by Asma Fazal, MD, MRCPI, MHSc

Covid-19 pandemic has changed world dynamics. Measures such as wearing a face mask, regular hand washing, cleaning surfaces with disinfecting substances, and practicing physical distancing have proven to be effective in controlling the spread of Covid-19. But now people are protesting the face mask mandate and considering it as an infringement of their right to live freely and decide for themselves. We should understand that the unprecedented measures to contain the spread of Covid-19 infection have resulted in school closure world-wide. This sudden and prolong school closure has negatively impacted the social, emotional, and behavioral aspects of childhood development and academics.

To compensate the educational loss, distance learning model is now considered an alternative, but all children do not have the support and resources available to benefit from this option. Lack of in-person teaching mode has disproportionately harmed children belonging to low-income and minority groups and those living with a disability. Many low-income families cannot facilitate distance learning because of limited or no access to a computer or internet and are solely dependent on the support of school-based services for their child’s academic progression.

Additionally, the in-person school environment contributes to many things other than just providing education. In-person school learning supports social and developmental skill sets and peer relationships while ensuring a safe learning environment. School closure negatively impacts these developmental areas. Significant social interactions that help develop critical emotional and social skills are limited when the students are not physically present in the school.

This kind of instruction mode is particularly vital for students with behavioral issues requiring assistance. Children with developmental delays, cognitive dysfunction and other disabilities in general, and with hearing difficulties, visual limitation, and learning disabilities like autism, attention deficit hyperkinetic disorder) in particular, find it difficult to absorb information in distant learning and face significant challenges in social and emotional skill development.

Moreover, extended school closures can have a detrimental effect on children’s mental health between avoidance behavior, post-traumatic stress disorder, and the length of quarantine. Prolong school closure can increase children’s chances of getting engaged in unhealthy behaviors like substance abuse. By being at school, students feel safe and connected. This feeling of connectedness decreases the incidence of depression, antisocial behavior, suicidal ideation, and they can constructively spend their time.

Additionally, in-person schooling provides access to mental health and social services for children like occupational therapy, speech and language therapy. Not to forget the role of school counselors trained to provide mental health support to children. Without in-person schooling, children cannot access these services.

For grades PK-12, social interaction at school is essential for language development, communication, interpersonal, social, and emotional skills. While being in-person at school, children can quickly learn how to make friends, continue their friendship, behave in groups, and build a social relationship outside their family circle. Students learn to respect each other’s opinions, practice tolerance, control their emotions, and develop decision-making skills. Prolonged school closure can have a detrimental effect on social-emotional growth and development.

Another disadvantage of extended school closure is the issue of safety and protection. Children who reside in unsafe living arrangements and neighborhoods are exposed to physical, sexual, and emotional abuse and maltreatment. In 2018, the Department of Health and Human services found out that teachers and other school staff reported more than one-fifth of reported child abuse cases. In the absence of the safety net provided by the trained school professionals who have the necessary skills to identify the signs of abuse and trauma and provide support, these numbers are expected to rise.

The role of schools in providing nutritional support to the children in need cannot be overlooked. In the US, more than 30 million children benefit from the National School Lunch Program, and around 15 million children participate in the School Breakfast Program. With the extended school closure, it is challenging to maintain such a school program, with certainty that the meals are provided to all the children in need.

Growing evidence suggests that children of all ages can have Covid-19 infection and have the tendency to spread the infection, but the benefits of in-person schooling outweigh the risks. But these risks cannot be overlooked. In the absence of a vaccine with proven benefits, implementing mitigation strategies to prevent Covid-19 infection like enforcing mask use, regular disinfecting and cleaning the surface and practicing physical distancing, and above all, staying home if unwell will ensure safe reopening of schools and will allow them to remain open for in-person learning.

The worldwide Covid-19 pandemic and the efforts to contain it represent a unique threat. We must recognize that the pandemic that will quickly follow it will be of mental and behavioral illness. To act in the child’s best interest and avoid harm, mental health and psychosocial support should be a core component of public health response. We must act now to support the mental health and psychological wellbeing of the world’s most vulnerable population at this extraordinary time.