Uninvited and unwelcome, COVID-19 has pervaded all facets of our lives. For racialized and lower-income communities in Toronto, the virus has taken a disproportionate toll, one that extends to their youngest members.
We know that racialized Torontonians have COVID-19 infection rates markedly higher than that of the city’s white residents. While about half of Toronto’s population belongs to a racialized group, 77 per cent of COVID-19 cases have been among non-white residents. The curtain, we hope, has been permanently drawn back on the deep-rooted inequities – racism, poverty – behind these numbers. What the data do not convey is the pandemic’s disparate, growing and gravely worrying effect on racialized children and their families.
At the outset of the pandemic, pediatricians braced themselves with guarded optimism. Symptomatic COVID-19 infection was and continues to be less common and generally less severe in children. However, last spring, we began to hear from colleagues around the world about clusters of children presenting with a striking inflammatory syndrome in the weeks following an often-asymptomatic course of COVID-19 infection. Our pediatric patients were no longer exempt from the virus’ harmful effects. This phenomenon, commonly called Multisystem Inflammatory Syndrome in Children (MIS-C) in Canada, results from the immune system becoming overactive, causing uncontrolled inflammation throughout the body and, in some cases, affecting the heart and other organs. Although reminiscent of and likely intimately related to another ailment familiar to pediatricians – Kawasaki syndrome – MIS-C tends to affect slightly older children, seems to cause more severe inflammation, and more frequently requires admission to the intensive care unit. Thankfully, it remains rare and there have been no reported deaths in Canada.
Yet, the Centers for Disease Control and Prevention (CDC) in the United States is reporting a marked increase in the number of children with MIS-C since October as well as a greater proportion of patients requiring intensive care compared to the spring. At SickKids, we have cared for approximately 130 children with presumed MIS-C over the course of the pandemic. Only one in five of these patients have been white.
This disparity is not unique to Toronto. In New York City, although Black youth make up just over 20 per cent of the population, nearly 35 per cent of patients with MIS-C are Black. Across the United States, 69 per cent of reported cases are in Latino or Black young people while only about 20 per cent are in white children. Importantly, racial disparities in the incidence of Kawasaki syndrome, thought to reflect differing genetic risk, predate the pandemic with children of East Asian descent disproportionately affected. What we are seeing with MIS-C, however, more strikingly follows racialized socioeconomic lines.
The result, beyond the immediate concern for children’s health, is yet another wedge in the growing gap between rich and poor, a chasm increasingly defined by race in Toronto. A parent, perhaps an essential worker, is infected at the workplace and unwittingly brings COVID-19 home – a situation that is particularly concerning for multigenerational households. Fears of missing work and losing income, or even their jobs, may prompt them to continue working despite their illness. Weeks later, their symptoms resolved, the youngest child feels hot and starts to show signs of severe illness – a fever that won’t break, red eyes, cracked lips – prompting the family to seek care at the emergency department. In rare cases, the family may be faced with a prolonged hospital stay, maybe a few days in the intensive care unit. Perhaps the unexpected hospital trip and follow-up appointments lead to more missed work, lost income, and disruptions to childcare – additional stress on parents who may be concerned for the long-term health of their child.
Our failure to support our most vulnerable communities does not end with adults. Their children are now bearing the consequences of this inaction. As we continue to learn from COVID-19, we must advocate for policies such as robust income supports, paid sick-leave, and an extended freeze on residential evictions that could help save the lives of racialized adults and their children alike – both now and after the pandemic.