COVID-19 impacts on children under 5 in temporary accommodation-co-developing solutions from lockdown to the recovery phase-A mixed-methods study

正如媒体所强调的那样，2019年冠状病毒病（COVID-19）已经并将产生巨大的直接健康和经济影响，但对儿童和家庭也可能产生无数重大的间接健康、社会和教育后果。这些影响可能会对最脆弱的CYP群体产生最强烈的影响，例如那些在临时或不安全的住所中无家可归的人。具体而言，五岁以下无家可归的儿童不仅由于不合标准的住房过度拥挤而面临更大的感染和传播风险，而且还会对生长、最佳健康和大脑发育产生直接和长期的影响。2019冠状病毒病大流行可能导致感染发病率进一步增加，并持续18个月或更长时间。因此，大流行病的长期和周期性不仅会对一些儿童产生短期影响，而且会对他们的大部分婴儿生活产生长期影响，有些儿童甚至出生时就面临大流行病。儿童事务专员表示，可能有超过21万名无家可归的儿童住在临时住所或“沙发上冲浪”，仅在英格兰就有大约58.5万名无家可归或有无家可归风险的儿童。本研究的目的是确定在全国范围内为自己和孩子住在临时住所的5岁以下儿童的父母所遇到的与COVID-19大流行以及我们相关的卫生服务和社会反应有关的障碍。首先，我们将探讨人们对获得卫生保健服务的看法，例如根据常见的儿童评估（例如发烧、腹泻、呼吸道症状、事故）寻求医疗审查。其次，我们将探索父母/照顾者支持孩子实现最佳健康结果的感知能力（例如营养，接种疫苗，整体健康，成长，达到完整的发展里程碑）。我们还将与这些弱势群体的父母和一线（卫生和社会护理）工作者共同开发一个信息工具包，以便在封锁期结束后解决他们的短期和长期需求，并努力恢复“正常”，同时需要从这些经验中吸取教训，为COVID-19可能在冬季卷土重来做好准备。为将来的任何流行病或大流行病，也为迅速解决这些儿童在这次大流行病期间遇到的健康挑战。

Coronavirus disease 2019 (COVID-19) has and will have huge direct health and economic implications as highlighted by the media, but there are and likely will be also a myriad of significant indirect health, social, and educational consequences for children and families. These impacts will likely be most keenly felt on the most vulnerable of CYP - such as those experiencing homelessness while living in temporary or insecure accommodation. Specifically, homeless children under age five (under5s) are not only at greater risk of exposure and transmission of COVID due to overcrowding in substandard housing, but also immediate and long-term impacts on growth, optimal health, and brain development. The COVID-19 pandemic could result in a number of further waves of increased infection incidence and last for 18 months or longer. The longevity and periodicity of the pandemic will therefore not have only short-term impacts but long-term for some children extending across most of their infant life with some children even being born into this pandemic. The Children's Commissioner suggested that there could be more than 210,000 homeless children in temporary accommodation or 'sofa surfing,' and approximately 585,000 who either are homeless or at risk of becoming homeless in England alone.The purpose of this study is to determine the barriers attributed to the COVID-19 pandemic and our associated health services and societal response, experienced by parents of under5s living in temporary accommodation nationally for themselves and their children. First, we will explore perceptions around access to health care services, such as seeking medical review in response to common childhood assessments (e.g. fever, diarrhoea, respiratory symptoms, accidents). Second, we will explore parent/carer perceived ability to support their child in achieving their optimal health outcomes (e.g. nutrition, vaccination uptake, overall wellbeing, growth, reaching full developmental milestones). We will also co-develop an information toolkit with the parents of this vulnerable population and front line (health and social care) workers to address their short-term and long-term needs once the lockdown period ends and there is an effort to return to "normalcy" while at the same time, there is a need to learn from these current experiences in preparation for a possible Winter resurgence of COVID-19, for any future epidemics or pandemics but also to rapidly address the health challenges that these children have encountered during this pandemic.