Will Strep A be only the start of Covid's long tail?

My friend’s four-year-old, who had been sent to A&E by his GP, was eventually examined and given the antibiotics now synonymous with Strep A. A week later, he is well on the way to recovery as, you hope, will be the rest of those who were anxious for medical advice that day.

Going to the emergency department is bad enough as an adult; when it’s children who are unwell, it is much worse. The speed with which they fall ill is scary. Having to queue, surrounded by others in the same predicament, is a miserable experience. Sadly, it’s one which, at the moment, with various viruses sweeping through the youngest members of the population, many are having to go through.

The state of alarm over the spread and virulence of Strep A infections this winter – cases are running at roughly three times the usual level – is entirely understandable. For a cohort of young people, whose immune systems have not had a chance to muster their defences, it can be nasty. As every parent in the land is all too well aware, in a very few cases it can prove fatal.

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Much has been said about how cruel the pandemic has been to the elderly, which undoubtedly is true. Less is written about those at the other end of the spectrum, who began life during this most peculiar and punitive of times, with who knows what consequences in the years ahead.

The current spate of Strep A cases, which is hitting pre-school and early school ages hard, feels like the visible manifestation of the travails of an age group that has been silently coshed by the pandemic. Those who were infants or toddlers during lockdown are now more vulnerable to every bug flying around. Whether their isolation from infection while very young will have any enduring impact on their health I am not in a position to say. Certainly, one hopes not. But the legacy of Covid on this cohort has made itself evident in other ways, whose long-term impact is difficult to assess.

Charles Kingsley wrote The Water Babies, and I think of this generation as the Covid Babies – C-Babies for short. What a raw deal they had, starting life cocooned from the rest of the world. In the maternity ward, they were handled by medical staff in masks. Peering out of their prams, they saw eyes and foreheads rather than faces, people’s smiles hidden and words muffled. The only faces these babies saw properly were those of their family or on a screen. Let’s hope they weren’t subjected to Keeping up with the Kardashians.

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It’s possible, of course, that they have developed a precocious facility to interpret expressions from people’s eyes alone. But they have also not been allowed to experience those precious early months and years when a child’s welcome into society stretches to almost everyone they encounter, be it in a café, shop or bus. The clucking and cooing, the proffering of sweets, the unanswerable questions older folk address to the very young, usually rendering them speechless, was lost to them.

The effect of this is unquantifiable, yet it is hard to believe it has not left its mark. Where the rest of us started out with signs of benevolence on all sides, these little ones have missed an early lesson in community warmth. More tangible, however, is the irrefutable evidence that, thanks to lockdown, some children’s early educational development has suffered, in some cases badly. An Ofsted report, in 2020, noted various ways in which children in this age group had been disadvantaged.

With no access to early years schooling or to contacts beyond the home, the vocabulary and numeracy of some declined markedly. Some, who previously were toilet trained and could eat with a knife and fork, regressed to toddlerdom. Those for whom English was a second language had little chance to learn English, whilst those living in flats could not enjoy playing outdoors. Heart-breakingly, some were observed having lost the ability to play at all.

Children from poorer households had fewer toys and games than their more affluent peers. And those with special education needs or disabilities went without the same level of professional support as before, raising concerns about their development stalling or regressing, and how this would affect them in future. Worst of all, and on a whole other scale of harm, were those children whose abuse at home went unnoticed or unmonitored, leading to tragic outcomes.

You didn’t need an official report to highlight these areas of concern, which have been obvious to anyone thinking about it. Nor was it only the youngsters who were cut-off. Their parents or carers were also under duress, often leading to tension at home. Children can always sense when adults are stressed, which they then absorb, leading to anxiety or behavioural issues.

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If this sounds like a litany of gloom, that is not the intention. The vast majority of kids learn and adapt swiftly. By now, the restraints of the Covid era have been lifted, and those at nursery or early primary school are enjoying what life has to offer as if there had never been a hitch. Indeed, things have returned so fully to normal that it would be easy to forget lockdown ever happened.

It takes something like the outbreak of scarlet fever to act as a reminder of what you might call the lost years, and the disruption they have caused.

Will the Covid generation ever catch up with those in the classes ahead of them, or will their faltering start put them on the back foot indefinitely? For most, surely, Covid will represent nothing more than a blip, eventually to be overcome. There will be a few, however, for whom the damage already is done. Quite how this will manifest itself remains to be seen, but I suspect Strep A is only the start.