource-limited regions such as East-Africa, apply a holistic approach, and strengthen socioeconomic and health-systems to protect the most vulnerable.

Well-being costs of perceived job insecurity: Mediating role of financial satisfaction, subjective healthiness and institutional trust

The fear of losing the current job or not finding a new job significantly affects an individual’s well-being. However, perceived job insecurity also affects an individual’s financial satisfaction, subjective healthiness, and trust in institutions - determinants of subjective well-being. This research explores the direct and indirect effects of perceived job insecurity on the life satisfaction of the full-time employed and unemployed people within a serial mediation analysis framework. Using the World Values Survey (6th wave) dataset, we estimated the effects in aggregate and disaggregated (by the income level of countries) samples. Regarding unemployed people, results display the almost equal contribution of direct and indirect channels. In contrast, the dominance of indirect impact channels is more considerable in the case of individuals employed full-time. In disaggregated samples, no significant impact is detected in low-income and upper-middle-income class members, while the effects are significant and economically meaningful for lower-middle-income and high-income countries. Non-pecuniary costs exceed pecuniary costs. The primary mediating factor is satisfaction with a household’s financial situation, especially in high-income countries. The availability of unemployment insurance benefits can partially compensate well-being costs of perceived job insecurity. Nevertheless, governments need to enhance labour market efficiency to diminish both unemployed and full-time employed individuals’ perceived job insecurity, which would improve societal welfare in the end.

Small matching grants for women entrepreneurs: lessons from the past recession

During the economic slowdown caused by the financial crisis in 2008, grants for entrepreneurs were made available to support economic development. Whether such a policy instrument is effective for business development is a highly relevant question in the aftermath of the COVID-19. We evaluate the causal effects of small business development matching grants using a quasi-experimental approach. The grants were exclusively targeted to women entrepreneurs and provided during the recession after the financial crisis. Our findings demonstrate an increase in bank loans and a positive impact on turnover, value-added, capital, employment, and overall factor productivity for more experienced women entrepreneurs. As the grants are too small to have direct economic effects or indirect effects via the certification effect, they alleviate time and information constraints of women entrepreneurs. The cost-benefit analysis shows an increase in value-added that outweighs the scheme-related costs.Plain English SummaryThis study evaluates the effect of small public grants for women entrepreneurs. Grants were used for childcare and business consultancy costs to alleviate time and information constraints of women entrepreneurs. Benefiting from these grants resulted in higher bank loans. The women entrepreneurs on average invested more money in capital and had better performance measures like turnover and value-added. The effect was particularly evident among more experienced women entrepreneurs. The cost-benefit analysis shows grant-induced increase in value-added outweighs the scheme-related costs. The study implies small public grants for women entrepreneurs increase small firms’ growth, and these grants are in addition a cost-effective policy tool.

Effects of Role Ambiguity on Work Stress with Islamic Coping as Mediation among Nurses during a Covid-19 Pandemic at the General Hospital in Aceh-Indonesia

The nursing work environment has changed during the Covid-19 pandemic. Its presence has impacted work stress among nurses in addition to other stressors including role ambiguity. Nurses with good stress coping can mitigate environmental stressors to minimize the work stress to the lowest level. This study intends to measure and analyze the direct effect of role ambiguity and Islamic coping on work stress. It also attempts to measure the indirect effect of role ambiguity on work stress through Islamic coping among nurses at the General Hospital dr. Zainoel Abidin (Rumah Sakit Umum dr. Zainoel Abidin - RSUDZA), Banda Aceh, Indonesia. A number of 206 nurses in inpatient rooms at the hospital were selected as the study's sample using a stratified random sampling method. The primary data were collected using the questionnaires and analyzed using a Structural Equation Modeling (SEM) approach. The study found that role ambiguity has positively influenced work stress, while Islamic coping has negatively impacted work stress. In addition, Islamic coping has mediated the effect of role ambiguity on work stress. These results have implications for reducing work stress of the nurses during the Covid-19 pandemic. The clarification of the roles and responsibilities and improvement of Islamic coping skills could mitigate the nurses' work stress during the Covid-19 pandemic. © 2022 IEEE.

Lessons for responding to COVID-19, from Exemplars in Under-five Mortality Reduction: [version 1;peer review: 3 approved with reservations]

COVID-19 may not have the same direct effects on children as it does on older adults, but its indirect effects still pose a threat to child health, by disrupting delivery of routine health services like immunizations. This has happened during previous crises, and early indications point towards similar disruptions due to the coronavirus pandemic. To mitigate this, countries need to build resilient health systems capable of maintaining essential maternal and child health interventions, while also responding to COVID. How can this be accomplished? To find some answers, we can learn from countries in the past who improved health outcomes in the face of challenging circumstances. Specific to child health, countries with positive-outlier performance in reducing under-five mortality provide helpful strategies. These lessons include a clear national plan that drives rapid response, leveraging existing data systems to inform decision-making, engaging communities via community health workers, and focusing on equity. Today, countries around the world are facing the challenge of responding to the pandemic while building resilient health systems that continue to deliver invaluable maternal and child health services. Studying lessons from previous success stories can help inform the road ahead.

LA POLÍTICA MONETARIA EN LA EUROZONA ANTE LA COVID-19 (*)

En este artículo se describe la rápida, flexible y eficaz actuación del BCE y sus efectos sobre la estabilidad financiera de la eurozona, como respuesta a la COVID-19. Para ello se revisan las principales medidas adoptadas por el BCE y sus resultados sobre las variables macroeconómicas y mercados financieros. La evidencia muestra que el tensionamiento en el mercado monetario al inicio de la pandemia fue reducido y transitorio, los gobiernos de los países de la eurozona han tenido abiertos los mercados y se han financiado a tipos y primas de riesgo muy reducidos -a pesar del fuerte incremento del déficit público-, los diferenciales de los bonos corporativos volvieron rápidamente a sus niveles previos, al igual que las primas de riesgo bancario, y el crédito ha seguido fluyendo a la economía. Todo ello pone de manifiesto que se evitó un grave accidente financiero en la zona del euro, así como la reaparición del riesgo de ruptura del euro que habría sido especialmente dañino para los países periféricos. La evaluación del impacto directo sobre la economía real de las medidas extraordinarias del BCE indica que su efecto ha sido económicamente relevante. En el caso concreto de España, se estima que han evitado al menos una caída adicional del PIB superior a 3 puntos porcentuales, a lo que hay que añadir los efectos indirectos, al hacer posible la adopción de medidas fiscales de ámbito nacional, con un impacto de unos 8 puntos porcentuales en los momentos más álgidos de la crisis.Alternate :This article describes the rapid, flexible and effective measures taken by the ECB and its effects on the financial stability of the euro area, in response to COVID-19. To this end, we review the main measures adopted by the ECB and their results on macroeconomic variables and financial markets. The evidence shows that financial tensions at the beginning of the pandemic were small and transitory, governments have had public debt markets open and have faced very low rates and risk premiums -despite the strong increase in the public deficit-, corporate bond spreads quickly returned to their previous levels, as did bank risk premiums, and credit has continued to flow into the economy. All of this evidence shows that the eurozone avoided a serious financial recession, as well as the reappearance of the risk of a breakdown of the euro, which would have been especially damaging for peripheral countries. The evaluation of the direct impact on the real economy of the measures taken by the ECB during the pandemic indicates that their effect has been economically relevant. In the specific case of Spain, we estimate that they have avoided at least an additional fall in GDP of more than 3 percentage points. Indirect effects should be added to this direct effect of monetary policy, by making it possible to adopt fiscal measures at the national level, with an impact of about 8 percentage points at the height of the crisis.

Generation Z and intention to use the digital library: does personality matter?

Purpose>This study aims to evaluate the role of personality in digital library systems (DLS) adoption intention among Generation Z (Gen-Z) students. The study uses the unified theory of acceptance and use of technology-2 and the five-factor model to investigate personality’s influence on Gen-Z’s DLS adoption intention.Design/methodology/approach>The study is a descriptive causal investigation based on primary data collected through a self-administered survey using pre-validated tools. The study uses structural equation modeling to investigate personality dimensions’ direct and moderating effect on the dependent, independent variables and their relation.Findings>The study results indicate that personality has no significant influence on Gen-Z’s DLS adoption, suggesting the ubiquity and inevitability of technology in current times. Also, only performance expectancy had a considerable impact on DLS adoption among Gen-Z going to college – a deviation from past studies where multiple independent variables have influenced DLS adoption when examined from different technology adoption model angles.Research limitations/implications>The current research is done on Gen-Z, and thus the results are ideographic to the cohort.Practical implications>The results of the study can be used to effectively design and communicate technology-enabled information solutions among the Cohort.Social implications>The results of the study help better understand the factors affecting the technology adoption intentions of Gen-Z. Such understanding can help in better design and implementation of technology-enabled solutions for the cohort, maximizing such system adoption and its effective and efficient utilization.Originality/value>The study explores the impact of personality on DLS adoption intentions, hitherto unexplored. The research also focuses on Gen-Z – a cohort born in a technology-enabled world whose attitude and preferences towards technology might differ. The study’s findings will help understand the influence of personality on DLS adoption among the Gen-Z and can be used to design, promote and evaluate such systems.

Direct and Indirect Effectiveness of mRNA Vaccination against Severe Acute Respiratory Syndrome Coronavirus 2 in Long-Term Care Facilities, Spain.

We conducted a registries-based cohort study of long-term care facility residents >65 years of age offered vaccination against severe acute respiratory syndrome coronavirus 2 before March 10, 2021, in Spain. Risk for infection in vaccinated and nonvaccinated persons was compared with risk in the same persons in a period before the vaccination campaign, adjusted by daily-varying incidence and reproduction number. We selected 299,209 persons; 99.0% had >1 dose, 92.6% had 2 doses, and 99.8% of vaccines were Pfizer/BioNTech (BNT162b2). For vaccinated persons with no previous infection, vaccine effectiveness was 81.8% (95% CI 81.0%-82.7%), and 11.6 (95% CI 11.3-11.9) cases were prevented per 10,000 vaccinated/day. In those with previous infection, effectiveness was 56.8% (95% CI 47.1%-67.7%). In nonvaccinated residents with no previous infection, risk decreased by up to 81.4% (95% CI 73.3%-90.3%). Our results confirm vaccine effectiveness in this population and suggest indirect protection in nonvaccinated persons.

Imperatives of recognising the complexities: gendered impacts and responses to COVID-19 in India.

This paper argues that the gendered impact of COVID-19 has both visible and hidden dimensions, and both immediate effects linked with lockdowns and longer-term effects that are likely to emerge sequentially in time and affect recovery. Much of the existing feminist literature on the impact of COVID-19 has neglected these complexities and focused mainly on care work and domestic violence. This has diverted attention away from other key concerns such as livelihood loss, food and nutritional insecurity, indebtedness, rising poverty, and the low resilience of most women in developing economies. Even care work and domestic violence have complex facets that tend to be missed. Using examples from India, the paper outlines the kinds of gendered effects we might expect, the extent to which these have been traced in existing surveys, and the data gaps. It also highlights the potential of group approaches in enhancing women's economic recovery and providing social protection from the worst outcomes of the pandemic-approaches that could guide us towards effective policy pathways for 'building back better.'

Path Analysis to Assess Socio-Economic and Mitigation Measure Determinants for Daily Coronavirus Infections.

(1) Background: With the rapid global spread of the coronavirus disease 2019 (COVID-19) and the relatively high daily cases recorded in a short time compared to other types of seasonal flu, the world remains under continuous threat unless we identify the key factors that contribute to these unexpected records. This identification is important for developing effective criteria and plans to reduce the spread of the COVID-19 pandemic and can guide national authorities to tighten or reduce mitigation measures, in addition to spreading awareness of the important factors that contribute to the propagation of the disease. (2) Methods: The data represents the daily infections (210 days) in four different countries (China, Italy, Iran, and Lebanon) taken approximately in the same duration, between January and March 2020. Path analysis was implemented on the data to detect the significant factors that affect the daily COVID-19 infections. (3) Results: The path coefficients show that quarantine commitment (ß = -0.823) and full lockdown measures (ß = -0.775) have the largest direct effect on COVID-19 daily infections. The results also show that more experience (ß = -0.35), density in society (ß = -0.288), medical resources (ß = 0.136), and economic resources (ß = 0.142) have indirect effects on daily COVID-19 infections. (4) Conclusions: The COVID-19 daily infections directly decrease with complete lockdown measures, quarantine commitment, wearing masks, and social distancing. COVID-19 daily cases are indirectly associated with population density, special events, previous experience, technology used, economic resources, and medical resources.

The indirect impact of COVID-19 large-scale containment measures on the incidence of community-acquired pneumonia in older people: a region-wide population-based study in Tuscany, Italy.

OBJECTIVE: To evaluate the indirect effect of COVID-19 large-scale containment measures on the incidence of community-acquired pneumonia (CAP) in older people during the first epidemic wave of COVID-19 in Tuscany, Italy. METHODS: A population-based study was carried out on data from the Tuscany healthcare system. The outcome measures were: hospitalization rate for CAP, severity of CAP hospitalizations, and outpatient consumption of antibacterials for CAP in people aged 65 and older. Outcomes were compared between corresponding periods in 2020 (week 1 to 27) and previous years. RESULTS: Compared with the average of the corresponding periods in the previous 3 years, significant reductions in weekly hospitalization rates for CAP were observed from the week in which the national containment measures were imposed (week 10) until the end of the first COVID-19 wave in July (week 27). There was also a significant decrease in outpatient consumption in all antibacterial classes for CAP. CONCLUSIONS: The implementation of large-scale COVID-19 containment measures likely reduced the incidence of CAP in older people during the first wave of the COVID-19 pandemic in Tuscany, Italy. Considering this indirect impact of pandemic containment measures on respiratory tract infections may improve the planning of health services during a pandemic in the future.

The impacts of COVID-19 on environmental sustainability: A brief study in world context.

The novel outbreak of Coronavirus disease 19 (COVID-19) and the ensuing global pandemic in 2020, has brought with it a number of unprecedented side effects. This resulted in a number of measures, including state-mandated lockdowns, as well as restrictions to economic and social activity. The direct effects of these measures were felt in the economy, as well as in key institutions within society; however, there were also indirect results from these changes. This review article focuses on these indirect effects, towards sustainable environment. It points to the fact that the net effect has been positive; in terms of reduction in greenhouse emissions, oil exploration activities, and pollution. By extension, at-risk ecosystems have been given improved environmental quality. Taken together, the article traces the progression of the virus and ensuing pandemic, in order to better understand how the environment was sustained.

Beyond COVID-19: a cross-sectional study in Italy exploring the covid collateral impacts on healthcare services.

With COVID-19, populations are facing unmet health needs due to fear of contagion, lockdown measures and overload of Healthcare services (HCS). The COCOS study aimed to investigate reduced healthcare access among Italian citizens, additionally looking for specific subgroups that will primarily need health services in the next future. A cross-sectional online survey was performed during the Italian lockdown between April and May 2020. Descriptive, univariable and multivariable (logistic regression models) analyses were performed: results are expressed as Odd Ratios and Adjusted Odd Ratios (ORs and AdjORs). Totally, 1,515 questionnaires were collected. Median age was 42 years (IQR 23), 65.6% were females. Around 21.8% declared to suffer from chronic diseases. About 32.4% faced a delay of a scheduled Medical Service (MS) by provider decision, 13.2% refused to access scheduled MS for the fear of contagion, and 6.5% avoided HCS even if having an acute onset issue. Alarmingly, 1.5% avoided Emergency Department when in need and 5.0% took medications without consulting any physician: patients suffering from chronic conditions resulted to be more prone to self-medication (AdjOR [95% CI]: 2.16 [1.16-4.02]). This study demonstrated that indirect effects of COVID-19 are significant. Large groups of population suffered delays and interruptions of medical services, and the most vulnerable were the most affected. Immediate efforts are needed to reduce the backlog that HCSs incurred in.

Pandemics and maternal health: the indirect effects of COVID-19.

Infectious diseases can directly affect women and men differently. During the COVID-19 pandemic, higher case fatality rates have been observed in men in most countries. There is growing evidence, however, that while organisational changes to healthcare delivery have occurred to protect those vulnerable to the virus (staff and patients), these may lead to indirect, potentially harmful consequences, particularly to vulnerable groups including pregnant women. These encompass reduced access to antenatal and postnatal care, with a lack of in-person clinics impacting the ability to screen for physical, psychological and social issues such as elevated blood pressure, mental health issues and sex-based violence. Indirect consequences also encompass a lack of equity when considering the inclusion of pregnant women in COVID-19 research and their absence from vaccine trials, leading to a lack of safety data for breastfeeding and pregnant women. The risk-benefit analysis of these changes to healthcare delivery remains to be fully evaluated, but the battle against COVID-19 cannot come at the expense of losing existing quality standards in other areas of healthcare, especially for maternal health.

Challenges of COVID-19 in children in low- and middle-income countries.

As the coronavirus pandemic extends to low and middle income countries (LMICs), there are growing concerns about the risk of coronavirus disease (COVID-19) in populations with high prevalence of comorbidities, the impact on health and economies more broadly and the capacity of existing health systems to manage the additional burden of COVID-19. The direct effects of COVID are less of a concern in children, who seem to be largely asymptomatic or to develop mild illness as occurs in high income countries; however children in LMICs constitute a high proportion of the population and may have a high prevalence of risk factors for severe lower respiratory infection such as HIV or malnutrition. Further diversion of resources from child health to address the pandemic among adults may further impact on care for children. Poor living conditions in LMICs including lack of sanitation, running water and overcrowding may facilitate transmission of SARS-CoV-2. The indirect effects of the pandemic on child health are of considerable concern, including increasing poverty levels, disrupted schooling, lack of access to school feeding schemes, reduced access to health facilities and interruptions in vaccination and other child health programs. Further challenges in LMICs include the inability to implement effective public health measures such as social distancing, hand hygiene, timely identification of infected people with self-isolation and universal use of masks. Lack of adequate personal protective equipment, especially N95 masks is a key concern for health care worker protection. While continued schooling is crucial for children in LMICs, provision of safe environments is especially challenging in overcrowded resource constrained schools. The current crisis is a harsh reminder of the global inequity in health in LMICs. The pandemic highlights key challenges to the provision of health in LMICs, but also provides opportunities to strengthen child health broadly in such settings.