Our next national priority should be to reopen all America’s schools for full time in-person learning
Now over a year into the closure of our nation’s schools, with 50.9 percent of students still in remote or in hybrid mode of education, we are witnessing likely the tip of the iceberg in terms of negative impacts on youth from prolonged isolation, excessive screen time, declining academic achievement and widespread school dropouts. One of the most disturbing aspects of these negative impacts is that they are disproportionately affecting children and families of lower socioeconomic status and minority groups.
COVID-19 deaths in children are tragic but rare. To put the mortality risk in perspective, in California, there were 14 deaths among children ages 5-17 from COVID-19 in 2020, lower than the number of children who die of influenza in a typical year. COVID-19 also poses a much lower risk of death than suicides in youth: There have been 213 deaths among 5-17 year olds in the U.S. from COVID-19 in the past 12 months; in 2018, there were nearly three times as many deaths by suicide — 596 deaths — in the smaller cohort of children between the ages of 10 and 14. This suggests that suicide and mental health disorders continue to remain a much larger threat to children’s health than either COVID-19 or influenza. These statistics that deaths from COVID-19 among children remain rare are mirrored around the U.S. and the world. As the data continue to accumulate that K-12 schools are not a major contributor to disease spread within a community, the growing negative impacts school closures are having on children are becoming increasingly unjustified.
In terms of children’s mental health, the CDC reported a rise in mental health emergency room visits by 24 percent and 31 percent in children 5-11 years and 12-17 years old, respectively, from January to October of 2020. One San Francisco hospital has reported a 75 percent increase in children requiring hospitalization for mental health diagnoses. Mental health concerns pose a much larger public health threat to our children than COVID-19.
In April 2020, the Lancet reported on the clear role schools play in preventing worsening mental health disorders by providing access to mental health professionals and teacher support. Initially worsening mental health status was seen predominantly in special educational needs or pre-existing mental health conditions. However, with time, the mental health effects are broadening to include all sectors of our nation’s young population. Isolation from peers, inability to participate in sports and extra-curricular activities, prolonged screen time and increases in failing grades are contributing to this trend. A sense of failure — either academically or athletically — can feel impossible to overcome at a young age and may impact the entire trajectory of a child’s life, including shortening it. Other negative physical effects from school closure that have begun to surface include progression of myopia and increasing obesity rates.
We know that children are less likely to contract COVID-19 in school with mitigation strategies in place than they are to contract it in the community. This has been reported in numerous studies including from Wisconsin, North Carolina, Johns Hopkins and Children’s Hospital of Philadelphia. This is presumably because elementary-aged children are being passed around between caretakers while parents are at work and high schoolers out of school are spending time at indoor locations socializing. Thus, closing schools to prevent COVID-19 in children is not supported by the current science. Furthermore, children may be at least one-third less likely to catch and transmit COVID than adults. Documented in-school spread of COVID-19 between children has indeed been exceedingly rare and even rarer to staff, even with asymptomatic surveillance testing.
Both the educational and health tolls of prolonged school closures are magnified among children of lower socioeconomic classes. Many of these children do not have sufficient internet access to log on virtually or have a caretaker at home during the day to help facilitate their learning. Sometimes, this results in neglect. Some of these children have had parents quit their jobs, disproportionately ethnic minority parents and especially mothers. Meanwhile, children at many private or parochial schools have been able to continue in-person learning, further widening the gap between those with and without privilege. School and/or school-related sports have historically provided a unique opportunity for children to come out of impoverished conditions as an adult.
At this point, as our COVID-19 case rates continue to drop and there’s a nationwide priority to get school teachers and staff vaccinated, which should remain effective against variants, it is our urgent call as a nation to not only open our schools full time for K-12 grades as quickly as possible, but to focus our resources on treating the educational disparities and mental health conditions that have developed as a result.
Finally, we commend the CDC for revising its six-foot guidelines for student social distancing, which were hindering schools from reopening in a timely manner. Recent data from Massachusetts do not support the necessity of six feet of distance between students, and data from Wisconsin not only found 3 feet to be sufficient but also found no support for the idea that a disease prevalence threshold should be required to reopen schools.
When our country is compared to the rest of the world, we are a clear outlier in our failure to return students to the classroom in a timely and science-based manner.
Our choice to not prioritize the well-being of our children, especially the most disadvantaged, will be felt for decades. Every pandemic has a group that has been disproportionately affected and, when it comes to COVID-19, we will likely look back and see it was our children, our elderly and our poorest.
We need to advocate together as a society for those who so urgently need a voice. No time is too soon to open our schools’ doors to all of our nation’s children full-time. As Mahatma Gandhi said, “The true measure of any society can be found in how it treats its most vulnerable members.”
Tracy Beth Høeg, MD, PhD, is a physical medicine and rehabilitation specialist with an Epidemiology PhD affiliated with the University of California-Davis and in private practice at Northern California Orthopaedic Associates. She is the senior author of the 2020 study of transmission of COVID-19 in the Wood County, Wis., schools (Falk et al. MMWR Morb Mortal Wkly Rep 2021; 70: 136-140). Follow her on Twitter @TracyBethHoeg
Tara O. Henderson, MD, MPH, is professor of pediatrics and interim chief of pediatric hematology, oncology and stem cell transplantation at the University of Chicago Comer Children’s Hospital. She is an NIH-funded health outcomes researcher focused on the long-term outcomes of childhood cancer survivors. She was a 2018 Presidential Leadership Scholar. Follow her on Twitter @doctortara
Daniel Johnson, MD, is professor of pediatrics and chief of pediatric infectious diseases and academic pediatric at the University of Chicago Comer Children’s Hospital. He is a member of the Illinois Department of Public Health’s COVID School Workgroup and co-lead of the Illinois Chapter, American Academy of Pediatrics’ Task Force on Return to School. Follow him on Twitter @DrDanielJohnson
Monica Gandhi, MD, MPH, is professor of medicine and associate division chief of the division of HIV, infectious diseases and global medicine at University of California-San Francisco. She is an NIH-funded investigator, Director of the UCSF Center for AIDS Research (CRAR), and a nationally recognized thought leader on COVID-19 and COVID-19 vaccination. Follow her on Twitter @MonicaGandhi9