Here is a running list of studies demonstrating the detrimental effects lockdowns have on children.
1. Agency: Deutsche Gesellschaft für Pädiatrische Infektiologie [December 19, 2020]
TITLE: Corona children studies “Co-Ki”: First results of a Germany-wide registry on mouth and nose covering (mask) in children
METHODS: “At the University of Witten/Herdecke an online registry has been set up where parents, doctors, pedagogues and others can enter their observations. On 20.10.2020, 363 doctors were asked to make entries and to make parents and teachers aware of the registry.”
CONCLUSION: “By 26.10.2020 the registry had been used by 20,353 people. In this publication we report the results from the parents, who entered data on a total of 25,930 children. The average wearing time of the mask was 270 minutes per day. Impairments caused by wearing the mask were reported by 68% of the parents. These included irritability (60%), headache (53%), difficulty concentrating (50%), less happiness (49%), reluctance to go to school/kindergarten (44%), malaise (42%) impaired learning (38%) and drowsiness or fatigue (37%).”
2. Archives of Disease in Childhood [December 9, 2020]
TITLE: Longitudinal increases in childhood depression symptoms during the COVID-19 lockdown
METHODS: “Mental health assessments on 168 children (aged 7.6–11.6 years) were taken before and during the UK lockdown (April–June 2020). Assessments included self-reports, caregiver reports, and teacher reports. Mean mental health scores before and during the UK lockdown were compared using mixed linear models.”
CONCLUSION: “A significant increase in depression symptoms during the UK lockdown was observed, as measured by the Revised Child Anxiety and Depression Scale (RCADS) short form. CIs suggest a medium-to-large effect size. There were no significant changes in the RCADS anxiety subscale and Strengths and Difficulties Questionnaire emotional problems subscale.
“During the UK lockdown, children’s depression symptoms have increased substantially, relative to before lockdown. The scale of this effect has direct relevance for the continuation of different elements of lockdown policy, such as complete or partial school closures. This early evidence for the direct impact of lockdown must now be combined with larger scale epidemiological studies that establish which children are most at risk and tracks their future recovery.”
3. JAMA Network Open
TITLE: Estimation of US Children’s Educational Attainment and Years of Life Lost Associated With Primary School Closures During the Coronavirus Disease 2019 Pandemic
METHODS: “This decision analytical model estimated the association between school closures and reduced educational attainment and the association between reduced educational attainment and life expectancy using publicly available data sources, including data for 2020 from the US Centers for Disease Control and Prevention, the US Social Security Administration,
and the US Census Bureau. Published peer-reviewed studies (2 US studies, 5 European studies) were identified that provided estimates of the relative risk (RR) of annual mortality related to educational attainment, which were weighted and applied to the most recent life table data to obtain YLL estimates across the life course. Direct COVID-19 mortality and potential increases in mortality that might have resulted if school opening led to increased transmission of COVID-19 were also estimated.”
CONCLUSION: “This decision analytical model found that missed instruction during 2020 could be associated with an estimated 13.8 (95% CI 2.5-42.1) million years of life lost based on data from US studies and an estimated 0.8 (95% CI 0.1-2.4) million years of life lost based on data from European studies. This estimated loss in life expectancy was likely to be greater than would have been observed if leaving primary schools open had led to an expansion of the first wave of the pandemic.”
“A total of 24.2 million children aged 5 to 11 years attended public schools that were closed during the 2020 pandemic, losing a median of 54 (interquartile range, 48-62.5) days of instruction. Missed instruction was associated with a mean loss of 0.15 (95% credible interval [CI], 0.08-0.22) years of final educational attainment for boys and 0.12 (95% CI, 0.06-0.19) years for girls. Summed across the population, based on the RR from US studies, an estimated 13.8 million (95% CI, 2.5-42.1) YLL may be associated with school closures. Summed across the population, based on the RR from the European studies, an estimated 0.8 million (95% CI, 0.1 -2.4) YLL may be associated with school closures. The Centers for Disease Control and Prevention reported a total of 88 241 US deaths from COVID-19 through the end of May 2020, with an estimated 1.50 million (95% CI, 1.23-1.85 million) YLL as a result. Had schools remained open, an estimated 4.4 million (95% CI 2.29-6.41,) YLL could have been expected as a result, based on results of studies associating school closure with decreased pandemic spread. Comparing the full distributions of estimated YLL under both “schools open” and “schools closed” conditions, based on the US studies and the European studies, the analysis observed a 98.9% probability and a 26.3% probability, respectively, that school opening would have been associated with a lower total YLL than school closure.”
4. The Lancet [July 27, 2020]
TITLE: Impacts of COVID-19 on childhood malnutrition and nutrition-related mortality
METHODS: Comment in journal
CONCLUSION: “What do our initial analyses and estimates suggest? First, the MIRAGRODEP projections suggest that even fairly short lockdown measures, combined with severe mobility disruptions and comparatively moderate food systems disruptions, result in most LMICs having an estimated average 7·9% (SD 2·4%) decrease in GNI per capita relative to pre-COVID-19 projections.”
“Second, the microeconomic model projections indicate that decreases in GNI per capita are associated with large increases in child wasting.9 Our own analyses, based on these estimates applied to 118 LMICs, suggest there could be a 14·3% increase in the prevalence of moderate or severe wasting among children younger than 5 years due to COVID-19-related predicted country-specific losses in GNI per capita. We estimate this would translate to an additional estimated 6·7 million children with wasting in 2020 compared with projections for 2020 without COVID-19; an estimated 57·6% of these children are in south Asia and an estimated 21·8% in sub-Saharan Africa.”
“The economic, food, and health systems disruptions resulting from the COVID-19 pandemic are expected to continue to exacerbate all forms of malnutrition. Estimates from the International Food Policy Research Institute suggest that because of the pandemic an additional 140 million people will be thrown into living in extreme poverty on less than US$1·90 per day in 2020. According to the World Food Programme, the number of people in LMICs facing acute food insecurity will nearly double to 265 million by the end of 2020. Sharp declines are expected in access to child health and nutrition services, similar to those seen during the 2014–16 outbreak of Ebola virus disease in sub-Saharan Africa. Early in the COVID-19 pandemic, UNICEF estimated a 30% overall reduction in essential nutrition services coverage, reaching 75–100% in lockdown contexts, including in fragile countries where there are humanitarian crises.“
5. Archives of Disease in Childhood [December 9, 2020]
TITLE: Longitudinal increases in childhood depression symptoms during the COVID-19 lockdown
METHODS: Mental health assessments on 168 children (aged 7.6–11.6 years) were taken before and during the UK lockdown (April–June 2020). Assessments included self-reports, caregiver reports, and teacher reports. Mean mental health scores before and during the UK lockdown were compared using mixed linear models.
CONCLUSION: “A significant increase in depression symptoms during the UK lockdown was observed, as measured by the Revised Child Anxiety and Depression Scale (RCADS) short form. CIs suggest a medium-to-large effect size. There were no significant changes in the RCADS anxiety subscale and Strengths and Difficulties Questionnaire emotional problems subscale.
“During the UK lockdown, children’s depression symptoms have increased substantially, relative to before lockdown. The scale of this effect has direct relevance for the continuation of different elements of lockdown policy, such as complete or partial school closures. This early evidence for the direct impact of lockdown must now be combined with larger scale epidemiological studies that establish which children are most at risk and tracks their future recovery.”
6. The Lancet Public Health [May 2020]
TITLE: Impact of school closures for COVID-19 on the US health-care workforce and net mortality: a modelling study
METHODS: “For this modelling analysis, we used data from the monthly releases of the US Current Population Survey to characterise the family structure and probable within-household child-care options of US health-care workers. We accounted for the occupation within the health-care sector, state, and household structure to identify the segments of the health-care workforce that are most exposed to child-care obligations from school closures. We used these estimates to identify the critical level at which the importance of health-care labour supply in increasing the survival probability of a patient with COVID-19 would undo the benefits of school closures and ultimately increase cumulative mortality.”
CONCLUSION: “Between January, 2018, and January, 2020, the US Current Population Survey included information on more than 3·1 million individuals across 1·3 million households. We found that the US health-care sector has some of the highest child-care obligations in the USA, with 28·8% (95% CI 28·5–29·1) of the health-care workforce needing to provide care for children aged 3–12 years. Assuming non-working adults or a sibling aged 13 years or older can provide child care, 15·0% (14·8–15·2) of the health-care workforce would still be in need of child care during a school closure. We observed substantial variation within the health-care system. We estimated that, combined with reasonable parameters for COVID-19 such as a 15·0% case reduction from school closings and 2·0% baseline mortality rate, a 15·0% decrease in the health-care labour force would need to decrease the survival probability per percent health-care worker lost by 17·6% for a school closure to increase cumulative mortality. Our model estimates that if the infection mortality rate of COVID-19 increases from 2·00% to 2·35% when the health-care workforce declines by 15·0%, school closures could lead to a greater number of deaths than they prevent.
“School closures come with many trade-offs, and can create unintended child-care obligations. Our results suggest that the potential contagion prevention from school closures needs to be carefully weighted with the potential loss of health-care workers from the standpoint of reducing cumulative mortality due to COVID-19, in the absence of mitigating measures.“
7. Journal of the American Academy of Child & Adolescent Psychiatry [November 2020] [PSYCHOLOGICAL]
TITLE: Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19
METHODS: “For this rapid review, we searched MEDLINE, PsycInfo, and Web of Science for articles published between January 1, 1946, and March 29, 2020. Of the articles, 20% were double screened using predefined criteria, and 20% of data was double extracted for quality assurance.
CONCLUSION: “Children and adolescents are probably more likely to experience high rates of depression and most likely anxiety during and after enforced isolation ends. This may increase as enforced isolation continues. Clinical services should offer preventive support and early intervention where possible and be prepared for an increase in mental health problems.”
Feature image: Elvert Barnes
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