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

Youngsters at the moment are getting ready to move again to highschool for the third time for the reason that onset of the COVID-19 pandemic. Faculties are anticipated to return in-person this fall, with most consultants now agreeing the advantages of in-person studying outweigh the dangers of contracting COVID-19 for kids. Although kids are much less doubtless than adults to develop extreme sickness, the chance of contracting COVID-19 stays, with some kids creating signs of lengthy COVID following prognosis. COVID-19 vaccines present safety, and all kids older than 6 months at the moment are eligible to be vaccinated. Nevertheless, vaccination charges have stalled and stay low for youthful kids. At the moment, only some states have vaccine mandates for college workers or college students, and no states have faculty masks mandates, although practices can range by faculty district. Rising COVID-19 variants, just like the Omicron subvariant BA.5 that has just lately precipitated a surge in instances, could pose new dangers to kids and create challenges for the back-to-school season.

Youngsters might also proceed to face challenges because of the ongoing well being, financial, and social penalties of the pandemic. Youngsters have been uniquely impacted by the pandemic, having skilled this disaster throughout essential intervals of bodily, social, and emotional growth, with some experiencing the lack of family members. Whereas many kids have gained well being protection as a consequence of federal insurance policies handed throughout the pandemic, public well being measures to scale back the unfold of the illness additionally led to disruptions or modifications in service utilization and elevated psychological well being challenges for kids.

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

Youngsters’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 doubtless as a consequence of federal insurance policies handed throughout within the pandemic and the security internet Medicaid and CHIP supplied. Following development within the kids’s uninsured fee from 2017 to 2019, knowledge from the Nationwide Well being Interview Survey (NHIS) present that the kids’s uninsured fee held regular from 2019 to 2020 after which fell from 5.1% in 2020 to 4.1% in 2021. Simply launched quarterly NHIS knowledge present the kids’s uninsured fee was 3.7% within the first quarter of 2022, which was under 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 knowledge present that kids’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 offer steady protection for Medicaid enrollees till the top of the month wherein the general public well being emergency (PHE) ends to be able to obtain enhanced federal funding.

Youngsters have missed or delayed preventive care throughout the pandemic, with a 3rd of adults nonetheless reporting a number of kids 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 – Could 9, 2022 (33%) down 3% from nearly a yr earlier (July 21 – August 2, 2021) in line with KFF evaluation of the Family Pulse Survey. Adults in households with earnings lower than $25,000 had been considerably extra more likely to have a toddler that missed, delayed, or skipped a preventive appointment previously 12 months in comparison with households with earnings over $50,000. These knowledge are in keeping with findings from one other research that discovered households reporting monetary hardship had been considerably extra more likely to report lacking or delaying kids’s preventive visits in comparison with these not reporting hardships. Hispanic households and households of different racial/ethnic teams had been additionally considerably extra more likely to have a toddler that missed, delayed, or skipped a preventive appointment previously 12 months in comparison with White households (based mostly on race of the grownup respondent).

Telehealth helped to offer entry to care, however kids with particular well being care wants and people in rural areas continued to face obstacles. 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 kids doubtless nonetheless must atone for missed routine medical care. One research discovered nearly 1 / 4 of fogeys reported not catching-up after lacking a routine medical go to throughout the first yr of the pandemic. The pandemic could have additionally exacerbated present challenges accessing wanted care and companies for kids with particular well being care wants, and low-income sufferers or sufferers in rural areas could have skilled obstacles to accessing well being care through telehealth.

The pandemic has additionally led to declines in kids’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 faculty yr in comparison with the earlier yr, and a few public well being leaders notice COVID-19 vaccine hesitancy could also be spilling over to routine little one immunizations. The CDC additionally reported 34% fewer U.S. kids had blood lead stage testing from January-Could 2020 in comparison with the identical interval in 2019. Additional, knowledge recommend declines in lead screenings throughout the pandemic could have exacerbated underlying gaps and disparities in early identification and intervention for lower-income households and youngsters of coloration. Moreover, many kids depend on in-school imaginative and prescient screenings to identification imaginative and prescient impairments, and a few kids went with out imaginative and prescient checks whereas colleges managed COVID-19 and turned to distant studying. These screenings are essential for kids to be able to establish issues early; with out remedy some situations can worsen or result in extra severe well being issues.

The pandemic has additionally led to issue accessing and disruptions in dental care. Information from the Nationwide Survey of Youngsters’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 yr of the pandemic (Determine 3). The share of kids reporting their enamel are in glorious or excellent 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 knowledge for Medicaid/CHIP beneficiaries below age 19 exhibits 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 companies have rebounded to pre-PHE ranges whereas blood lead screenings and dental companies charges stay under per-PHE ranges. Telehealth utilization mirrors nationwide developments, growing 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 little one screening companies and vaccination charges declined by 5% (Determine 4). Blood lead screening companies and dental companies noticed bigger declines when evaluating the PHE interval to earlier than the PHE, declining by 12% and 18% respectively amongst Medicaid/CHIP kids.

Youngsters’s Psychological Well being Challenges

Youngsters’s psychological well being challenges had been on the rise even earlier than the onset of the COVID-19 pandemic. A current KFF evaluation discovered the share of adolescents experiencing anxiousness and/or despair has elevated by one-third from 2016 (12%) to 2020 (16%), though charges in 2020 had been just like 2019.  Charges of tension and/or despair 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 more likely to report persistent emotions of unhappiness and hopelessness than their heterosexual friends. Previously few years, adolescents have skilled worsened emotional well being, elevated stress, and an absence of peer connection together with growing charges of drug overdose deaths, self-harm, and consuming problems. Previous to the pandemic, there was additionally a rise in suicidal ideas from 14% in 2009 to 19% in 2019.

The pandemic could have worsened kids’s psychological well being or exacerbated present psychological well being points amongst kids. The pandemic precipitated disruptions in routines and social isolation for kids, which may be related to anxiousness and despair and can have implications for psychological well being later in life. Quite a lot of research present a rise in kids’s psychological well being wants following social isolation because of the pandemic, particularly amongst kids who expertise opposed childhood experiences (ACEs). KFF evaluation discovered the share of fogeys responding that adolescents had been experiencing anxiousness and/or despair held comparatively regular from 2019 (15%) to 2020 (16%), the primary yr 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 kids’s education and over half saying the identical about their kids’s psychological well being. Researchers additionally notice it’s nonetheless too early to totally perceive the impression of the pandemic on kids’s psychological well being. The previous two years have additionally seen a lot financial turmoil, and analysis has proven that as financial situations worsen, kids’s psychological well being is negatively impacted. Additional, gun violence continues to rise and will result in unfavorable psychological well being impacts amongst kids and adolescents. Analysis suggests that kids and adolescents could expertise unfavorable 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 throughout the pandemic. Preliminary knowledge for Medicaid/CHIP beneficiaries below age 19 finds utilization of psychological well being companies throughout the PHE declined by 23% when in comparison with previous to the pandemic (Determine 4); utilization of substance use dysfunction companies declined by 24% for beneficiaries ages 15-18 for a similar time interval. The information present utilization of psychological well being companies stays under pre-PHE ranges and has seen the smallest enchancment in comparison with different companies utilized by Medicaid/CHIP kids. Telehealth has performed a major function in offering psychological well being and substance use companies to kids early within the pandemic, however has began to decline. The pandemic could have widened present disparities in entry to psychological well being care for kids of coloration and youngsters 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 earnings kids much less more likely to obtain wanted psychological well being companies when in comparison with greater earnings teams (Determine 5).

Youngsters’s Well being and COVID-19

Whereas much less doubtless than adults to develop extreme sickness, kids can contract and unfold COVID-19 and kids with underlying well being situations are at an elevated threat of creating extreme sickness. Information via July 28, 2022 present there have been over 14 million little one COVID-19 instances, accounting for 19% of all instances. Amongst Medicaid/CHIP enrollees below age 19, 6.4% have obtained a COVID-19 prognosis via January 2022. Pediatric hospitalizations peaked throughout the Omicron surge in January 2022, and youngsters below age 5, who weren’t but eligible for vaccination, had been hospitalized for COVID-19 at 5 occasions the speed throughout the Delta surge.

Some kids who examined constructive for the virus at the moment are going through lengthy COVID. A current meta-analysis discovered 25% of kids and adolescents had ongoing signs following COVID-19 an infection, and finds the most typical signs for kids 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 kids who didn’t have a confirmed COVID-19 case. Nevertheless, researchers have famous it may be troublesome to tell apart lengthy COVID signs to normal pandemic-associated signs. As well as, a small share of kids are experiencing multisystem inflammatory syndrome in kids (MIS-C), a severe situation related to COVID-19 that has impacted nearly 9,000 kids. A variety of unknowns nonetheless encompass lengthy COVID in kids; it’s unclear how lengthy signs will final and what impression they are going to have on kids’s long-term well being.

COVID-19 vaccines had been just lately licensed for kids between the ages of 6 months and 5 years, making all kids 6 months and older eligible to be vaccinated towards COVID-19. Vaccination has already peaked for kids below the age of 5, and is way under the place 5-11 year-olds had been on the identical level of their eligibility. As of July 20, roughly 544,000 kids below the age of 5 (or roughly 2.8%) had obtained at the least one COVID-19 vaccine dose. Vaccinations for kids ages 5-11 have stalled, with simply 30.3% have been totally vaccinated as of July 27 in comparison with 60.2% of these ages 12-17.  Faculties have been essential websites for offering entry in addition to info to assist increase vaccination take-up amongst kids, although kids below 5 aren’t but enrolled in class, limiting this feature for youthful youngsters. A current KFF survey finds most dad and mom of younger kids newly eligible for a COVID-19 vaccine are reluctant to get them vaccinated, together with 43% who say they are going to “undoubtedly not” achieve this.

Some kids have skilled COVID-19 via the lack of a number of relations because of the virus. A research estimates that, as of June 2022, over 200,000 kids within the US have misplaced one or each dad and mom to COVID-19. One other research discovered kids of coloration had been extra more likely to expertise the lack of a guardian or grandparent caregiver when in comparison with non-Hispanic White kids. Shedding a guardian can have long run impacts on a toddler’s well being, growing their threat of substance abuse, psychological well being challenges, poor academic outcomes, and early demise. There have been over 1 million COVID-19 deaths within the US, and estimates point out a 17.5% to twenty% improve in bereaved kids as a consequence of COVID-19, indicating an elevated variety of grieving kids who might have further helps as they head again to highschool.

Wanting Forward

Youngsters might be again within the classroom this fall however could proceed to face well being dangers as a consequence of their or their instructor’s vaccination standing and growing transmission as a consequence of COVID-19 variants. New, extra transmissible COVID-19 variants proceed to emerge, with the latest 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 kids whose vaccination charges have stalled.

Faculties, dad and mom, and youngsters will doubtless proceed to atone for missed companies and lack of educational time within the upcoming faculty yr. Faculties are doubtless nonetheless working to handle the lack of educational time and drops in pupil achievement as a consequence of pandemic-related faculty disruptions. Additional, many kids with particular training plans skilled missed or delayed companies and lack of educational time throughout the pandemic. College students with particular training plans could also be entitled to compensatory companies to make up for misplaced abilities as a consequence of pandemic associated service disruptions, and a few kids, reminiscent of these with disabilities associated to lengthy COVID, could also be newly eligible for particular training companies.

To deal with worsening psychological well being and obstacles to care for kids, a number of measures have been taken or proposed on the state and federal stage. Many states have just lately enacted laws to strengthen faculty based mostly psychological well being methods, together with initiatives reminiscent of 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 must entry native and state funded disaster facilities, and the Biden Administration launched a technique to handle the nationwide psychological well being disaster in Could 2022, constructing on prior actions. Most just lately, in response to gun violence, the Bipartisan Safer Communities Act was signed into legislation and allocates funds in the direction of psychological well being, together with trauma care for college kids.

The unwinding of the PHE and expiring federal reduction could have implications for kids’s well being protection and entry to care. The American Rescue Plan Act (ARPA) prolonged 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 yr with out additional motion from Congress, which might improve premium funds for 13 million Market enrollees. As well as, provisions within the FFCRA offering steady protection for Medicaid enrollees will expire with the top of the PHE. Thousands and thousands of individuals, together with kids, might lose protection when the continual enrollment requirement ends if they’re now not eligible or face administrative obstacles throughout the course of regardless of remaining eligible. There’ll doubtless be variation throughout states in how many individuals are in a position to keep Medicaid protection, transition to different protection, or develop into uninsured. Lastly, there have additionally been a number of insurance policies handed all through the pandemic to offer monetary reduction for households with kids, however some advantages, just like the expanded Little one Tax Credit score, have expired and the price of home items is rising, growing meals insecurity and decreasing the utility of advantages like SNAP.


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