Headed Back to School: A Look at the Ongoing Effects of COVID-19 on Children’s Health and Well-Being

Kids are actually getting ready to move again to highschool for the third time for the reason that onset of the COVID-19 pandemic. Colleges are anticipated to return in-person this fall, with most specialists now agreeing the advantages of in-person studying outweigh the dangers of contracting COVID-19 for youngsters. Although youngsters are less seemingly than adults to develop extreme sickness, the danger of contracting COVID-19 stays, with some youngsters creating signs of lengthy COVID following prognosis. COVID-19 vaccines present safety, and all youngsters older than 6 months are actually eligible to be vaccinated. Nevertheless, vaccination charges have stalled and stay low for youthful youngsters. At the moment, just a few states have vaccine mandates for college employees or college students, and no states have college masks mandates, although practices can differ by college district. Rising COVID-19 variants, just like the Omicron subvariant BA.5 that has not too long ago precipitated a surge in circumstances, could pose new dangers to youngsters and create challenges for the back-to-school season.

Kids may proceed to face challenges because of the ongoing well being, financial, and social penalties of the pandemic. Kids have been uniquely impacted by the pandemic, having skilled this disaster throughout essential durations of bodily, social, and emotional improvement, with some experiencing the lack of family members. Whereas many youngsters have gained well being protection attributable to federal insurance policies handed in the course of the pandemic, public well being measures to scale back the unfold of the illness additionally led to disruptions or adjustments in service utilization and elevated psychological well being challenges for youngsters.

This transient examines how the COVID-19 pandemic continues to have an effect on youngsters’s bodily and psychological well being, considers what the findings imply for the upcoming back-to-school season, and explores latest coverage responses. A companion KFF brief explores financial results of the pandemic and up to date rising prices on households with youngsters. We discover households with youngsters have been significantly onerous hit by lack of revenue and meals and housing insecurity, which all affect youngsters’s well being and well-being.

Kids’s Well being Care Protection and Utilization

Regardless of job losses that threatened employer-sponsored insurance coverage protection early within the pandemic, uninsured charges have declined seemingly attributable to federal insurance policies handed throughout within the pandemic and the security internet Medicaid and CHIP supplied. Following development within the youngsters’s uninsured charge from 2017 to 2019, data from the Nationwide Well being Interview Survey (NHIS) present that the kids’s uninsured charge held regular from 2019 to 2020 after which fell from 5.1% in 2020 to 4.1% in 2021. Simply released quarterly NHIS knowledge present the kids’s uninsured charge was 3.7% within the first quarter of 2022, which was beneath the speed within the first quarter of 2021 (4.6%) however a slight uptick from the fourth quarter of 2021 (3.5%), although none of those variations are statistically important. Administrative data present that youngsters’s enrollment in Medicaid and CHIP elevated by 5.2 million enrollees, or 14.7%, between February 2020 and April 2022 (Determine 1). Provisions within the Households First Coronavirus Response Act (FFCRA) require states to supply continuous coverage for Medicaid enrollees till the tip of the month wherein the general public well being emergency (PHE) ends as a way to obtain enhanced federal funding.

Kids have missed or delayed preventive care in the course of the pandemic, with a 3rd of adults nonetheless reporting a number of youngsters missed or delayed a preventative check-up previously 12 months (Determine 2). Nevertheless, the share lacking or delaying care is slowly declining, with the share from April 27 – Might 9, 2022 (33%) down 3% from virtually a 12 months earlier (July 21 – August 2, 2021) in keeping with KFF evaluation of the Household Pulse Survey. Adults in households with revenue lower than $25,000 had been considerably extra prone to have a toddler that missed, delayed, or skipped a preventive appointment previously 12 months in comparison with households with revenue over $50,000. These knowledge are according to findings from one other study that discovered households reporting monetary hardship had been considerably extra prone to report lacking or delaying youngsters’s preventive visits in comparison with these not reporting hardships. Hispanic households and households of different racial/ethnic teams had been additionally considerably extra prone to have a toddler that missed, delayed, or skipped a preventive appointment previously 12 months in comparison with White households (primarily based on race of the grownup respondent).

Telehealth helped to supply entry to care, however youngsters with particular well being care wants and people in rural areas continued to face limitations. Total, telehealth utilization soared early within the pandemic, however has since declined and has not offset the decreases in service utilization general. Whereas preventative care charges have elevated since early within the pandemic, many youngsters seemingly nonetheless have to compensate for missed routine medical care. One study discovered virtually 1 / 4 of oldsters reported not catching-up after lacking a routine medical go to in the course of the first 12 months of the pandemic. The pandemic could have additionally exacerbated existing challenges accessing wanted care and providers for children with special health care needs, and low-income sufferers or sufferers in rural areas could have skilled barriers to accessing health care via telehealth.

The pandemic has additionally led to declines in youngsters’s routine vaccinations, blood lead screenings, and imaginative and prescient screenings. The CDC reported vaccination protection of all state-required vaccines declined by 1% within the 2020-2021 college 12 months in comparison with the earlier 12 months, and a few public well being leaders note COVID-19 vaccine hesitancy could also be spilling over to routine baby immunizations. The CDC also reported 34% fewer U.S. youngsters had blood lead stage testing from January-Might 2020 in comparison with the identical interval in 2019. Additional, knowledge suggest declines in lead screenings in the course of the pandemic could have exacerbated underlying gaps and disparities in early identification and intervention for lower-income households and youngsters of coloration. Moreover, many youngsters depend on in-school imaginative and prescient screenings to id imaginative and prescient impairments, and a few youngsters went with out vision checks whereas faculties managed COVID-19 and turned to distant studying. These screenings are essential for youngsters as a way to establish issues early; with out therapy some situations can worsen or result in extra critical well being issues.

The pandemic has additionally led to issue accessing and disruptions in dental care. Knowledge from the Nationwide Survey of Kids’s Well being (NSCH) present the share of kids reporting seeing a dentist or different oral well being supplier or having a preventive dental go to previously 12 months declined from 2019 to 2020, the primary 12 months of the pandemic (Determine 3). The share of kids reporting their tooth are in wonderful or superb situations additionally declined from 2019 (80%) to 2020 (77%); the share of kids reporting no oral well being issues additionally declined however the change was not statistically important.

Lately launched preliminary data for Medicaid/CHIP beneficiaries beneath age 19 reveals steep declines in service utilization early within the pandemic, with utilization then rebounding to a various diploma relying on the service sort. Little one screening providers have rebounded to pre-PHE ranges whereas blood lead screenings and dental providers charges stay beneath per-PHE ranges. Telehealth utilization mirrors nationwide traits, rising quickly in April 2020 after which starting to say no in 2021. When evaluating the PHE interval (March 2020 – January 2022) to the pre-PHE interval (January 2018 – February 2020) general, the information present baby screening providers and vaccination charges declined by 5% (Determine 4). Blood lead screening providers and dental providers noticed bigger declines when evaluating the PHE interval to earlier than the PHE, declining by 12% and 18% respectively amongst Medicaid/CHIP youngsters.

Kids’s Psychological Well being Challenges

Kids’s psychological well being challenges had been on the rise even earlier than the onset of the COVID-19 pandemic. A latest KFF evaluation found the share of adolescents experiencing anxiousness and/or melancholy has elevated by one-third from 2016 (12%) to 2020 (16%), though charges in 2020 had been much like 2019.  Charges of tension and/or melancholy had been extra pronounced amongst adolescent females and White and Hispanic adolescents. A separate survey of highschool college students in 2021 discovered that lesbian, homosexual, or bisexual (LGB) college students had been extra prone to report persistent emotions of disappointment and hopelessness than their heterosexual friends. Previously few years, adolescents have skilled worsened emotional well being, elevated stress, and a scarcity of peer connection together with rising charges of drug overdose deaths, self-harm, and consuming problems. Previous to the pandemic, there was additionally a rise in suicidal thoughts from 14% in 2009 to 19% in 2019.

The pandemic could have worsened youngsters’s psychological well being or exacerbated current psychological well being points amongst youngsters. The pandemic precipitated disruptions in routines and social isolation for youngsters, which could be associated with anxiety and depression and can have implications for psychological well being later in life. Quite a lot of studies present a rise in youngsters’s psychological well being wants following social isolation because of the pandemic, particularly amongst youngsters who expertise antagonistic childhood experiences (ACEs). KFF analysis discovered the share of oldsters responding that adolescents had been experiencing anxiousness and/or melancholy held comparatively regular from 2019 (15%) to 2020 (16%), the primary 12 months of the pandemic. Nevertheless, the KFF COVID-19 Vaccine Monitor on views of the pandemic at two years discovered six in ten dad and mom say the pandemic has negatively affected their youngsters’s education and over half saying the identical about their youngsters’s psychological well being. Researchers additionally word it’s nonetheless too early to completely perceive the affect of the pandemic on youngsters’s psychological well being. The previous two years have additionally seen a lot financial turmoil, and research has proven that as financial situations worsen, youngsters’s psychological well being is negatively impacted. Additional, gun violence continues to rise and will result in adverse psychological well being impacts amongst youngsters and adolescents. Research suggests that youngsters and adolescents could expertise adverse psychological well being impacts, together with signs of tension, in response to highschool shootings and gun-related deaths of their communities.

Entry and utilization of psychological well being care could have additionally worsened in the course of the pandemic. Preliminary data for Medicaid/CHIP beneficiaries beneath age 19 finds utilization of psychological well being providers in the course of the PHE declined by 23% when in comparison with previous to the pandemic (Determine 4); utilization of substance use dysfunction providers declined by 24% for beneficiaries ages 15-18 for a similar time interval. The data present utilization of psychological well being providers stays beneath pre-PHE ranges and has seen the smallest enchancment in comparison with different providers utilized by Medicaid/CHIP youngsters. Telehealth has performed a big role in offering psychological well being and substance use providers to youngsters early within the pandemic, however has began to decline. The pandemic could have widened current disparities in entry to psychological well being look after children of color and children in low-income households. NSCH knowledge present 20% of kids with psychological well being wants weren’t receiving wanted care in 2020, with the bottom revenue youngsters much less prone to obtain wanted psychological well being providers when in comparison with greater revenue teams (Determine 5).

Kids’s Well being and COVID-19

Whereas less seemingly than adults to develop extreme sickness, youngsters can contract and unfold COVID-19 and children with underlying health conditions are at an elevated threat of creating extreme sicknessData by July 28, 2022 present there have been over 14 million baby COVID-19 circumstances, accounting for 19% of all circumstances. Amongst Medicaid/CHIP enrollees beneath age 19, 6.4% have received a COVID-19 prognosis by January 2022. Pediatric hospitalizations peaked in the course of the Omicron surge in January 2022, and youngsters beneath age 5, who weren’t but eligible for vaccination, had been hospitalized for COVID-19 at five times the speed in the course of the Delta surge.

Some youngsters who examined constructive for the virus are actually going through long COVID. A latest meta-analysis discovered 25% of kids and adolescents had ongoing signs following COVID-19 an infection, and finds the commonest signs for youngsters had been fatigue, shortness of breath, and complications, with different lengthy COVID signs together with cognitive difficulties, lack of odor, sore throat, and sore eyes. One other report discovered a bigger share of kids with a confirmed COVID-19 case skilled a brand new or recurring psychological well being prognosis in comparison with youngsters who didn’t have a confirmed COVID-19 case. Nevertheless, researchers have famous it may be difficult to differentiate lengthy COVID signs to basic pandemic-associated signs. As well as, a small share of kids are experiencing multisystem inflammatory syndrome in youngsters (MIS-C), a critical situation related to COVID-19 that has impacted almost 9,000 children. A number of unknowns nonetheless encompass lengthy COVID in youngsters; it’s unclear how lengthy signs will final and what affect they are going to have on youngsters’s long-term well being.

COVID-19 vaccines had been not too long ago authorized for youngsters between the ages of 6 months and 5 years, making all youngsters 6 months and older eligible to be vaccinated in opposition to COVID-19. Vaccination has already peaked for youngsters beneath the age of 5, and is much beneath the place 5-11 year-olds had been on the identical level of their eligibility. As of July 20, approximately 544,000 youngsters beneath the age of 5 (or roughly 2.8%) had acquired at the least one COVID-19 vaccine dose. Vaccinations for youngsters ages 5-11 have stalled, with simply 30.3% have been absolutely vaccinated as of July 27 in comparison with 60.2% of those ages 12-17.  Schools have been important sites for offering entry in addition to info to assist broaden vaccination take-up amongst youngsters, although youngsters beneath 5 are usually not but enrolled at school, limiting this selection for youthful youngsters. A latest KFF survey finds most dad and mom of younger youngsters newly eligible for a COVID-19 vaccine are reluctant to get them vaccinated, together with 43% who say they are going to “positively not” accomplish that.

Some youngsters have skilled COVID-19 by the lack of a number of members of the family because of the virus. A study estimates that, as of June 2022, over 200,000 youngsters within the US have misplaced one or each dad and mom to COVID-19. One other study discovered youngsters of coloration had been extra prone to expertise the lack of a father or mother or grandparent caregiver when in comparison with non-Hispanic White youngsters. Dropping a father or mother can have long run impacts on a toddler’s well being, increasing their threat of substance abuse, psychological well being challenges, poor educational outcomes, and early death. There have been over 1 million COVID-19 deaths within the US, and estimates point out a 17.5% to 20% increase in bereaved youngsters attributable to COVID-19, indicating an elevated variety of grieving youngsters who may have further supports as they head again to highschool.

Trying Forward

Kids shall be again within the classroom this fall however could proceed to face well being dangers attributable to their or their trainer’s vaccination standing and rising transmission attributable to COVID-19 variants. New, extra transmissible COVID-19 variants proceed to emerge, with the newest Omicron subvariant BA.5 driving a brand new wave of infections and reinfections amongst those that have already had COVID-19. This might result in challenges for the back-to-school season, particularly amongst younger youngsters whose vaccination charges have stalled.

Colleges, dad and mom, and youngsters will seemingly proceed to compensate for missed providers and lack of educational time within the upcoming college 12 months. Colleges are seemingly nonetheless working to handle the lack of educational time and drops in pupil achievement attributable to pandemic-related college disruptions. Additional, many youngsters with particular training plans experienced missed or delayed providers and lack of educational time in the course of the pandemic. College students with special education plans could also be entitled to compensatory providers to make up for misplaced abilities attributable to pandemic associated service disruptions, and a few youngsters, resembling these with disabilities associated to lengthy COVID, could also be newly eligible for particular training providers.

To deal with worsening psychological well being and limitations to care for youngsters, a number of measures have been taken or proposed on the state and federal stage. Many states have not too long ago enacted laws to strengthen college primarily based psychological well being methods, together with initiatives resembling from hiring extra school-based suppliers to permitting college students excused absences for psychological well being causes. In July 2022, 988 – a federally mandated disaster quantity – launched, offering a single three-digit quantity for people in have to entry native and state funded disaster facilities, and the Biden Administration launched a strategy to handle the nationwide psychological well being disaster in Might 2022, constructing on prior actions. Most not too long ago, in response to gun violence, the Bipartisan Safer Communities Act was signed into legislation and allocates funds in direction of psychological well being, together with trauma care for college youngsters.

The unwinding of the PHE and expiring federal reduction could have implications for youngsters’s well being protection and entry to care. The American Rescue Plan Act (ARPA) extended eligibility to ACA medical insurance subsides for folks with incomes over 400% of poverty and elevated the quantity of help for folks with decrease incomes. Nevertheless, these subsidies are set to run out on the finish of this 12 months with out additional motion from Congress, which might enhance premium funds for 13 million Market enrollees. As well as, provisions within the FFCRA offering steady protection for Medicaid enrollees will expire with the tip of the PHE. Millions of individuals, together with youngsters, may lose protection when the continual enrollment requirement ends if they’re not eligible or face administrative limitations in the course of the course of regardless of remaining eligible. There’ll seemingly be variation throughout states in how many individuals are capable of keep Medicaid protection, transition to different protection, or change into uninsured. Lastly, there have additionally been a number of insurance policies handed all through the pandemic to supply monetary reduction for households with youngsters, however some advantages, just like the expanded Little one Tax Credit score, have expired and the price of home items is rising, increasing meals insecurity and lowering the utility of advantages like SNAP.


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