Clinical care, public health, social policy, and the research agenda must change to meet the new imperatives of COVID-19 if we are to protect children today and foster recovery for future generations. Pandemic response naturally directs resources and emphasis toward those who suffer most directly, but a failure to respond to the needs of children will create a long arc of increased risk for negative outcomes. Bronfenbrenner’s ecological systems theory explains how a microsystem of institutions and groups directly impact a child’s growth and development, including family, school, religious institutions, neighborhood, and peers.2 Each of these essential components has been severely disrupted in this pandemic. The social safety net refers to programs to protect citizens from poverty and hardship and includes programs that augment a child’s microsystem institutions to identify risk and provide benefits to children and families. Policy interventions must address the generational impact of the pandemic, shore up the safety net, and ameliorate the far-reaching consequences for children, adolescents, and families.

The initial phase of this pandemic found that coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19, affected children less severely compared to adults.3 Serious COVID-19 illness occurs in <10% of infected children, although severe illness is likely in identifiable subpopulations: the very young and those with underlying pulmonary pathology or immunocompromising conditions. Additionally, multisystem inflammatory syndrome in children has emerged as a dangerous manifestation of COVID-19 infection in some children. Vertical transmission from mother to fetus appears rare, but severe COVID-19 illness during pregnancy can lead to premature birth or intrauterine asphyxia.4

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