Doctors say ‘health is about more than the absence of COVID-19’ for children

If there’s anything parents have learned from the COVID-19 pandemic over the last two years, it’s the importance of in-person learning for children. “Remote learning exacerbated existing educational inequities and was detrimental to the educational attainment of students of all ages and worsened the growing mental health crisis among children and adolescents,” according to the American Academy of Pediatrics.

While new COVID cases are rapidly declining across the country, hospitalizations are peaking and deaths are still increasing, according to the Centers for Disease Control and Prevention.

In November 2021, a vaccine approved for emergency use in 5- to 11-year-olds was going to help restore some semblance of normalcy for children when it came to school, extracurricular activities or having playdates again. But Omicron had other plans.

Dr. Lucy McBride, a physician in Washington, D.C., and a Yahoo News Medical Contributor, is one of 13 medical experts who developed the “Children, COVID and the urgency of normal” toolkit as a guide to help restore a sense of normalcy to children in schools post-Omicron surge.

(Some responses have been edited for clarity.)

Yahoo News: At this point in the COVID-19 pandemic, why is there an urgent need to restore a sense of normalcy for children?

Dr. Lucy McBride: The surgeon general as well as the American Association of Pediatrics and other expert groups have declared a pediatric state of emergency for mental health because there's evidence that levels of anxiety, depression, suicide ideation, ER visits for suicide attempts, substance use disorder and overall despair in children ages 18 and below are at high levels.

This is happening at the same time we are living through a pandemic where children have been deprived of their normal social and emotional coping skills, or tools, and deprived of normalcy being at school. It's important to recognize that some children are suffering from COVID-19 itself. Some are suffering from having lost a loved one to the virus. Some children, however, are suffering from the loss of safety and security in their everyday lives.

Returning to school will not heal every child's wounds, nor will it be an overnight fix for 22 months of living through a pandemic. But getting back to normal is an equitable and fair and smart way to help children begin to heal the wounds from living through a traumatic experience.

How are healthy children generally affected by COVID-19?

COVID poses very little threat of a serious disease for students in highly vaccinated communities and for students who have been vaccinated themselves. COVID is a flu-like risk for unvaccinated children, and new data shows us that even unvaccinated children under 5 face very little risk for severe outcomes. That is not to say that we haven't lost children to COVID-19. Tragically, we have. It's to say that the vast majority of children who get COVID-19 recover fully.

What are the risks of children getting ‘long COVID’?

Long COVID is a rare complication from a COVID-19 infection and clearly is a concern for children. Studies, though, consistently find that post-infection symptoms are similar in children who had COVID-19, compared to children who had other non-COVID infections. Long COVID is an area that we need a lot more research in. But most of the public health officials and physicians I speak to don’t think we should organize schools and restrictions around the potential for this very rare complication.

What should the bigger picture of health look like for children?

Children need to begin to reclaim more normalcy, and ideally a better normal, because COVID is only one threat to their health and wellbeing. Tragically, kids can get COVID, they can get very sick. Tragically, children have died from COVID-19. But health is about more than the absence of COVID-19. Health involves social and emotional connections. Health involves going to school, feeling safe and in many cases, being fed. So it’s important that as we transition, gradually and in different parts of the country at different times, into endemicity, that we adjust our policies in conjunction with the evolution of the pandemic.

What are the possible policy solutions?

Thirteen public health and medical experts [including McBride] around the country have created an ‘Urgency of normal’ school advocacy toolkit to help school policymakers and anyone who’s making decisions about schools understand the facts so as to make balanced nuanced decisions, and to understand that health is about more than the absence of COVID-19 for schoolchildren.

Our recommendations are:

1) Continue to encourage vaccination for all eligible children, particularly where vaccination rates are lowest.

2) Continue to upgrade school ventilation systems. We know that crowded and poorly ventilated spaces are where coronavirus likes to spread the most.

3) We recommend stopping asymptomatic testing and contact tracing. There's abundant evidence that this does not meaningfully reduce in-school transmission, and this data is supported by the Children's Hospital of Philadelphia's policy lab recommendation.

4) We also recommend returning children to normal lunchtime socialization. Free time is critical for children's social, emotional and interpersonal development, and after two years of virtual learning and social distancing, it’s time to nurture childhood friendships and to strengthen the bonds of our school community by socialization.

5) We recommend removing mask mandates in schools after the Omicron surge and when local hospitalization rates are low. For example, under 10 per 100,000, and in the meantime, continue to encourage vaccination, encourage people who are sick to stay home and encourage people who want to continue to mask to wear a well fitted N95 respirator, which protects the wearer and does not rely on the behaviors of other people around them.

6) Last, we recommend scaling up mental health services in schools. Digging out from two years of trauma will require significant resources, including support animals and compassionate leadership from in-school counselors. This would be to minimize the long-term impact of students' mental and physical health.

The toolkit is intended to help everyone who needs to make important evidence-based decisions in schools, whether it is teachers, mentors, school administrators, school policymakers. It’s meant to give people a framework with which to make complex decisions. As physicians and scientists, our goal is to inform people with accurate data and to put it in context and to provide guidance, not to tell people what to do. We hope people will take this information and bring it to their own communities and share it with others as we navigate this complex time together.