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Pediatricians: Pandemic Recovery Plans Ignoring Child Health, Education

From states' reopening plans to federal emergency aid, the U.S. response to the novel coronavirus pandemic has "focused on the health and economic effects facing adults," and top pediatricians argue child wellness and school reopening plans must be included in discussions for the nation's recovery.

"Even as states provisionally plan on opening workplaces, most are giving no consideration to opening schools," said Dimitri Christakis, director of Seattle Children's Research Institute, Center for Child Health, Behavior, and Development and editor of JAMA Pediatrics, in the first of a trio of articles on the reopening problem published online today in that journal. "The risks posed by delaying school openings are real and sizeable, particularly for students from low-income families. ... No credible scientist, learning expert, teacher, or parent believes that children aged 5 to 10 years can meaningfully engage in online learning without considerable parental involvement, which many families with low incomes are unable to provide because parents must work outside the home."

In a separate article, researchers led by Dr. Danielle Dooley, of the Child Health Advocacy Institute at Children's National Hospital in Washington, D.C., argue that state and federal governments must do more to target support to the health and learning needs of low-income children who have been disproportionately hit by the virus and the school closures.

The nearly $2.5 trillion in federal emergency aid so far has covered protective health gear and coronavirus testing, lost paychecks and small business loans, food assistance and help for local governments—but relatively little aid targeted directly to low-income children, Dooley and her colleagues noted. (The Coronavirus Aid, Relief, and Economic Security Act provides $16 billion earmarked for states and school districts for K-12 and higher education.)

"This legislation has understandably aimed to contain the pandemic and its economic fallout," Dooley and her colleagues wrote. "While many adults will experience months of challenges, low-income children are at risk of experiencing consequences for a lifetime. To prevent these harms, the U.S. should commit to fully addressing the needs of children as part of its national response" including emergency funding for family services and early-childhood learning, and money to close the digital divide for distance learning, they wrote.

Closer Looks at Child Infections

In the third research analysis, on coronavirus-related school closures this spring, Italian research physicians Susanna Esposito, of the pediatric clinic at Pietro Barilla Children's Hospital in Parma, and Nicola Principi, of the Università degli Studi di Milano, in Milan, suggest the closures are not contributing as much to controlling the spread of COVID-19 as prior studies have found school closures contributed to mitigating the spread of influenza outbreaks.

Modeling studies of data from China and the United Kingdom showed school closures alone were not significantly effective at flattening the curve, Esposito and Principi found. And those studies aligned with studies from earlier outbreaks of related coronaviruses responsible for severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), which also found school closures less effective for controlling the spread of coronavirus than influenza. 

Why? Because the models "seem to indicate that school closure can be significantly effective for infection control only when the outbreaks are due to viruses with low transmissibility and attack rates are higher in children than in adults"—true for flu, but not for SARS or COVID-19, which has hit older people harder than children.

Other new studies out this month suggest that children who contract coronavirus do shed infectious particles, and that school closures still have a role to play in curbing or delaying the peak of outbreak, as long as the closures are done in combination with broader social-distancing measures

Christakis called for President Donald Trump's coronavirus task force to set up an expert panel of epidemiologists and infectious disease experts, as well as  educators and child psychologists, to review the evidence on both children's risk for coronavirus infection and transmission, and the potential educational and mental health risks and best practices for continuing distance learning. 

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