Fall School Closure = Long-Term Health, Learning Costs for Kids
(AP Photo/John Locher)
Fall School Closure = Long-Term Health, Learning Costs for Kids
(AP Photo/John Locher)
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At what point do our public health interventions themselves cause a public health crisis?  Might our efforts to keep the public equally safe be reinforcing unsafe levels of inequality?  We obviously need to protect those most at risk from the current pandemic, but we should also consider the costs, especially if disproportionate burdens are being placed upon those without a voice who are least well-placed to bear them.

If we are following the evidence, the data on the risks and costs of keeping children out of school are clear and compelling:  keeping children out of school is harmful.  Medical professionals from across the world, from the American Academy of Pediatrics  to the Royal College of Paediatrics and Child Health, have recently stated that the risk of keeping children out of school greatly outweighs the dangers of school-age children contributing to increases in COVID-19 cases. Others, including the former FDA chair and the American Academies of Science, Engineering and Medicine, are also urging schools to open this fall after weighing the available evidence.

Keeping schools closed will have long-term detrimental educational and societal consequences that could possibly last a lifetime.  Gaps in schooling, such as the summer slide, decrease academic readiness in all subjects, especially in mathematics, according to the Brookings Institution. These achievement gaps are going to be greatly exacerbated due to the pandemic-motivated school closures, based upon analysis from the nonprofit organization NWEA (Northwest Evaluation Association), which is projecting the potential loss of a half-a-year to one full year of math achievement.  

A big reason for these worsening regressions in academic achievement relate to the inherent limitations of online learning.  Studies done at the Center for Research on Education Outcomes and at the Mathematica Policy Research Center have shown that online learning, especially in younger children and those with certain learning disabilities, is not as effective as in-person learning.  These studies bolster previous research showing that online charter school students learn less than students at traditional public schools.

Worse, these adverse impacts to educational achievement would not be borne equally across all income levels, since many of these families cannot afford the compensating resources that better-off families have, such as high-speed Internet service or adequate numbers of electronic devices to allow each child to undertake online learning individually.  In examining Zearn, an online math program, it was discovered that students in high income ZIP codes increased their math skills by 45%, while those of middle-income students decreased by 0.7% and those of low-income students decreased by 36%.  As many higher-income families, with ample resources, are already searching for tutors and micro-schools for the upcoming school year, this achievement gap will only widen.   Similarly, McKinsey research predicts that school-closure-related regression in educational attainment will be greatest in low-income, Black and Hispanic communities, with such communities suffering more than a year loss in education.  This pandemic-related impact will come on top of the already existing achievement gaps that are cumulative and growing.  Learning gaps can increase anxiety and diminish enthusiasm for school, leading to rising dropout rates.  McKinsey estimates that an incremental 2%-9% of high school students could drop out in the wake of the announced COVID-related school closures.  The loss of lifetime earning potential for these at-risk learners will carry permanent adverse consequences, effectively cementing their socio-economic disadvantages.

Yet school closures will adversely impact more than our children’s learning, since primary education institutions offer much more than instruction to students.  They offer a source of stability, security and nutrition, and the school closures related to the pandemic have already highlighted the loss of this source of support in recent months. 

The school closures appear to have raised the risk of malnourishment.  An April survey co-sponsored by the Hamilton Project found that more than 40% of mothers with children age 12 and younger are food insecure, a 260% increase from 2018. This is a troubling jump in the number of American mothers reporting that their children did not have enough food to eat.  Food banks have seen dramatic increases in utilization and have often run out of food.  The inability of children to receive low-cost meals in many school districts has exacerbated the risk of pediatric malnourishment – this poses a threat to a child’s brain development with lasting adverse impacts.

Schools can also serve as a support for children socially and emotionally. Teachers and school personnel are the most likely third parties to report child abuseUnder COVID lockdowns, reports of suspected abuse have decreased, but evidence of child abuse in the nation’s emergency rooms has not. The stripping away of this safe haven puts vulnerable children at risk of depression, anxiety and even abuse.  Indeed, the Center for Global Development and the World Bank have each sounded the alarm on how the COVID-19 closures will lead to systemic inequality, learning losses and increased dropout rates, as well as negative health effects.

As has been widely reported, the economic lockdowns and school closures seem to have hit the poorest families the hardest in terms of job loss, and the maintenance of these closures undoubtedly will cause further hardship in the families with the most vulnerable children.  Moreover, because the parents of many at-risk children are more likely to be deemed essential and to be employed in lower-paid service sector positions in transportation, food production, delivery or grocery, these children’s families are most at risk if the schools do not open in the fall.  Because school is often the only form of child care available, these at-risk families may be put in the dire predicament of having to choose between caring for their children at home or working to put food on the table, an impossible dilemma that would plunge many families deeper into poverty and economic insecurity.  This danger may be especially profound for single-parent households.

While the data clearly shows that children — especially those from challenged socioeconomic backgrounds — are harmed in a variety of ways when schools are shut down, the sad reality is that there appears to be scant empirical basis to claim any countervailing benefit to public health from such pandemic-related school closures. 

In fact, several relevant studies show a dearth of evidence that such closures would have any measurable public health benefit in ameliorating the spread of COVID.  One study done in Ireland showed no secondary transmissions of coronavirus among six infected children who had 1,155 social contacts while participating in activities such as choir practice, sports practice and woodwind practice.  Similar findings were shown in Australian schools.  Studies from China, South Korea, Japan and Iran of household transmission clusters suggest that children are unlikely to be the source of viral transmission within households. Systematic reviews of the literature suggest that school transmission and children are not major drivers of COVID transmission.  Germany analyzed more than 1,500 of its older children and over 500 teachers and found that schoolchildren do not play a big role in spreading the virus.  A study done in New South Wales, Australia, examining 18 reported COVID cases (nine students and nine teachers)  and 863 contacts, found only two secondary infections and uncovered no evidence of any children infecting teachers.

Iceland conducted a population-based study of over 10,000 people and did not find a single child under 10 who was positive.  A June 23 study by Institute Pasteur found that children in school were more likely to be infected by their parents, and that those students did not transmit coronavirus to their teachers or other students.  The Finnish Institute of Health and Welfare and the Swedish Public Health Authority conducted a joint study of Swedish schools (which did not close) and Finnish Schools (which reopened on May 13), comparing transmission among children and infection rates of teachers versus other professions in the two countries; the study concluded that closing of schools “had no measurable direct impact on the number of laboratory confirmed cases of school-aged children in Finland or Sweden,” and also found no increased risk of contracting COVID for teachers in either nation compared to those risks for individuals in other professions.

Across the world, the data are equally clear that there is little health benefit to school-age children from closing schools amid the pandemic.  Indeed, children have markedly decreased risks of mortality due to COVID-19. According to the U.S. Centers for Disease Control, as of July 22, 2020, Americans 65 years of age and older accounted for 80% of all COVID-19 deaths in the U.S. In a recent CDC report, children under 18 account for less than 0.1% of COVID deaths in the U.S. This age distribution of COVID-19 deaths, which contrasts with previous pandemics in that the dangers are not equally borne by young versus old, is similarly observed in many other countries. Furthermore, children tend to have mild or asymptomatic infections.  A study published on June 16 in the journal Nature Medicine indicates that children (including teenagers) are much more likely to be asymptomatic than adults.  Thus, those who have the least risk of morbidity and mortality due to COVID-19 — the world’s children — are bearing a disproportionate share of the burden related to the global fight against this pandemic. 

The initial decisions to shutter schools could at least have been defended by our initial ignorance and fear surrounding how COVID-19 is spread. Today, however, we know better.  A large body of evidence shows that school closures not only are likely to prove ineffective as a countermeasure to the pandemic, but they also pose severe risks to our children’s welfare, health and development.  The true costs of the lockdowns are still not fully known, but they are undoubtedly growing — and growing more apparent.  The growing societal upheaval caused in part by the widespread job losses, rising food insecurity and widening chasm in educational achievement should be viewed as a signal warning and a call to reflect carefully on our policy choices.

Indeed, every decision we make in response to the pandemic, including those of omission, reflects a choice and carries with it a set of costs. We, as a society, will decide, either explicitly or implicitly, who will bear this cost. In this pandemic, there are no “safe” decisions, since every policy choice carries risks that must be recognized, especially if they cannot be easily mitigated.  Failure to reopen schools in the fall will inflict greater hardship and potentially life-long developmental deficits on our most vulnerable children and grandchildren long after this pandemic has faded – a tragically ironic victimization of those least at risk of morbidity and mortality. If kids are indeed our future, we must find a way to reopen the schools.

Christina Ramirez, Ph.D., is a mother of school-age children and a professor of biostatistics at the Fielding School of Public Health, University of California, Los Angeles.

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