The pandemic’s impacts on children

[0:00:20]

BECKY HAZEN: Hi, everyone. Welcome to SciLine’s media briefing on the impacts of COVID-19—of the COVID-19 pandemic on children. I’m one of SciLine’s deputy directors, Becky Hazen. For those not familiar with us, SciLine is a free service for reporters and scientists based at the nonprofit American Association for the Advancement of Science—AAAS. We are philanthropically funded and editorially independent. Our whole mission is to help reporters like you get more scientific evidence into your news stories, and not just stories about science but really any story that we think can be strengthened with some science. In our experience, that’s actually most stories. In addition to media briefings like this, we offer a range of free services for reporters, one of which is expert matching to connect you with scientists who are both deeply knowledgeable in their field, as well as excellent communicators, all on your deadline. Just go to sciline.org and click on the blue I need an expert button. And while you’re there, check out all of our other helpful reporting resources.

Here in the U.S., it’s been nearly two years since all of our lives were first touched and completely changed by the COVID-19 pandemic. What started for many people as a temporary adjustment intended to curb the spread of disease has become a long-term change to our very way of life. This is especially true for children who suddenly found themselves home from school, abruptly separated from friends and family and facing a new reality that no one, including their parents and caregivers, could truly explain. Kids missed out on the social interactions and structured learning environments they had come to know in their schools, as well as key family and cultural milestones. Some children saw family members become ill, and others contracted COVID-19 themselves. All of these changes have left imprints on children’s lives, and this briefing will explore some of the ways that children’s health, development and routines have been impacted by the pandemic.

A few quick logistics before we get going – we have three expert panelists today who will each make brief presentations before we open things up to questions. To enter a question either during or after the presentations, just hover over the bottom of your Zoom window and select Q&A. Enter your name, your news outlet and your question. If you’d like to pose the question to a specific panelist, just note that when you type it in. A full video of this briefing should be available on our website by tomorrow and a transcript within a couple of days. If you’d like a raw copy of the recording before then for a story, please submit a request with your name and email in the same Q&A box, and we’ll send you a link to the raw video by the end of the day today. You can also use the Q&A box to alert SciLine staff of any technical difficulties you’re experiencing.

Now, I’m not going to give full introductions of all of our speakers. Their bios are on the SciLine website. But as a quick summary, we’re first going to hear from Dr. Jim Soland, an assistant professor of quantitative methods at the University of Virginia. He’ll focus on what we know so far about how the disruptions of school closures and other pandemic-driven changes in our education systems have affected student learning outcomes. We also have Dr. Tali Raviv, a psychologist and associate director of the Center for Childhood Resilience at the Ann & Robert H. Lurie Children’s Hospital of Chicago. Dr. Raviv will discuss how the pandemic and changes in day-to-day life it has brought to kids have impacted children’s mental health, including disproportionate impacts for groups at higher risk. And finally, we’ll hear from Dr. Alexandra Yonts, an attending physician at Children’s National Hospital, who will speak about COVID-19 infections in children, what we know about the lingering effects of the illness on children’s physical health.

So let’s get started. Dr. Soland, the floor is yours.

[0:04:25]

JIM SOLAND: Great, thanks so much. It’s a pleasure to be here with you to discuss a sobering topic. Let me see if I can share my screen here. Everybody see this OK? All right. I’m going to talk to you today about the impact of COVID-19 on student achievement, what we know at this point in the pandemic and what we can surmise about where things are going. And in particular, I’m going to examine two questions, which each correspond to a study that I’ve been involved in with some of my colleagues. And the first question is just, how has math and reading learning in grades three through eight been affected nationwide by COVID-19? And the second is, how has readiness to read in kindergarten changed since COVID-19? So looking at some of the really young kids, how has their reading readiness been affected?

In the first study, which I conducted with colleagues at NWEA, which is an assessment nonprofit, we looked at this question of math and reading in grades three through eight nationwide. And in particular, we compared fall test scores from 2019, just before the pandemic, 2020 and 2021. We use this assessment called MAP Growth, which is given to about 1 in 10 U.S. schools, and it has a vertical scale, which just means that it can be used to look at a kid’s growth over time. And then we examined how school readiness immediately post-pandemic – so in fall of 2020 and over a year into the pandemic, fall 2021, compares to pre-pandemic levels, fall of 2019. And the reason we focused on fall is really just if you think about what a kid knows when they walk in the door to school, what they’re ready to do on day one, how has that potentially shifted from right before the pandemic to where we are at the beginning of this current school year?

I’m going to show you some figures with results. And what we really see overall is that students are less ready for school, as you might expect, and that it differs quite a lot by subject – math versus reading. So in these figures, the vertical scale is how much achievement has changed relative to 2019 as a baseline, where the green bars are changes in fall 2020 and the purple are changes by fall 2020 relative to 2019. And so what we see are two pretty divergent stories. In math, we saw big declines between fall of ’19 and fall 2020 – so in some cases, about a tenth to almost two-tenths of a standard deviation. And then we also saw almost equally large declines between 2020 and 2021. So this is a story of an immediate impact from the pandemic, and then that impact, that negative impact on achievement continued.

Whereas we see something quite different in reading, which is that right after the pandemic, in that first sort of summer period after COVID-19 began, reading wasn’t only not impacted, but it seemed to go up in a lot of cases. But then if you look from 2020 to 2021, there are some pretty large declines. And to put some of these things in context, some of the declines in achievement we’ve seen, if you compare them to something like study results from kids who are affected by Hurricane Katrina, some of these declines are similar in magnitude.

And one thing I want to be sure to point out is that we certainly don’t see this as a story about declines happening even when kids were back in school as in some way being an indictment of teachers – far from it. We really see it as a story of teaching being a very difficult job that just got innumerably harder in the context of the pandemic. So the other thing to note relative to these small changes is that achievement gaps, so differences in achievement, have changed quite a lot too by school income, and those gaps are getting bigger. So if we look at kids who are attending schools that tend to be low-income, higher poverty, and we look at that essentially using something like whether the kids are eligible for free or reduced price lunch, what we see is big increases in the gaps in achievement between kids in those low-income schools versus those who are not. And so on the vertical axis here we have how much the achievement gap between those schools has changed between fall of 2019 and fall of 2021, and then the percentage point change. So what we see are big impacts in the lower grades, and in math in particular, you see that there is over a 20 percentage point increase in that gap. So inequalities, inequities in the U.S. educational system have certainly gotten worse by all accounts.

Now turning to the second question, we ask how has readiness to read in kindergarten changed since COVID-19? And this is based on a study I conducted with some of my colleagues at University of Virginia. And we used an assessment called the phonological awareness literacy screener – PALS. And this is something that’s given to pretty much every kid in the state and used to determine if they need a reading intervention or not when they get to kindergarten. As you may know, being able to read in kindergarten is clearly very important, and also being able to read really fluently and efficiently by the time you’re in third grade is hugely important to a lot of long-term outcomes. So that’s one of the motivations for this kind of assessment.

And so we looked at the proportion of kindergarten students identified as needing a reading intervention before and immediately after COVID-19 hit. What we have here are – is a bar graph showing the proportion of students who needed an intervention. Overall, this is the total on the right hand side of the screen, but then broken down by whether the students were low-income or not. And so if we look at the overall, this blue bar is the proportion that needed an intervention in 2019. The orange is the proportion that needed it in 2020. And so what we see is essentially a 10 percentage point increase in the number of students who need some sort of reading intervention, which, to my knowledge, is unprecedented in the history of this exam. And when we disaggregate that, when we look at it specifically for low-income and high-income kids, we see that these jumps in the proportion of kids who need a reading intervention are even bigger for low-income children.

So a question we get a lot is just – clearly, this is not a good picture, some serious impacts from COVID-19. What can potentially be done about it? And so this is a figure that is part of an upcoming Brookings Institute blog. Should be coming out in the next day or two. And what we essentially said is, well, how big are the drops due to COVID in – here in reading, in elementary school versus middle school? So this purple bar is how big the drop is. And then we look at common intervention strategies like extending the school day or reducing the class size or providing extra tutoring. And what we’ve generally seen, with a bunch of big caveats, is that there certainly are some approaches that may be to start to address some of these – some of the interrupted learning that we’ve seen. And in particular, tutoring might be a promising option with uncertainty about how well this works at scale and in a post-COVID context and a host of other considerations.

So by way of concluding thoughts, this is really not just a story of initial shock and recovery. What we’ve seen are patterns of lost learning persisting and in some cases being even stronger in 2020-’21. In some ways, the gaps between low-income and non-low-income schools we’ve seen grew more during 2020-’21 than during the initial period after the pandemic hit. Early literacy is a particular concern. We focus a lot on grades three through eight, mainly because we have tests for those kids, but some of the most pressing issues might be for younger kids. And I’ll say, too, we also don’t know a lot about high school kids because they tend to be given assessments of the nature that we are using much less frequently. Our most vulnerable students are also the ones being hit the hardest. And that means both low-income kids but also kids living in communities where there have been higher rates of COVID-19 infections. There are a bunch of different ways to define the vulnerable, and along almost all of those dimensions, those kids have had bigger interruptions to their learning. Recovery is likely to be a truly long-term endeavor and involves supports beyond what schools can provide alone. And then the final is just that, in my opinion, too little attention has been given to students’ psychological and socio-emotional needs, in large part because we don’t measure those things quite so frequently. But hopefully, that’ll be something that we can think more about and that our next speaker will have something to say about as well. Thank you very much for your time, and I look forward to discussion and questions.

[0:14:12]

BECKY HAZEN: Thanks so much, Dr. Soland. Those are really interesting, somewhat sobering statistics. So let’s move on to our next presenter. Dr Raviv, over to you.

[0:14:22]

TALI RAVIV: Yeah, and I’m afraid I’m not going to have much better news than my colleague here. So I will share my screen as well, and thank you for having me here today to speak to this. So – let me make sure I can advance my slides here. There we go. So I want to start off by kind of providing some context to the data that I’m going to present on children’s mental health. So early in the pandemic, we didn’t yet have data about the effects of COVID on youth mental health. But what we did have that people in the field were paying attention to was really decades of research on risk factors for mental illness, including stress and trauma, and factors that had been shown by research to be protective in the face of adversity and buffer from that risk for mental health. And so what we have with COVID really is this perfect storm of increased stress and trauma and those risk factors combined with a decrease in the protective factors.

So I’m just going to start by giving that overview. So I find it helpful – I get asked a lot, is this – is COVID a trauma? Is this a trauma? And so I really find it helpful to think about stress and trauma as a continuum. So we all experience stress. Children experience stress. And it’s actually healthy for children to experience some amount of stress because it helps them learn to cope, and it helps them learn to gain some mastery. So when stress falls in the realm of positive stress, like taking some free throws at a basketball game, or tolerable stress, so things like not getting invited to a party or even for some kids, the uncertainty or disruption by COVID, if it’s buffered by protective factors like adults and supportive relationships, it can be OK. What we see for some is what we’re talking about in toxic stress and trauma. So when we have a prolonged, strong, frequent adversity like food insecurity, having a family member die of COVID or be significantly ill, housing disruptions, those kinds of things, that are not buffered by those strong, positive relationships that we know were disrupted in COVID – so having less contact with grandparents or coaches or teachers or others who could help children kind of weather those storms, especially for communities that were already coping with things like community violence or families that had mentally ill caregivers or abuse – that’s when the stress comes into this level of toxic stress, which has really significant impacts on the developing brain and long-standing consequences, potentially, if it’s not supported for health and mental health.

So I – this report here is based on data from the Voices [of Child Health] in Chicago health parent panel run by Lurie Children’s Hospital, as well as partners at the University of Chicago. And we asked parents to report on what their children were doing more of and less of as part of the pandemic. So what you see here is the light blue bars are showing that children are spending less time in certain activities, and the dark blue bars is what percentage of parents said their children were spending more time. So, for example, you can see that about 80% of families were saying that their children were spending significantly less in-person time with friends. Now, we know that positive peer relationships is a very important protective factor for youth to help protect them against stress and adversity. Similarly, we see that 63% of parents were saying their kids were spending more time on screens for non-educational purposes. And so this has really changed how youth spend their time and has changed their access to some of the protective factors that are important for healthy development. So this what – here is data from a study that I did in participation with colleagues at Lurie Children’s and Northwestern University. We worked with Chicago Public Schools in June and July of 2020 to really look at what were the impacts of those early school closures – right? – early in the pandemic. We surveyed over 30,000 caregivers of students in Chicago Public Schools, pre-K through 12th, who were reporting about – on about 40,000 children. And what we found is really significant increases in every metric of mental health concerns after school closure as compared to before. So the dark blue is the percentages who were endorsing their children had these characteristics prior to school closure. The light blue bars are the percent who are endorsing that their children were showing these signs and symptoms after school closure. And so you can see that we’re up – over a third of children were described as lonely. And then when we look at anxious and stressed and agitated and angry, we’re up nearly at 25%. And then depression was a little bit lower but still significant.

So this is kind of significant. We also asked families to report on 20 COVID-19-related stressors, such as disruption in employment, food insecurity, having a family member contract COVID-19, et cetera. And what you can see there on the x-axis is that the – as you move on the x-axis, that’s more of the stressors – the COVID-related stressors being endorsed. And you can see that as there’s more stressors endorsed, the predicted probability of all of those mental health concerns increases in kind of a linear fashion. Not surprisingly and consistent with everything we’ve seen in reporting on the COVID-19 pandemic, in our sample, Black and Latinx families were more likely to experience more of those COVID-related stressors.

So our study was conducted early in the pandemic, exclusively in the city of Chicago, also didn’t look at mental health diagnoses. It was asking caregivers to kind of report on things they were seeing – kind of signs of mental health and wellness. And so we – unfortunately, what we’re seeing is that these trends have continued and even intensified. So these data are from a study. The citation’s below. It was a meta-analysis conducted in 2019. So that means they took 29 studies from across the globe and estimated depression and anxiety in youth under age 18 across the globe. And what they found is that the global rates of youth depression and anxiety have doubled. And so what we’re seeing is about 20% of youth being anxious and 25% with depression. So those rates are really staggering. And this is in the context of rising rates of mental health concerns even prior to the pandemic.

Even more concerning, recent data reported by the CDC has showed increases in emergency department visits for suspected suicide attempts. And so what you see here, they looked at data about emergency room visits from February and March 2021 as compared to the same period in 2019. And for females aged 12 to 17, rates of suicide attempts were 51% higher in that period. And for males, there was also an increase, but much more modest. Teenage suicide rates, incidentally, have been rising steadily in this country since 2007, and it has been a particular crisis among African American youth. And so this is already – you know, this is in the context of an already concerning trend of rising rates of teen suicide.

So risk factors for mental health challenges, including exposure to poverty, violence or trauma, a caregiver with mental illness – those occur kind of across race, ethnicity, geography, income. However, it’s also true that structural racism, classism and long-standing inequities in health and wealth in our country mean that it – they really do determine not only who is more likely to experience those stressors or risk factors, but also who is likely to have access to the resources they need to cope or recover. And so here, I’m just going to, you know, put up some of the emerging data that I think is important to dig into, and we can dig into it more in the Q&A. Some of the populations of youth who are more at risk during this pandemic and, you know, including – when I say, minoritized youth, I’m talking about Black, Latinx and indigenous youth, youth with preexisting conditions such as health, academic, developmental problems or mental health concerns that were preexisting prior to the pandemic, rural youth, immigrant refugee youth, et cetera.

In 2021, in October, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry and the Children’s Hospital Association declared a national emergency in child and adolescent mental health. And that is because the mental health system was taxed prior and not functioning very well prior to the pandemic. So the data – some of the data here are from 2016 in terms of the percentage of youth in 2016 prior to the pandemic who had a mental health disorder. Only 16% were – had one. I think now we’re looking at much higher rates. And at that time, 50% of youth on average would receive treatment for their mental health problem. And that was prior to the increased demand that we’re seeing with great variability, by the way, from state to state. So that shows that this was a crisis prior to the pandemic. And now with increasing rates of mental health problems, it’s only going to get worse. Data – kind of that bottom statistic, that 37% of Americans are living in areas lacking mental health professionals – that is from government data from the Department of Labor and HRSA. That is really showing that we have a significant workforce shortage that is really causing access issues. Related – in December of ’21, U.S. Surgeon Dr. Vivek – Surgeon General Dr. Vivek Murthy issued this advisory on youth mental health with – I really urge you, it’s in the resources linked here – I really urge you to look at it, and it really talks about the need for a whole community approach. It’s not enough for just the mental health professionals to handle this. It’s really going to need a much broader approach.

And so I wanted to conclude with a few of the recommendations that I see as important, and I wanted to also emphasize what I haven’t said enough in this presentation – which is a little bit doom and gloom – which is that children do – really are inherently resilient. And if they’re given the right supports, they will be able to thrive despite kind of the challenges and adversities and stressors that we’re seeing. That support includes mental health treatment, but we really do need to think much broader than just waiting until a problem emerges before we treat it. So that’s my first recommendation here is that we need to focus on prevention. We need to identify. We know what the risk factors are. We need to target those, like socioeconomic inequality, health disparities and stress. We really need to increase mental health literacy among all the adults that are working with children so they can promote healthy development and also recognize early signs that a child may need more support. We need to reduce stigma around mental health and increase listening to youth and community about what are they experiencing and what are the solutions that will work for them. We need to deliver services in the right time and place, so clearly the mental health system needs to expand. Currently, 70% of youth that get mental health treatment get that treatment in schools. So we need to support that system to provide more of that because that’s where kids are, but also look at primary care and expanding telehealth access. We do need to build workforce diversity within the mental health workforce. According to the American Psychological Association, about 85% of psychologists are white. And we need to increase capacity, as I mentioned earlier. We don’t have enough mental health professionals in this country to meet the need. And finally, despite the fact that mental health parity laws were passed decades ago – at this point over a decade ago, we are still a far way from mental health parity, and we need to integrate mental health more fully into the health care system to improve access. And I’m looking forward to more discussion in the Q&A. Thank you very much.

[0:27:08]

BECKY HAZEN: Thank you so much, and I appreciate your positive note about the resilience of kids there at the end. I’m going to turn it over now to Dr. Yonts.

[0:27:21]

ALEXANDRA YONTS: Wow. Those are some really great presentations. I’m so honored to be on the panel with both of you. So I am Alexandra Yonts. I am a pediatric infectious diseases physician at Children’s National Hospital in Washington, D.C, and I have the very broad topic of the impacts of the COVID pandemic on pediatric physical health of children and adolescents. So I will hit some high points, hopefully have a little bit more hopeful news to discuss at the end of this but lots of room for questions later – so sort of first off the bat wanting to discuss acute COVID-19, which is the infection that was experienced when the virus is first acquired. These statistics are already out of date. They’re from the AAP, American Academy of Pediatrics, State-Level Data Report. And actually, they updated today. It’s now 12.5 million children have been diagnosed with COVID-19, and that’s individuals less than 18 years of age, which is the definition I’ll use for the rest of my slides. And that now represents 19% of all cases in the U.S., which is a proportion that has been increasing, in particular, over the past two months. Thankfully, the majority of kids that get this infection are asymptomatic or have mild upper-respiratory type of symptoms – some sore throat – but that does not mean there aren’t severe manifestations of COVID in children.

So to date, there have been over 112,000 hospitalizations of children with COVID-19, and over 800 children have died from COVID-19. And in addition to those more acute problems, there are some post-infectious and more lingering illness scripts that we have come to identify, the first of which is the multisystem inflammatory syndrome in children or MIS-C, which first really came to the table in May of 2020. Just as a brief reminder, the sort of definition of this is clinical and vague, but essentially three to seven weeks after initial COVID exposure or infection, patients present with fever, signs of inflammation on lab work, as well as at least two symptoms. And that can be one of many different organ systems involved. But things like rash, red eyes and lips, joint pains, abdominal pains and headaches are some of the most common complaints. Thankfully, this is generally uncommon. There have been 6,800 cases sort of investigated and given the stamp of approval by the CDC at this point. However, they are still investigating many more cases. And I would say anecdotally, as a pediatric infectious disease physician, I see this all the time in our hospitals. And the disturbing thing about MIS-C, while more rare, is it is often more severe in terms of leading to children being hospitalized or put in the ICU needing blood pressure support and is actually has a higher rate of fatalities. There have been 59 deaths out of those 6,800 cases reported in the United States. And then following that, there is the more smoldering but potentially more insidious diagnosis of post-acute sequelae of COVID or PASC, which has also been referred to as long COVID or long-haul COVID. This is a little bit of a trickier diagnosis to sort of wrap our brains around, but the current diagnostic definition is a persistent symptom, at least one, that occurs at least four weeks after the acute COVID-19 illness. There are lots of efforts to further define that. I will say in our experience, we – I am the director of our post-COVID program clinic here at Children’s National, and of the 40 patients that we have evaluating clinics so far, the vast majority have come with complaints of fatigue, headache, decreased exercise tolerance and decreased appetite, as well as some brain fog and sort of concentration issues, but really could be a wide range of symptoms ranging from joint pains to rashes to just loss of taste and smell.

This is more frequently identified in teenagers, but we have seen children as young as 2 in our clinic presenting with symptoms. There may be some reporting differences in terms of what teenagers are able to vocalize and in terms of the impact on their daily lives. It’s thought to be relatively uncommon, but we actually don’t have a great denominator in terms of how many cases are happening, or a numerator, I suppose, because the case definition remains a little bit flexible. There have been studies in children, and they’ve shown a range of these persistent symptoms anywhere between 4- to 66% of kids that have initial COVID infection. Most of us working in this field think the real number is closer to 10%, but additional studies are needed to further refine that definition, in particular in the pediatric population, and look at the incidents with that definition.

Another comment on post-acute sequelae of COVID – there have been recent publications put out – actually, a preprint in Cell by Su et al – that have identified potential risk factors for long COVID. This study was done in adults – so with the caveat of forever that likely things are different in children because they’re not just small adults – but some of the risk factors identified in that study included type 2 diabetes, a higher level of viral RNA in the bloodstream at the time of infection, presence of autoantibodies – so antibodies against our own human cells in the blood, either at the time of infection or before – as well as previous history of EBV infection, or Epstein-Barr virus, more commonly known as the virus that causes mono. So these are some interesting areas for further investigation and potentially have treatment implications, but still very early stages. And I will say most of the management for these types of symptoms at this point is symptomatic and multidisciplinary, meaning that, at least in our clinic, we have psychology, physical medicine and rehabilitation, infectious diseases and other subspecialists get together, see the patients and come up with joint recommendations for how to give them tools, coping mechanisms, get them reconditioned and treat any other symptoms. But it’s likely multiple different pathologies happening at once, rather than one single process that can be treated with one single treatment.

And last thing I’ll say about this is both MIS-C and long COVID are sort of cousins, if you will, or likely fall on the spectrum of diseases that have previously been described in children. So MIS-C has a lot of overlap with something called Kawasaki disease, which is a hyperinflammatory state that is seen in children thought to be triggered by an infection, and long COVID is very similar to things like chronic fatigue syndrome, post-Lyme treatment disorder. So likely, we’re going to unlock more information about both of these diagnoses going forward, or all of these diagnoses going forward, because they probably have similar genetic risk factors and other things in common. Moving on to additional pediatric health impacts of the pandemic – because it actually isn’t all COVID, although sometimes it feels like it – early on in the pandemic and – in particular there was concern about decreased routine childhood visits to the doctor and routine childhood vaccinations sort of going along with that. So this graph on the right, it comes from a paper published in “Pediatrics” last year out of a group in Kaiser Permanente, Southern California, which is a very closed medical system. And they compared rates – a number of vaccine doses given to various patient populations in 2019 and compared that to the same period in 2020. The blue bars on the graph represents 2019 vaccine doses, and the red bars represent 2020. And this is a dose over time – so starting in January 2020 through August of 2020. So you can see in the March-April timeframe, when things were under lockdown in the state of California, there was a significant change between the blue bars and the red bars in the 2- to 6-year-olds. You can see there was some recovery after lockdown, but there still remain lower number of doses in 2020 compared to 2019. And I will say other age groups, so basically 2 on up to age 18, showed less recovery of those doses – so less make up for catch up vaccination. Thankfully, less than 2-year-olds seem to have a pretty good bounce back in terms of their rates of vaccination, most likely because they’re seeing the doctor more frequently anyway. But this is concerning because while we have not yet seen any rise in the rates of vaccine-preventable diseases like chickenpox or measles, which is great, as things open up again, there – the risks of those combined with the risks of a less immunized population are certainly going to factor into each other. Masks and social physical distancing and quarantine have decreased the rates of all infections over the course of the pandemic.

So I think the next, you know, several months to years as things loosen up is going to be very enlightening. And so we should make all efforts to get kids back on schedule for their immunizations. Another study, this is – dovetails very nicely with what Dr. Raviv discussed in her presentation – but significant decrease in physical activity. So a pair of authors did reviews of multiple studies looking at mostly survey-based data that showed that teenagers in particular had a 33% decrease in their physical activity and an 80% increase in their sedentary behavior, meaning seated non-active behaviors including watching television, any other types of screen time, eating. And while this in itself is not presenting a diagnosis, there is a lot of research that demonstrates increased sedentary behavior leads to obesity, leads to increased risk of metabolic complications like multisystem inflammatory syndrome in children or MIS-C and future risk of heart disease. So this is very concerning and, you know, something that we need to see improve as we recover from the pandemic as well. Lastly, you may have recently seen an article that got some press from Gottesman et al. looking at the rates of type 1 diabetes, which is thought to be more of an autoimmune phenomenon rather than an obesity sort of lifestyle phenomenon like type 2 diabetes in adults. And over the – since the pandemic started, there was a very sharp increase, so 57% increase in new diagnoses of type 1 diabetes compared to the five years before the pandemic. So that is notable. That is not within the margin of error and likely relates to similar phenomenon post-infection like we have seen in MIS-C and long COVID, some sort of autoimmune trigger from the virus itself. And lastly, touching on a little bit of hope, so COVID vaccination in children. So the good news is that it has been demonstrated in multiple studies with intensive regulatory oversight to be safe and effective. And in particular, we have the most information about the Pfizer vaccine, but our accumulating data – and soon we’ll have evaluation for Moderna and some of the other vaccines in the pediatric population. But the caveat is that that is only true when it’s used.

So my one sort of downer for this slide is that, per CDC and American Academy of Pediatrics data, only 25% to 57% of eligible children have been vaccinated to date. That lower number of that range reflects the 5- to 11-year-old population who has only had access to the vaccine for a few months. But still, only, you know, about half of the teenagers that could be vaccinated have been vaccinated, which is a bit challenging. So my next couple of comments sort of speak to why – I guess, give additional carrots to why vaccination should be considered in these groups. So on the left, there is a graph taken from a recently published study in “Pediatrics” by Thakkar et al. that studied, essentially, rates of COVID infection by vaccination status in sixth through 12th grade students. So they started at the beginning of the 2021 school year in August and followed any kids that were diagnosed with COVID-19 and compared the status of vaccinated versus unvaccinated. And as you can see, as school went on, there were more and more cases of COVID-19. And the difference in who was affected grew over time. And the gap between unvaccinated, demonstrated by the red bar, and vaccinated students, demonstrated by the blue bar, became quite staggering. So evidence that it helps decrease infection. There have also been recent studies that have stated or demonstrated protection against complications like MIS-C. So a recent paper published by the CDC through their Morbidity and Mortality Weekly Report showed that there was a 90% efficacy in preventing MIS-C in vaccination in teenagers, which is great. And there’s also some studies that suggest it may be protective against long COVID. Both of which make some degree of sense – if you prevent the original infectious assault, you’re likely to prevent the complications. But having that data is very helpful in supporting vaccination. Just a couple of more comments – so I know the concerns about myopericarditis after mRNA vaccination have been a conversation we’ve been having for almost a year now. But thankfully, long-term studies, while still pending official data report, do appear reassuring. So far, what we have published is two to three months out from these myocarditis cases. And at that point, most subjects – almost all subjects are asymptomatic and don’t have any evidence of disease on cardiac imaging. And longer-term studies that should be published over the next several months will likely demonstrate similar. So it is a scary side effect, but lacking long-term consequences from what we have available in the data at this point. And then last two bits, just to rephrase, we are making progress, continuing to expand vaccine studies in children. So the Pfizer phase three study of safety and immunogenicity in younger children – so particularly 6 months to less than 5 years – is ongoing. An EUA, there was discussion about a submission for that population. However, for whatever reasons, Pfizer and the FDA put that on hold and now are waiting or pursuing third dose studies, hopefully will be coming in the next few months.

And then Moderna, who’s been relatively quiet in terms of the pediatric vaccine developments, has been doing ongoing dose adjustment studies recommended by the FDA in their older populations and have stated that they should have data in the 2 to 5-year-old age group coming within the next couple months. So a lot of exciting news, a lot additional evidence that vaccination is safe and a tool that we need to exercise. Here’s my list of references since I kind of breezed through some of them, but lots of great reading in ongoing publications. And with that, I will stop.

[0:44:08]

BECKY HAZEN: Thank so much, Dr. Yonts, all of our panelists, for excellent and very data-rich presentations. So we’ll move on to a Q&A now. And just a reminder to those logged in, to submit a question, just click on the Q&A icon at the bottom of your screen. While we are gathering your questions, I’m going to kick things off by asking each of our panelists to briefly address a question that I hope will be valuable to everyone who’s on the call today. And that is, what have you seen in the media’s coverage of this topic that has either frustrated you as an expert in this domain or impressed you and something you’d like to see more of? So, Dr. Soland, I’m going to start with you for that question.

[0:44:53]

JIM SOLAND: Sure. Thanks. So a couple of things. On a really positive note, you know, I work with big data studies with lots and lots of kids, and so it’s been really helpful to get sort of individual personalized stories about kids and teachers and superintendents and how they’re dealing with some of the challenges they’re facing. It’s been some really nice contexts that we’ve gotten. I’d say one of the negatives has just been, you know, there’s occasionally a tendency to give things these big sort of dire labels that I think get in the way of potentially the reality of the situation and the optimism we should have that we can address things for kids. So, you know, avoiding describing things in really sweeping ways would be my one thought on that.

[0:45:40]

BECKY HAZEN: Great advice. Dr. Raviv.

[0:45:44]

TALI RAVIV: Yeah. Thanks for the question. I mean, I think one of the biggest silver linings that comes out of COVID from my perspective is the conversation about mental health, that it’s – it has really done a lot to reduce the stigma and to make everybody understand that we cannot have learning or health or employee productivity or anything if we don’t really attend to mental health. So I think keep that coming in terms of reducing stigma and keeping that part of the conversation and really front and center.

[0:46:17]

TALI RAVIV: I think, like Dr. Soland said, I – it is challenging when there are, you know, dire – and maybe I contributed to this. You know, it is scary and daunting when we say things like suicide rates are up and doubling of anxiety and depression. And so I think some of the good news stories about some of the more innovative programs that are looking to – you know, I don’t think as a country, we do very well focusing on prevention of any things, including heart disease or, you know what, whatever we’re talking about. So I think really elevating those stories of the good news and the programs that are really building connections and engaging communities are helpful to focus more on as well.

[0:47:03]

BECKY HAZEN: Thank you. Dr. Yonts.

[0:47:06]

ALEXANDRA YONTS: My comments in line …

[0:47:13]

BECKY HAZEN: Your audio is breaking up just a little bit.

[0:47:16]

ALEXANDRA YONTS: Oh. Is this better?

[0:47:24]

BECKY HAZEN: Maybe you can mute and unmute yourself.

[0:47:27]

ALEXANDRA YONTS: Yeah. Let me try that. Is that better? No?

[0:47:32]

BECKY HAZEN: Why don’t we move to another question and we’ll come back to you in a minute? We’ve got one question here for Dr. Soland. In your presentation, you listed some possible strategies for making up for learning losses – longer school days, summer school. For reporters who are covering this, do you have any suggestions for how we can understand the feasibility of these interventions and whether they’re actually working?

[0:48:04]

JIM SOLAND: Yeah. Good question. I mean, one of the benefits we have is that a lot of the results we’re looking at come from these meta analyses, which as one of my colleagues said is where you look across a whole bunch of different studies, so you can see, you know, if we’ve done this over and over in different contexts, does this seem to be working or not? But I think it’s a question that we’re all really struggling with because the answer is for most of these things, we know they can work in a pre-pandemic context. But I don’t think for any of them, if we really know whether in the context of COVID-19, scaling them up really, really quickly, you know, managing all of these other challenges – the health challenges, the mental health challenges – whether they would have the same benefits or not. So all to say, your question is something that we’re struggling with too and don’t really know the answer to, in honesty. But probably the best place to go is – there are researchers who have done a lot of studies specifically on some of these strategies – intervention approaches. So, for example, Matt Kraft at Brown has done a huge amount on some of these tutoring strategies and has done some articles that I think would probably help point you in the right direction. So all to say, if there are follow-up questions too, or if people want to email me, I can put you in touch with individuals who can talk to the specific intervention strategies.

[0:49:39]

BECKY HAZEN: Thank you. We’ve got another question here from Chris Persaud at the Palm Beach Post. And Dr. Yonts, this one might be for you, so we’ll see if your microphone is working. The question is, have there been studies on how masking affects children’s speech development? Have you seen anything about that?

[0:50:00]

ALEXANDRA YONTS: Well, let’s see. Do I sound less like a robot now?

[0:50:02]

BECKY HAZEN: You sound great.

[0:50:04]

ALEXANDRA YONTS: OK, great – speaking of speech development, right? know, to my knowledge, there haven’t been any large, sort of scalable or well-controlled, although that’s a challenge to do. You would have to use sort of historical comparison in that area, so I don’t know. Dr. Raviv may also be familiar with this area, as it relates to mental health, too. But, to my knowledge, the best we’ve seen are small sort of case series in this area.

[0:50:35]

BECKY HAZEN: Great. Another question here, and I think Dr. Raviv, Dr. Yonts, either of you might want to address this. What are the effects of stress on the developing brain? How does experiencing acute stress as a child correlate to mental or physical problems during adulthood?

[0:50:55]

TALI RAVIV: I can take a first stab at that. So I do a lot of research in the area of adversity and stress and trauma, and there is actually a very substantial body of research that shows, even prenatally, that there is effects of prenatal exposure to maternal stress that does really impact the brain’s architecture development. And then there’s a study that many of you may have heard of called the Adverse Childhood Experiences study that’s since been replicated, looking at adults’ kind of retrospective reports of adversities they encountered during childhood, including, you know, living in a household with someone who was abusing substances or having experienced abuse as children. There’s 10 of those kind of adversities that were measured, and they really saw that if you had four or more of those ACEs, as they call them, then you really were at much higher risk for not only mental health, but physical health problems, like heart disease, cancers. And so the mechanisms of that are really thought to be related to that chronic and toxic stress, as I talked about earlier, in terms of how that, you know, really does kind of trigger inflammatory responses in the body and shuts down some of the prefrontal cortex, which is responsible for learning and higher-order thinking.

We often talk about it as survival brain. And so if those are not treated early on, then we can expect to see those physical and mental health consequences. And so what we know from decades of research also is that stable, supportive adult relationships really do buffer that – and so to the extent that we can build those relationships and reconnect people to not only family members, but community members and other adults, coaches, mentors – those kinds of things – that we would expect to see a nice recovery. Children’s brains are very plastic. They change and grow in response to the environmental input that they get, and so there is lots of hope for recovery and resilience. But we need to put the right supports in place for those that are exposed to high levels of toxic stress.

[0:53:08]

BECKY HAZEN: Thank you. Dr. Yonts, anything you want to add to that?

[0:53:12]

ALEXANDRA YONTS: No, I think she pretty much nailed it. And, again, the plasticity and resilience of children is one of the most magical things that we see. So there is room for correction and recovery, but the data on accumulation of ACEs is staggering in terms of what it contributes to long term.

[0:53:34]

BECKY HAZEN: Great. We’ve got a question here from Dana Branham at The Oklahoman in Oklahoma City. I think, Dr. Raviv, this one’s for you. And Dr. Soland, you might want to chime in here as well. The question is, what role do you foresee or would you like to see schools and educators playing in addressing more kids struggling with their mental health?

[0:54:00]

TALI RAVIV: You want to take that one – take a first shot, or would you like me to take that, Dr. Soland?

[0:54:05]

JIM SOLAND: Well, I’ll let you kick it off if you are willing.

[0:54:09]

TALI RAVIV: Yeah, sure. So the question – just to restate it – is, what role would we like who to take in the mental health? Sorry, just want to make sure I’m getting it right.

[0:54:20]

BECKY HAZEN: Yes – schools and educators.

[0:54:22]

TALI RAVIV: Schools and educators – OK. I wanted to make sure I wasn’t – I was hearing that right. Yeah. So we – this is a lot of what I do. Our work in the Center for Childhood Resilience really focuses on schools as a big access point for mental health services. And what we like to say is, you don’t have to be a therapist to be therapeutic, meaning that every adult in a child’s life has a role to play in building, you know, that stress and coping. So these are programs that have been around Hfor a long time, and schools really do have the potential to kind of – they have children there all day long. So that’s a lot of hours per week with a supportive educator. So we’ve already been involved in a lot of efforts in Illinois and nationally to build educators’ capacity to support positive development, social and emotional learning skills. Those are important both for academic success and for just general health and well-being. I think the challenge that we see in COVID is really that schools are not meant to be a mental health service delivery, but they – system, but they are kind of de facto serving in that. And so we do have shortages of counselors, social workers and psychologists in schools, and educators have a lot on their plate. So when you’re thinking about all of the data that Dr. Soland presented about the, you know, educational achievement gap and learning loss, that’s what teachers are looking at. And so, sometimes, it’s very challenging for them. And they’re living through the same stressors as we all are.

So we really need to think differently about the supports that we are providing in schools, how we’re supporting teachers and other people who are really, you know, experiencing record levels of burnout and job-related stress and leaving the profession. So while it’s a promising place for service delivery and it has been functioning that way for a long time, I think schools – we really need to think about what is realistic to ask and what do we need to change in the structures of schools, including things like co-located school-based health centers, I think, is a really promising approach to advocate for that.

[0:56:27]

JIM SOLAND: Yeah.

[0:56:27]

BECKY HAZEN: Dr. Soland, anything to add there?

[0:56:29]

JIM SOLAND: Oh, well – just second how important it is to have the resources to address some of these questions because, in my experience and from some of the research I’ve seen, teachers are usually aware of some of these challenges that kids are facing but just don’t have the bandwidth to address it, and they don’t have the staff at the school to address it. The one other piece I’d add is just that we often see sort of the mental health and learning components as being separate. And I think there’s a big sort of social, emotional learning component that can be baked into how you teach a math lesson or how you do reading. And so giving educators the latitude to focus on some of those aspects, maybe even, in some cases, at the expense of some of the pure math and reading, could be a worthwhile approach.

[0:57:12]

BECKY HAZEN: And I know we’re reaching the end of the hour, so I want to wrap up by asking each of our panelists to offer the reporters who are logged in one key take-home message. What is the most important thing that they can leave here knowing as they consider developing stories on this topic? And, Dr. Yonts, why don’t we start with you?

[0:57:36]

ALEXANDRA YONTS: Sure. COVID in kids is real and thankfully mild, but there are many complications, and there is evidence that vaccination can help minimize or prevent those complications. So, really, that should be the push. And parents, if that’s what your audience is, should also know that these complications are real as well. And they need to talk to their doctor and seek an audience or another physician that will listen to their complaints and help them help their child get better so that they can succeed at school and have their best mental and educational help.

[0:58:15]

BECKY HAZEN: Thank you. Dr. Soland, over to you.

[0:58:20]

JIM SOLAND: Thanks. So I think one of the biggest takeaways is just that helping kids regain some of what they have missed is going to be a long-term process. It’s going to require sort of long-term strategies and some optimism to go with it. It’s certainly going to be a process that extends far beyond schools. I think if our panel has spoken to anything, it’s the fact that this is not just something that educators can tackle all on their own because it’s a host of issues. And the last thing is, I just think, in terms of how we approach this and think about teachers, seeing teachers as partners in this process and recognizing just how hard they’re working to serve kids and treating them in that way as policies are being developed would be a strong strategy.

[0:59:06]

BECKY HAZEN: Great advice. Thank you. And Dr. Raviv.

[0:59:11]

TALI RAVIV: Yeah, I think the biggest takeaway that I would want people to walk away with is that the effects of COVID-19 on mental health and the challenges in our mental health service delivery system were there prior to COVID-19. So the rates of mental health problems were escalating and the access to services was low prior to COVID-19. So it’s really just magnified, I think, the cracks in the system, and that’s as a society as a whole, too. So I think that this is an opportunity, in my view, to rethink the way we’ve done things in the – and how we’re promoting mental health and how we’re promoting access to mental health services for those who need them. And I hope that that’s going to be a silver lining, that this is a chance to really think differently about how we, as a society, approach mental health problems in childhood and get kids help sooner. So that’s what I would want to cover.

[1:00:12]

BECKY HAZEN: Thank you. I want to thank all of you so much, our panelists, for sharing your time and expertise today. I want to thank our reporters for joining us and for your commitment to scientifically informed reporting. For the journalists who are logged in, you’re going to get a short three-question survey prompt right as you log off. Please take 30 seconds to fill it out. It’s really helpful to us as we plan these briefings. As always, please follow us on Twitter at @RealSciLine and register with us at sciline.org to get notified about future events. Thank you again to our scientists who joined us today. It’s been an excellent and informative briefing. Thank you so much.

[1:00:51]

TALI RAVIV: Thanks for having me.

[1:00:52]

JIM SOLAND: Thank you.