We are regional leaders in pediatrics who care for the children and teenagers of western Massachusetts. We hold open the doors of Baystate’s Pediatric Emergency Department, Pediatric Intensive Care Unit, and Childrens’ Specialty Center. In our roles we understand the complexities of the COVID-19 pandemic and response. While children have been largely spared from serious illness due to COVID-19, we are witnessing an unexpected erosion of their health and safety. There is emerging understanding that absence of in-person school is negatively impacting our children. These effects may be lifelong. We need to embrace emerging safety data and prioritize in-person learning.
What is happening in our region mirrors that which is being reported nationally and has been quantified in the medical literature yet has remained largely under-recognized by the press. In October, the journal “Pediatrics” published the results of a national survey in which one in three parents report worsening mental or behavioral health in their children, and one in 10 families report food insecurity. Our experience is similar to what has been described by dozens of children’s hospitals from around the country. Our children are not OK. Our region’s children are displaying increased rates of physical and emotional illness.
Rates of overdose and suicide attempts in adolescents and young adults resulting in ICU admission have risen significantly. Children with autism and developmental disabilities are showing regression and loss of prior achievements. Children with medical conditions like asthma and diabetes are requiring hospitalization because their disease is poorly controlled due to lack of structure and motivation. A child recently admitted in diabetic crisis explained: “Every day is the same. I just don’t have the energy to get up some days — much less take my insulin.”
Some working parents are forced to choose between leaving an older child to supervise younger siblings while all are remote learning, or to lose their job and income. Not only does this lead to a situation in which none of the children can engage in learning, but also in some cases leads to emergency care for unintentional cooking burns, serious falls or accidental ingestions of adult medications, as in the case of a 9-year-old who recently was left to care for her younger brother. These undocumented effects of fully remote learning result in significant and long-lasting consequences which must be considered and mitigated.
“Virtual school” has not filled the gaps that have resulted from a lack of in-person education. Up to 20% of children in some school districts have not logged on to remote learning. In addition to the educational losses, this model of learning places many children at serious emotional and physical risk. Although every family is affected differently, we are seeing community-wide effects, even in resilient children. Not surprisingly, these consequences are more difficult to overcome for families with fewer resources. Marginalized groups are most impacted. More of our nation’s children are going hungry as the result of not being in school. Younger children and those with disabilities will never make up this year of education that is being lost. Older children are losing critical thinking skills from lack of engagement. In this time where racial disparities are being openly exposed, limiting access to the power of education is most damaging to our communities of color.
In March, there was so much we didn’t know about the transmission, the risks or the treatment of COVID-19. Early decisions were conservative and based on the best information available. By closing schools and businesses, we protected ourselves from the unknown and minimized the chances of overwhelming our medical system.
As frontline providers, we were scared. We came home after our shifts and changed our clothes in the garage. We showered before hugging our kids. We stopped seeing medically fragile loved ones. It was hard, but we and our colleagues trusted in what we did know. Because of mandatory masking, frequent hand washing and physical distancing, health care workers in our area have maintained infection rates equal to or lower than in the general community. Our fear has been replaced by common sense practices, and well-established protocols are part of our routine. We are staying healthy and taking care of our region’s kids.
Today, we know so much more about COVID-19, how it is transmitted and how to limit its spread. We now know with appropriate distancing, masking and hygiene, in addition to environmental disinfection, the risk of viral transmission in schools is lower than the risk of transmission in the surrounding community. The National COVID-19 School Response Data Dashboard, which tracks data from over 3 million students and 400,000 staff members in 5,700 schools, nationally demonstrates lower rates of infection in October compared to September in students and in staff as children across the country have returned to school, despite rising rates of COVID infection nationally. We know the Centers for Disease Control and Prevention recommends that “in-person learning is in the best interest of students, when compared to virtual learning” and with appropriate measures “schools can reopen and stay open safely for in person learning.” Some experts have suggested the risk of viral transmission is increased with remote-only schooling as families find alternate means of child care and allow children to participate in less structured, higher risk activities without proper precautions. Gov. Charlie Baker and his administration have been strongly in favor of in-person learning for all these reasons.
In Massachusetts, with 77% of school districts having returned to some form of in-person learning and more than 450,000 students back in schools, outbreaks from in-school transmission are not being seen. Nearly all private and parochial schools in our area have opened with hybrid or full return to the classroom and have experienced isolated cases without evidence of transmission in the school setting. Yet many of our local public schools and school committees remain hesitant to allow children to return to in-person education. The essential role that schools play in the lives of our children and families has been underestimated. We must treat our teachers as the essential workers we know they are. We must recognize the value of having our children in the classroom with them. For those families who see their children losing ground educationally, physically and emotionally, we must provide them the option of in-person learning. Every day we delay in doing this is an opportunity lost for our children.
Christine McKiernan, MD FAAP, is chief, Pediatric Intensive Care, Baystate Children’s Hospital; Joeli Hettler, MD, is chief, Pediatric Emergency Medicine, Baystate Children’s Hospital; and Mary-Alice Abbott, MD PhD, is vice chair, Pediatric Specialties, Baystate Children’s Hospital.