March 2020 was a tough time – most kids went on spring break, never to return to school that year. The pandemic presented a difficult decision for our school systems and lawmakers – what do we need to do to try to help stop the spread of this illness we knew little about?
Some people may assume that based on my previous posts about kids and how sick they get from COVID, I would recommend schools remain closed, partially virtual, or some other option. I do NOT support that idea, nor have I supported that concept for quite a while now. Many of the reasons for this are outlined below.
Why Close the Schools in the First Place?
When we first began to hear about COVID-19, it was in an area of China that also knew little about how it spread, who were considered super spreaders, and other important information. Once it hit the shores of the United States, we were playing with very little information to go from. Secondary to this, we had to make choices based on what we knew about other viruses.
One large concern was that kids would be “super spreaders” for this particular virus. One of the main viruses we hear about on an annual basis is influenza. We know the pediatric population has a high rate of contracting and spreading this virus to our older populations. Therefore, we recommend flu vaccines each winter, hand washing, etc. (Of note, this is also a reason I wish we would split the summer vacation months from school, using half of it in the winter months to try to curb the impact of it on our population – and apparently we didn’t have a flu season this year, so maybe it will come back in the summer?) Kids also are high spreaders of other forms of coronaviruses – the kinds that typically cause the common cold symptoms.
Another reason to close the schools – we wanted to protect our school staff. We did not know how the virus would spread from the younger population to the older population, and vice versa. Many of the adults in the school system (like teachers) were also at risk for contracting the illness outside of school and then possibly spreading it to others in the building.
With little information on how this virus spread and who was most affected, the tough choice was made to stop in-person schooling and activities.
How Has This Affected Our Kids?
When schools were initially closed, I am sure there were many kids possibly EXCITED about the idea of not having to go back, starting summer vacation early, etc. However, they quickly realized no in-person school meant not getting to see their friends, missing out on sport seasons and activities, and still having to do school through remote learning. Let’s be honest – no school was ready to transition to remote learning. We were rushed to come up with a teaching plan that would engage kids, keep them on track, and make sure no one was left behind. Teachers were given an almost unachievable task of keeping kids motivated.
In 2006, the dropout rate was about 10% in the United States. In 2018 this rate was down to 5% across the country. I don’t currently have the national rates from 2020, and 2021 is just finishing. There is some data out of California showing a 9% dropout rate for the 2019-2020 year, but this was relatively unchanged from the year prior to this.
However, we do know that high school dropout is not typically a quick event. After the first failed or missed semester (like the end of 2019-2020 or during the 2020-2021 school year), the risk for dropout increases as each new semester occurs and failure is experienced. So, we may not see an increase in the rate of dropouts in the final 2020 numbers, but we may see a slight bump in 2021 and a continual climb into the following years. Many students feel they got behind on core subjects like Math, English, Science, etc. If they start next year behind, that only puts them at higher risk for future failure and dropout.
When you remove a child’s normal routine, sense of self, areas for motivation, or feelings of success, mental health changes are sure to follow. When schools were closed in 2020, many kids lost all of these. It sadly became very routine over the summer of 2020 when an adolescent would come in for their annual exam or sports physical to find signs of depression or anxiety. Without sports, some kids felt lost in their purpose. Without school, kids became socially isolated. The problem is that there was no set resource for them to turn to.
Working in our own office, I have seen a significant increase in depression, anxiety, and suicidal thoughts over the last year. The same was being seen across the country in other pediatric offices. Pediatric emergency rooms and intensive care units were seeing an increase in patients from suicide attempts. Wait times to get in with mental health specialists drastically increased, and still schools were only partially open in some areas (or in some cases not at all).
An article released in October 2020 by Duan, Li, et al (An Investigation of Mental Health Status of Children and Adolescents in China During the Outbreak of COVID-19. J Affect Disord. 2020 Oct 1; 275:112-118.) looked out how the shut down of the country was affecting adolescents. A questionnaire was administered to over 3000 adolescents to assess the changes in rates of depression and anxiety. They found that 22.3% of the youth had a positive depression screening. This is compared to an expected 13.2% prevalence in China at that time. That is a 9% increase! Anxiety levels were also increased in these children; especially in those who had a family member diagnosed or affected by COVID-19.
Another study done in China around this time (Zhou, Shuang-Jiang; et al. Prevalence and Socio-demographic Correlates of Psychological Health Problems in Chinese Adolescents During the Outbreak of COVID-19. European Child & Adolescent Psychiatry. 29, 749-758. 2020) screened over 8000 students using two screening tests known as a PHQ-9 (used for depression screening) and GAD-7 (anxiety screening). We use these in our offices as well. They found a prevalence of depressive symptoms at 43.7%, anxiety symptoms at 37.4%, and a combination of the two at 31.3%. Females seemed to have higher levels of depression and anxiety as did the older grade levels.
This is a significant concern around the world. More studies show similar findings – kids have become more depressed or anxious since the pandemic began. This can easily be multifactorial, including school closures, isolation, fear of illness, fear of family getting sick, deaths of close friends or family, etc. However, the closure of school has absolutely made a huge impact on this.
Parental anxiety also plays a huge role in our own child’s mental health. Not only do kids mimic our fears or concerns, but when we are not in a good headspace about current situations, it prevents us from being there to help our children with their mental health when they are struggling. Parents have a right to be anxious – schools were out, and kids were home earlier than expected. Jobs had to be changed or possibly even abandoned. Parents had to play teacher or make sure their kids were attending online schooling. Parents had just as much of a change in routine as our children did.
Yet, when we are stressed or anxious as parents, it makes it harder to help our kids. Toxic stress is a known contributor for pediatric abnormalities in development including their mental health. One of the key factors involving toxic stress is when a child is put into a situation of moderate stress (like school closures or a pandemic) but they do NOT have a supportive parent or guardian to help them through it. I am not saying parents are being neglectful, but when we are absorbed in our own concerns and anxieties involving the pandemic, we fail to recognize our kid’s struggles as well.
The initial plan to close schools in March 2020 was secondary to a lack of knowledge on how SARS-CoV-2 was spread, who got the sickest from infection, and what the impact would look like for our youth. However, we have seen that kids are not the super spreaders we first assumed, and the developmental and psychological impact has had a much greater effect. My solution? We need to find a way to protect our kids from illness as well as get them back to activities and in-person school full time. One solution is the vaccine. Actually, this is a great solution, as this allows kids to be in-person, protect from severe illness, and potentially protect from asymptomatic spread as well (early studies indicate this).
We won’t know the true effects for years, but we are already seeing them now. It is up to all of us to help our youth get back to where they were before the pandemic and help them reach their full potential.
Imperfect Dad MD