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）已经并将对健康和经济产生巨大的直接影响，但也可能对儿童和家庭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人产生最强烈的影响，例如那些住在临时或不安全住所的无家可归者。具体而言，五岁以下无家可归的儿童不仅因不合标准的住房过度拥挤而面临更大的接触和传播新冠病毒的风险，而且对成长、最佳健康和大脑发育产生直接和长期影响。COVID-19疫情可能导致感染率进一步上升，并持续18个月或更长时间。因此，这一流行病的持续时间和周期性不仅会产生短期影响，而且会对一些儿童产生长期影响，影响贯穿其婴儿生命的大部分时间，有些儿童甚至在这一流行病中出生。儿童专员表示，仅在英格兰，可能就有超过21万名无家可归的儿童住在临时住所或“沙发冲浪”，大约58.5万名儿童无家可归或面临无家可归的风险。这项研究的目的是确定COVID-19大流行造成的障碍以及我们相关的卫生服务和社会反应，为自己和子女居住在全国临时住所的5岁以下儿童的父母的经历。首先，我们将探讨人们对获得医疗保健服务的看法，例如寻求医疗审查以应对常见的儿童评估（如发烧，腹泻，呼吸道症状，事故）。其次，我们将探讨父母/照顾者感知的支持孩子实现最佳健康结果的能力（例如营养，疫苗接种，整体健康，成长，达到全面发展里程碑）。我们还将与这一弱势群体和前线的父母共同开发一个信息工具包一旦封锁期结束，（卫生和社会护理）工作人员将努力解决他们的短期和长期需求，并努力恢复“正常”，同时，需要从目前的经验中学习，为冬季可能出现的COVID-19疫情做好准备，这不仅是为了预防未来的任何流行病或大流行病，而且也是为了迅速解决这些儿童在这一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.