COVID studies note online learning stress, fewer cases in schools with protocols

Stressed student at laptop
Stressed student at laptop

Prostock-Studio / iStock

A trio of new studies describe the effects of the COVID-19 pandemic on public school students and staff, one finding that a quarter of children and teens in Chicago schools were stressed after school closures and the implementation of distance learning, another showing that coronavirus cases were elevated in schools that took few or no mitigation measures, and the last concluding that in-person learning in New York City public schools wasn't tied to increased viral infections.

Loneliness, anger, anxiety, depression

The first study, led by researchers from Children's Hospital of Chicago and published yesterday in JAMA Network Open, consisted of an anonymous survey of 32,217 caregivers of Chicago public school students 3 or 4 months after the COVID-19 pandemic forced school closures and the implementation of online learning.

Surveyed from Jun 24 to Jul 15, 2020, caregivers rated the mental health of more than 40,000 students in pre-kindergarten through 12th grade. After school closures, caregiver concerns about student loneliness grew more than eightfold (3.6% vs 31.9%), while concerns about suicidal ideation or self-harm stayed about the same (0.5% vs 0.6%). From 12.8% to 30.2% of students were characterized as angry, anxious, depressed, lonely, or stressed after school closures, when they had not been before.

At the same time, caregivers' reports of positive adjustment characteristics fell 13.4 percentage points in terms of plans for the future (44.3% before school closures vs 30.9% after) and dropped 13.6 percentage points in terms of positive peer relationships (60.4% vs 46.8%). From 21.1% to 44.3% of youth were described as having positive adjustment characteristics after the start of virtual learning.

All mental health concerns increased in probability after accounting for covariates (eg, anger odds ratio [OR], 1.55), while all positive adjustment characteristics decreased (eg, hope or positivity OR, 0.88) as coronavirus exposures and family stressors mounted.

COVID-19 exposures were significantly different across race and household income strata, with Black, Latino, and low-income families reporting higher rates of COVID-19–related stressors, which the researchers attributed to systemic racism and structural inequities such as a lack of resources and poor access to healthcare. Among caregivers, 39.3% were White, 30.2% were Latino, 22.4% were Black, and 8.1% were multiracial.

"The prevalence of these concerns demonstrate[s] the need for a comprehensive public health approach that prioritizes children's well-being and draws broad public attention to the mental health needs of youth," the authors wrote.

Co-senior author Kenneth Fox, MD, of Chicago Public Schools said in a Children's Hospital of Chicago news release that the pandemic has revealed how important schools are to the community in terms of access to food, health, mental health services, and child protection.

"While schools continue to meet those needs, we think they will also serve as sites of community healing where public health strategies and systems can converge and align to serve families in innovative ways," Fox said. "This convergence may be a powerful way to address the increased mental health needs the pandemic has wrought among our students, especially those from Black and Latinx communities, to ensure equitable access to support and care."

The case for reopening

In an editorial in the same journal, Danielle Dooley, MD, MPhil, of Children's National Hospital in Washington, DC, and Dimitri Christakis, MD, MPH, of Seattle Children's Research Institute, said that children's well-being has been eclipsed by an emphasis on reopening workplaces, restaurants, and other businesses and the needs of adults.

"At every stage of the evolving pandemic in most communities, school reopening has been an afterthought and not a priority," Dooley and Christakis wrote. "The time for debating school reopening has passed. We need to focus on school re-envisioning."

They called for large investments in school-based healthcare services, improved access to multigenerational mental health services, better school safety protocols, districtwide reopening plans, expedited contact tracing, shortened quarantines after exposure to minimize lost learning time, and training of school workers to address cognitive decline, trauma, and mental health issues related to the pandemic.

"There must be transparent and honest communication between families, policy makers, and teachers' unions regarding what constitutes acceptable risk related to school openings," the editorial authors said. "It will never be zero, and that cannot be an operational principle for opening."

The more mitigation measures, the better

In the second study, published yesterday in Science, a team led by Johns Hopkins researchers electronically surveyed 576,051 parents or other caregivers of a pre-kindergarten to high school child attending one of more than 130,000 US schools during the COVID-19 pandemic.

The surveys were sent from Nov 24 to Dec 23, 2020, and Jan 11 to Feb 10, 2021, before broad vaccine availability and the widespread proliferation of the B117 coronavirus variant in the United States. The variant has been tied to greater disease transmission.

After adjusting for county-level COVID-19 activity and factors other than school mitigation measures, people living in a household with a child attending in-person school were 38% more likely than other adults to report a coronavirus-like illness with symptoms such as fever, cough, shortness of breath, or trouble breathing. They were 21% more likely to report a loss of smell or taste and 30% more likely to have a positive COVID-19 test result. These associations became stronger with increasing grade level.

Respondents reported, on average, 6.7 school mitigation measures, with the least reported in South Dakota (4.6) and the most in Vermont (8.9). Each school mitigation measure, such as daily symptom screening, teacher masking, and cancellation of extracurricular activities, was tied to a 9% decrease in the likelihood of coronavirus-like illness, an 8% decrease in the odds of loss of smell or taste, and a 7% decreased likelihood of a positive COVID-19 test result. Schools that took at least seven mitigation measures eliminated the excess risk of in-person education.

"The results presented here provide evidence that in-person schooling poses a risk to those living in the households of students, but that this risk can be managed through commonly implemented school-based mitigation measures," the authors wrote.

Fewer infections in schools than in community

In the third study, published today in Pediatrics, a team led by scientists from the New York City mayor's office and the Centers for Disease Control and Prevention analyzed data on 234,132 people tested for COVID-19 at 1,594 New York City public schools from Oct 9 to Dec 18, 2020. The schools were operating in person under stringent mitigation protocols.

Of the 234,132 people tested, 0.4% were positive for COVID-19. The prevalence of COVID-19 in the schools was similar to or lower than that in the surrounding community for all weeks studied.

When the researchers compared data on 2,231 COVID-19 cases that occurred in students and staff with those of 86,576 cases in New York City over the study period, they found that coronavirus incidence was lower for students and staff than in the community. Among 36,423 school-based close contacts, 0.5% later tested positive for COVID-19, with an adult likely being the source of 78.0% of secondary cases.

"When strict protocols were implemented for preventing, diagnosing, and managing school-associated cases, in-person learning in public schools was not associated with increased prevalence and incidence overall compared with the general community, and secondary transmission was infrequent," the authors concluded.

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