A growing body of evidence indicates that school closures place children and teens at considerable risk for a wide array of physical, emotional, and social harms that far outweigh the risk that they will catch or spread COVID-19. In an open letter published in June, more than 1500 members of the United Kingdom’s Royal College of Paediatrics and Child Health (RCPCH) warned that continued closures risk “scarring the life chances of a generation of young people.” And the American Academy of Pediatrics has come out forcefully in favor of schools reopening for in-person learning this fall.
The following is an outline of important data regarding the relationship of school closures, COVID-19, and student health. It will be updated as more information becomes available.
Children and teens are much less likely than adults to contract COVID-19
- MassGeneral: Children appear to have lower attack rates than adults; if exposed to COVID-19 are less likely to become infected.
- Center for Disease Control (CDC) data show that infants, young children, and teenagers combined have accounted for roughly 5% of coronavirus cases in the U.S.
- International research confirms that the percentage of children among the confirmed COVID-19 patients is low, ranging from 1% in young children to 6% in older children.
- In the Netherlands, children aged 0-17 years represent only 1.3% of all reported patients with COVID-19, although they comprise 20.7% of the population.
Children and teens who contract COVID-19 are not likely to become seriously ill
- MassGeneral: Among children with COVID-19 disease, severe/critical illness and death are rare.
- Scott W. Atlas, MD, Hoover Institute: “Children under 18 have virtually zero risk of death from [COVID-19], they have virtually zero risk of a serious illness from this.”
- CDC: Infants, young children and teenagers combined account for 0.06% of all reported deaths from COVID-19.
- CNN: The vast majority of children who contract COVID-19 experience mild symptoms and recover easily.
- JAMA Pediatrics: Between March 14 and April 3 only 48 children were admitted to 14 pediatric intensive care units in the U.S., and 83% had an underlying condition.
- Hospitalizations and hospitalization rates for people under the age of 18 remain low. Massachusetts hospitalizations and hospitalizations rates as of June 29, 2020:
- JAMA Oncology: Although recent studies have found that adults with cancer have a higher rate of death from COVID-19 than those without cancer, pediatric cancer patients are NOT more likely to acquire COVID-19 than their peers — nor are they more likely than their peers to develop severe illness if they catch it.
- The Lancet: Although there is a possible emerging inflammatory syndrome associated with COVID-19, similar to Kawasaki disease, the association with Kawasaki disease is small, and the chances of kids’ contracting this new form of the disease appears to be extremely low.
- Scott W. Atlas, MD, Hoover Institute: Kawasaki disease is “typically treatable and never has been regarded previously as a risk so serious that schools must be shuttered.”
- The Lancet: “[I]t is crucial to reiterate—for parents and health-care workers alike—that children remain minimally affected by SARS-CoV-2 infection overall.”
Kids are not super-spreaders
- Wall Street Journal: “[U]nlike with other respiratory viruses, children don’t appear to be large spreaders.”
- Scott W. Atlas, MD, Hoover Institute: Children rarely transmit the disease to adults, including to parents.
- The Netherlands: Children do not commonly spread the virus to each other or to adults. The virus is mainly spread from adult family members to children, not the other way around.
- China: Kids are more likely to pick up the virus from their parents than vice versa.
- Sweden: A review of 47 papers found that children are “seldom” the cause outbreaks and unlikely to be the drivers of the pandemic.
School are not likely to be settings for outbreak clusters and are not likely to be significant sources of transmission
- MassGeneral: transmission from students to staff and from students to other students appears to be rare and will likely be even more rare with risk mitigation protocols in place.
- In a review of COVID-19 clusters, only 4% (8 of 210) involved school transmission.
- Ireland: A study found no evidence of secondary transmission of COVID-19 from school children.
- Australia: A study tracked COVID-19 cases at 15 schools from March 1 to April 16 and found no cases of students passing the virus to teachers.
- France: A study of 1,340 people, including 510 students, in a town northeast of Paris that suffered an outbreak in February and March, found three probable cases among kids that didn’t lead to more infections among other pupils or teachers.
- Sweden: The Swedish study cited above concluded that opening up schools and kindergartens is unlikely to impact COVID-19 mortality rates in older people.
It is doubtful whether school closures this spring helped save lives or even slowed the spread of the virus.
- JAMA Pediatrics: Data from mainland China, Hong Kong, and Singapore suggest that school closures did not help to control the epidemic.
- JAMA Pediatrics: Modeling studies indicate that, while school closures are an effective means to control the spread of influenza (where attack rates are higher in children than in adults), school closures do not seem to help reduce the spread of COVID-19 (where children are unlikely to spread the virus to adults).
- The Lancet: School closures may lead to a greater number of deaths than they prevent.
- Mother Jones: closures have (a) little effect and (b) are not worth the major negative impact they have on students and parents.
- Mother Jones reports on a study that indicates suggests school closures may have no effect on reducing the spread of the virus and may even increase its spread. This is in contrast to other measures, such as restaurant bans, which do seem effective in slowing the spread. Mother Jones produced the below graphic to summarize the data:
Daycare centers and schools that are open have not seen a spike in cases
- NPR: “YMCA of the USA and New York City’s Department of Education have been caring for, collectively, tens of thousands of children [of essential workers] since March, and both tell NPR they have no reports of coronavirus clusters or outbreaks.”
- ProPublica: “We called [New Jersey’s] Department of Health to see if COVID-19 had been spreading within the child care centers that had opened April 1 to serve children of essential workers. There have been no reports of outbreaks of two or more cases, an official said.”
- Brown University economist Emily Oster: As of Tuesday, June 22, just over 1% of staff and 0.16% of children at 916 day care centers, serving more than 20,000 children, were confirmed infected with the coronavirus.
- International data is consistent with these findings. A study conducted in Iceland showed that child care facilities and schools were not the source of chains of infection.
- On June 10, an article in Early Learning Nation noted that, “[t]wenty-two European Union member states have now re-opened child cares and schools in some capacity, and none have had COVID cases spike as a result. In fact, no nation in the entire world reports child cares or elementary schools as significant sources of transmission.”
Virtual learning has significant drawbacks
- The New York Times [NYT] reports that the abrupt switch to remote learning wiped out academic gains for many American students.
- Former Secretary of Education John King Jr. notes that, “[e]ven in places that do distance learning well, we can expect that students will lose significant ground.”
- In Boston, only half of students showed up for online instruction on any given day; 20 percent of them never logged on to the designated website.
- In Philadelphia, roughly 57% of students attended online meetings and classes.
- NYT: “[B]y September, most students will have fallen behind where they would have been if they had stayed in classrooms, with some losing the equivalent of a full school year’s worth of academic gains.”
- Research indicates that the average student could begin the next school year having lost as much as a third of the expected progress from the previous year in reading and half of the expected progress in math.
School closures exacerbate educational disparities
- For decades, there have been troubling economic and racial disparities in education. These disparities have been exacerbated by school closures due to COVID-19.
- Researchers at Brown and Harvard found that through late April, student progress in math decreased by about half in classrooms located in low-income ZIP codes, by a third in classrooms in middle-income ZIP codes, and not at all in classrooms in high-income ZIP codes.
- McKinsey & Company estimates that the average student could fall 7 months behind academically due to COVID closures, while black and Hispanic students could fall 10 months behind.
- School closures have negative impact on students with disabilities. Pediatricians warn that, “[c]hildren with disabilities are at a greater risk for regressing and worse developmental outcomes, especially if they rely on school-based therapies.”
- Many educators are worried about the potential rise in drop out rates, particularly since there is now greater economic pressure on teens to work to help support their families. The longer schools remain closed, the harder it will be to get these kids back.
- Education Week: Virtual learning raises equity concerns with respect to low-income students, English-language learners, and all others who need extra support.
- “Our education system is fraught with inequities that existed before COVID-19 . . . . COVID-19 has exacerbated these educational disparities” — Former Secretary of Education John King Jr.
Kids are suffering emotionally and physically from school closures
- Loneliness, anxiety and depression:
- Research from China indicates that kids confined to their homes to slow the spread of COVID-19 experienced higher levels of anxiety and depression than previously reported.
- The absence of in-person peer interaction and the disappointment of canceled events and extracurriculars contributes to increased isolation and loneliness.
- The increased screen time that inevitably occurs when schools are closed has been linked to increases in anxiety and depression.
- Studies show that young people may be at risk of depression and anxiety for up to 9 years after their period of social isolation ends.
- Developmental delay:
- “[S]ocial distancing can interfere with the basic developmental needs of teenagers—who are evolutionarily wired to become increasingly independent from parents and increasingly dependent on their peers.”
- “[T]he absence of in-person peer interaction can negatively affect youths’ social skills, including reduced comprehension of nonverbal emotional cues.”
- Physical Danger
- Increased obesity:
- Research indicates that children experience unhealthy weight gain primarily when they are out of school during the summer months, not during the school year.
- “[C]hildren and adolescents’ lifestyle behaviors, such as physical activity (PA) and sedentary behavior (SB) may have been drastically impacted due to the prolonged school closures and home confinement during the COVID-19 pandemic.”
- “[A]vailable data show that online video game usage is already soaring. Screen time is associated with experiencing overweight/obesity in childhood, likely because of the dual issues of sedentary time and the association between screen time and snacking.”
What do the experts say?
- Joshua M. Sharfstein, MD, Johns Hopkins Bloomberg School of Public Health: “Reopening schools this fall is an urgent national priority.”
- JAMA: school closures may lead to greater medical, economic, and social problems than those caused by the virus itself.
- Dimitri A. Christakis, MD, Seattle Children’s Hospital: “The risks posed by delaying school openings are real and sizeable, particularly for students from low-income families.”
- AAP: “[P]olicy makers should acknowledge that COVID-19 policies are intended to mitigate, not eliminate, risk.”
- Scott W. Atlas, MD, Hoover Institute: “[W]e now know that social distancing and face coverings for children are completely unnecessary.”
- A report by a panel of Canadian experts recommends against masks in class and advises that “strict physical distancing is not practical and could cause significant psychological harm.”
This post has been updated as of July 8, 2020 with emerging evidence and perspectives.