Mary Altaffer/AP Photo
Kindergarten students wear masks and are separated by plexiglass during a math lesson at Milton Elementary School, May 18, 2021, in Rye, New York.
When COVID-19 cases started to rise in western New York last fall, Dr. Rachel Hoopsick made the difficult decision to pull her four-year-old out of day care. Her daughter, Meadow, has juvenile idiopathic arthritis, an autoimmune condition that requires immunosuppressant drugs to prevent the disease from progressing. After Meadow was hospitalized twice in the past year for infections, sending her daughter into an environment where children were not required to wear masks was too big of a risk. This hasn’t been without costs.
“It’s really hard to explain the pandemic in a way that a four-year-old will understand,” says Hoopsick. “When we first pulled her out of day care, she would cry that she didn’t have friends anymore, and when she played with her dolls she would make believe that they were either children from her class or her grandparents … [it was] really heartbreaking.”
For the past year, the question of whether or not kids have been subject to undue harm as a result of pandemic mitigation measures has been a contentious topic. Practically all parties agree that children have faced harms in the past year from a lack of in-person schooling. But the source of the harm, and whether or not it is worse than exposing children to the virus, has been up for debate.
Coalitions of parents, backed by a few epidemiologists, academics, and pundits, have argued that children over the past year have been subjected to extreme stress caused by isolation from their peers during school closures, resulting in a rise in suicides and failure rates.
Rather than allowing some children to remain in a hybrid learning model, there is a push to have students back in school completely.
Mentioned more often than children’s mental health is the concept of learning loss. Proponents of this theory argue that the quality of remote learning being delivered to children is subpar. In some cases, children do not have access to this type of learning due to gaps in internet coverage, particularly in low-income urban and far-flung rural communities. In some cities, children are also signing on to virtual classes less. These disparities, they say, will lead to educational and achievement gaps years into the future.
While educators do not deny that children are learning less than they usually do, some say that focusing on the potential “loss” purely through academic progress and standardized tests misses the broader socialization trauma of the pandemic, which could be ameliorated by providing students with the support they need to get through this time.
Last year, as some school districts remained closed during the fall surge, some argued that schools did not contribute to the spread of the virus, and that there would not be outbreaks when good mitigation practices like masks, ventilation, and reduced capacity were in place. There was mixed evidence for this, with some studies backing this argument and other studies from Florida and Texas finding a rise in cases at school and within communities. These mixed results suggest that opening schools may be a question of whether or not mitigation practices are followed. Oddly, proponents of fully reopening schools are now suggesting we start rolling back some of these practices.
Rather than allowing some children to remain in a hybrid learning model in the fall as vaccines continue to be rolled out for children, there is a push to have students back in school completely. In a recent op-ed in The New York Times, Drs. Tracy Beth Hoeg, Monica Gandhi, and Daniel Johnson argue that school reopening need not be tied to childhood vaccinations, and that once cases and deaths are low enough, children can return to school without masks (New York is already seeking to get rid of them.) They also say that surveillance testing for asymptomatic cases is unnecessary.
Another commentary published in the British Medical Journal, by proponents who have also argued for school reopening, argued against emergency use authorization for childhood vaccinations, stating that the risk for adverse reactions is potentially higher than the benefit children may get from a vaccine for a disease that is seldom high-risk for them. Both these pieces expand on the logic articulated earlier by professor Emily Oster of Brown University, who argued that with sufficient adult vaccination, children are effectively protected from the virus.
Consistently repeated is the idea that COVID-19 is low-risk for children. But low-risk is not “no risk”; children have indeed been hospitalized for COVID-19 and have died. Around 327 children have died from COVID in the United States since the pandemic began, and around 16,000 have been hospitalized. Some children are also suffering from “long COVID” symptoms months after their infection, whether their cases were symptomatic or not.
Consistently repeated is the idea that COVID-19 is low-risk for children. But low-risk is not “no risk.”
Though cases and hospitalizations are declining nationwide, the latest data from the CDC underscores the need to remain vigilant about youth cases increasing in the future. In a study published on June 4 in the CDC’s Morbidity and Mortality Weekly Report (MMWR), there was a rise in adolescent hospitalizations from March to April, and a third of those hospitalized had to be admitted to the ICU. This was after an initial drop from January to March. And significant gaps in vaccinations in many communities, particularly in the South, could herald another uptick in localized outbreaks in the fall.
Black, Latinx, and Indigenous children are overrepresented in the deaths and hospitalizations of children from COVID-19. Black and Latinx children also make up the majority of cases of the rare inflammatory condition MIS-C, associated with the virus. Risk is not divided evenly among groups. It is no surprise then that these groups have also been more likely to opt for remote learning during the pandemic.
Variants also pose a threat. In Brazil, for instance, where the gamma variant is dominant, many young children are dying from COVID. In the U.K., which has a similar proportion of vaccinated people as the U.S., outbreaks in schools increased by 78 percent in the final weeks of May, due to the Delta variant. Even if variants do not put children at a higher risk of death and hospitalization statistically, allowing for uncontrolled spread of a more virulent virus means that as the number of kids infected goes up, so too will the number of kids who die.
Talking about kids as being “low-risk” and therefore not needing vaccination also ignores the experiences of immunocompromised and disabled children. Like Rachel Hoopsick, Kendra Kline also has an immunocompromised child who is four years old. Living in Georgia, she had to cancel her son John Henry’s four-day-a-week private therapies, and he has been unable to start school. The school has not come up with a plan on how to safely deliver services to children like John Henry.
“He has missed an entire year of school and special ed services. Our district recently announced a return to 100 percent in-person school in the fall with no masking,” she says. “After public outcry on their Facebook post, someone wordlessly edited out the ‘no masking’ part, but they did not actually address anyone’s concerns. I have no hope or faith that they will do the right thing in the fall.”
Kline adds that, despite the difficulties of not receiving treatment and schooling for her child, one of the most difficult aspects has been the broader insistence that children cannot be seriously affected by COVID, and the complete erasure of disabled and immunocompromised children. “Being bombarded with these messages that kids like mine don’t exist, that his life didn’t matter, and that it’s too much of a burden to make the world safe for him, was the most difficult thing to deal with,” she says.
We should not have to choose between the happiness of most children and the deaths of some children.
Children are suffering during the pandemic, but few school reopening advocates have stopped to ask whether the cause of this suffering is bigger than the lack of in-person learning. A recent study estimated that approximately 40,000 children have lost one parent to the virus. In some tragic cases, children have lost both parents and are orphaned. Black children are once again disproportionately represented in this group. While others are coping with the loss of a parent, some teenagers have stepped in with new caregiving and work responsibilities, due to illness and job loss. Despite this historic stress, there have been few attempts to alleviate the academic burden children face; standardized tests, college applications, and pre-pandemic grading metrics all continue.
The U.S. response to the crisis the pandemic has caused for young people has been to leave individuals to cope on their own. Young people do not receive support for the stress and trauma they may be feeling; instead, they are being asked to return to the classroom before being vaccinated and continue as normal. Similarly, the U.S. vaccination campaign has emphasized personal responsibility for one’s safety, completely overlooking the fact that herd immunity is a collective responsibility. Without herd immunity, immunocompromised children are left out and are at greater risk. Even while vaccinated, this subset of children may not mount as efficient of an immune response.
We should not have to choose between the happiness of most children and the deaths of some children. We should not force children to have to choose between learning and risking exposure to a deadly virus. By keeping schools hybrid this fall, at least for those most susceptible to the virus, and by making childhood vaccination mandatory, we can soon create a safe environment where children like John Henry are free to learn and play safely. In the meantime, school boards can choose to use alternative methods of evaluation, reduce workloads, and prioritize safe, outdoor opportunities for socializing.
“Disabled and immunocompromised children are children,” says Kendra Kline. “They want to have friends, and be able to play, and explore their interests, and learn new things, and do all the things that non-disabled children do. Make room for them.”
There are many important decisions to be made regarding schools and children in the next few months. In making them, will we make room for children like Meadow and John Henry?
