By: Andres Pacherres and Stephany Santos
Education is a fundamental right of the individual and society. It transforms lives and is a fundamental tool for human development. (UNESCO, 2021) Investing in education implies investing in a better society for citizens. However, this right has been affected since the arrival of the COVID-19 health emergency. Since March 11, when the state of national health emergency was declared, to date all children have not yet returned to school either in a fully face-to-face or semi-presential format. To understand the closure of schools and the return to face-to-face classes, it is necessary to analyze information and experiences from other countries. However, the most important factor is the context of each country, region and community.
Globally, the control and status of the pandemic is heterogeneous among the 5 regions. For example, vaccination is progressing at an uneven pace with regions such as Europe and North America exceeding 40% of the population fully immunized. In the opposite direction, the African region has barely been able to fully immunize 2.3% of its population (Our World in Data, 2021). The World Health Organization has criticized the actions of high-income nations in having approved the use of third doses or boosters, calling for prioritizing equity in vaccine distribution globally (New York Times, 2021).
COVID-19 in children and adolescents
In the global scenario, it is important to contextualize which new variants of SARS-CoV-2 are currently predominant. The greatest emphasis is being placed on the variants termed "Delta" and "Lambda" by the WHO. The Delta variant is the variant that has the highest human-to-human transmissibility, being 60% more transmissible than the Alpha variant. It has also been reported to have a greater capacity to infect respiratory tract cells. On the other hand, the Lambda variant is the predominant one in our territory.
Epidemiological characteristics of children and adolescents vary from country to country based on restrictions, vaccination, social determinants, etc. It is worth mentioning that age is a very important factor in COVID-19 mortality. In this regard, children have a case fatality rate for infection between 0.001 and 0.01% compared to older adults who have a case fatality rate higher than 5 or 10%. Likewise, hospitalizations, severe illness and ICU requirements among children and adolescents were very low compared to other age groups. In this regard, according to reports from England, deaths associated with COVID-19 in children are very rare. However, other factors such as: emerging variants (Delta and Lambda), comorbidities and "persistent or long COVID" should be considered. (Nature, 2021).
Effects of school closures
The implementation of distance education programs in Peru was very heterogeneous between private and public sectors. Private schools used different platforms to connect synchronously and asynchronously with their students while the public sector used the strategy of "Aprendo En Casa" (I learn at home) through TV and radio, as well as the delivery of tablets.
The impact on the learning process is big for this generation. The World Bank estimates that this would mean the loss of 2.4 years of education. Evidence has been generated from the context of other countries such as Belgium, which reported a decrease in math and language averages by 2020. Likewise, it was reported that grade point averages were 1/5 lower compared to previous years and this increase if mothers have a lower educational level or live in a poor neighborhood. On the other hand, in Brazil, scores on standardized tests decreased and it is estimated that students learned 27.5% of what they would have learned face-to-face. (Lichand, Doria, Neto & Cossi, 2021).
There are also negative effects on adolescent girls, such as an increase in the risk of marriage by almost 25% per year. This results in 2% of girls not returning to school (UNICEF, 2021). It has been estimated that for every additional 3 months of total quarantine, there is a 20% increase in cases of sexual violence, with an estimated 15 million new cases (UNFPA, 2020). (UNFPA, 2020). The closure of educational institutions, prolonged quarantines, loss of family members and, consequently, orphanhood, leave adolescent girls vulnerable to sexual abuse and child marriage.
Economically, it has been estimated that school closures are equivalent to a reduction of 0.8% of the world's annual economic growth rate and in low-income countries, on an individual level, a loss of US$2,833 is estimated. Similarly, to low-income countries, losses in GDP are 43 to 61% (World Bank, 2020). The long-term consequences must be understood in the context of the profound inequalities in societies and the social determinants of health. Therefore, in the long term, lower productivity, increased inequalities, lower income for affected children and adolescents, lower employability and lower human capital are foreseen.
Impact on mental health
The return to classes during the state of emergency due to COVID-19 is one of the actions that various countries have been implementing in response to the impact on mental health that virtual classes have had on minors. COVID-19 has produced changes around the world. Since these changes created uncertainty about the future; anxiety has been generated in adults, young people and children, which has led to a reflection on the state of mental health of the population in the framework of COVID-19. As well as anxiety, another element that appeared in the present situation was depression, since the fact of staying at home without social contact generates loneliness and sometimes sadness. These elements added to the risk factors of minors such as the transition of life stages and adaptation to new scenarios have been able to influence the academic performance of students, thus generating low performance or behavioral change, however, as virtual classes have already been developed for approximately a year and a half, students have managed to adapt to this new school environment. It is expected that soon it will be possible to return to face-to-face classes gradually and gradually so that the children can develop their social and intellectual skills in their school and thus reduce the risk of affecting their mental health and quality of life.
A meta-analysis estimated the overall prevalence with 1 in 4 children presenting symptoms of depression and 1 in 5 presenting symptoms of anxiety. Likewise, some risk factors for developing anxiety symptoms are lack of routine, adolescence, excessive exposure to COVID-19 information, frequency of cases in the community, and relatives with frontline duties. Finally, it has been reported that children with emotional instability experience 15.5% more stress and have fewer positive learning experiences.
In Peru, we have managed to surpass 20% of the population fully immunized in August (Our World In Data, 2021). However, children have not been able to access face-to-face classes for 17 months. It is important to point out that , according to the Ministry of Education, there are around 68,127 educational institutions authorized for semi-presential schools and/or programs. Likewise, 21 regions have approved the return to classes in blended learning format, prioritizing rural sectors, benefiting 189 thousand schoolchildren.
For the return to face-to-face classes, both international evidence and the national context should be taken into account. International evidence suggests that the risk of SARS-CoV-2 infection and transmission within schools has been very low, approximately 0.16%. Likewise, the probability of contagion also remains low, with Norwegian records of child-to-child transmission of 0.9% and child-to-adult transmission of 1.7%. Likewise, teachers and employees are more likely to infect each other. This factor can be controlled with complete immunization.
In relation to the national context, it is essential to continue with genomic surveillance of the Delta and Lambda variants to monitor potential outbreaks in children and adolescents. In this regard, in view of the Ministry of Health's announcement of a potential third wave, it will be necessary to accelerate the vaccination of teachers and the population in general. On the other hand, biosecurity conditions should be ensured in educational institutions, prioritizing the use of masks and adequate ventilation. Transportation, access to water and sanitation, and social conditions are key factors that require the coordination of all actors.
What is the estimated overall prevalence of anxiety symptoms in children?
1 in 5 (correct)
1 in 10
1 in 7
1 in 4
Which of the following is NOT a risk factor for the development of anxious symptoms in children and adolescents?
Lack of routine
Family communication (correct)
Exposure to COVID-19 info
Do children transmit more and contagion is the same as in adults?
Brandal, L. T., Ofitserova, T. S., Meijerink, H., Rykkvin, R., Lund, H. M., Hungnes, O., Greve-Isdahl, M., Bragstad, K., Nygård, K., & Winje, B. A. (2021). Minimal transmission of SARS-Cov-2 from paediatric COVID-19 cases in primary schools, Norway, August to November 2020. Eurosurveillance, 26(1). https://doi.org/10.2807/1560-7917.es.2020.26.1.2002011
Bravata, D., Cantor, J., Sood, N., & Whaley, C. (2021). Back to school: The effect of school visits during COVID-19 on COVID-19 transmission. https://doi.org/10.3386/w28645
COVID-19 in children and the role of school settings in transmission - second update. (2021, July 8). European Centre for Disease Prevention and Control. https://www.ecdc.europa.eu/en/publications-data/children-and-school-settings-covid-19-transmission
COVID-19: A threat to progress against child marriage. UNICEF DATA. (2021, July 22). https://data.unicef.org/resources/covid-19-a-threat-to-progress-against-child-marriage/.
Dahir, A. L. (2021, August 19). Booster shots 'make a mockery of vaccine equity,' the W.H.O.'s Africa director says. The New York Times. https://www.nytimes.com/2021/08/19/world/africa/africa-vaccine-booster-shots.html.
El derecho a la Educación. UNESCO. (2019, February 14). https://es.unesco.org/themes/derecho-a-educacion.
Iterbeke, Kaat, & De Witte, Kristof. (2020). Helpful or harmful? The role of personality traits in student experiences of the COVID-19 crisis and school closure. KU Leuven – Faculty of Economics and Business.
Ledford, H. (2021, July 15). Deaths from COVID 'INCREDIBLY RARE' among children. Nature News. https://www.nature.com/articles/d41586-021-01897-w.
Lichand, G., Dória, C. A., Neto, O. L., & Cossi, J. (2021). The impacts of remote learning in Secondary EDUCATION: Evidence from Brazil during the pandemic. https://doi.org/10.21203/rs.3.rs-568605/v1
Mahase, E. (2021). Covid-19: How many variants are there, and What do we know about them?: Video 1. BMJ. https://doi.org/10.1136/bmj.n1971
Maldonado, J. E., & De Witte, K. (2021). The effect of school closures on standardised student test outcomes. British Educational Research Journal. https://doi.org/10.1002/berj.3754
O’Driscoll, M., Santos, G. R., Wang, L., Cummings, D. A. T., Azman, A. S., Paireau, J., Fontanet, A., Cauchemez, S., & Salje, H. (2020). Age-specific mortality and IMMUNITY patterns OF Sars-cov-2 infection in 45 countries. Nature. https://doi.org/10.1101/2020.08.24.20180851
Panchal, U., Salazar de Pablo, G., Franco, M., Moreno, C., Parellada, M., Arango, C., & Fusar-Poli, P. (2021). The impact of COVID-19 lockdown on child and adolescent mental health: Systematic review. European Child & Adolescent Psychiatry. https://doi.org/10.1007/s00787-021-01856-w
Psacharopoulos, G., Collis, V., Patrinos, H. A., & Vegas, E. (2020). Lost wages: The COVID-19 cost of school closures. SSRN Electronic Journal. https://doi.org/10.2139/ssrn.3682160
Racine, N., McArthur, B. A., Cooke, J. E., Eirich, R., Zhu, J., & Madigan, S. (2021). Global prevalence of depressive and anxiety symptoms in children and adolescents during COVID-19. JAMA Pediatrics. https://doi.org/10.1001/jamapediatrics.2021.2482
Ritchie, H., Mathieu, E., Rodés-Guirao, L., Appel, C., Giattino, C., Ortiz-Ospina, E., Hasell, J., Macdonald, B., Beltekian, D., & Roser, M. (2020, March 5). Coronavirus (covid-19) VACCINATIONS - statistics and research. Our World in Data. https://ourworldindata.org/covid-vaccinations.
Simulating the potential impacts of the covid-19 school closures on schooling and learning outcomes: A set of global estimates. World Bank. (2020, June 18). https://www.worldbank.org/en/topic/education/publication/simulating-potential-impacts-of-covid-19-school-closures-learning-outcomes-a-set-of-global-estimates.
UNFPA. (2020, April 27). Impact of the COVID-19 pandemic on family planning and ending gender-based violence, female genital mutilation and child marriage. UNFPA - United Nations Population Fund. https://www.unfpa.org/resources/impact-covid-19-pandemic-family-planning-and-ending-gender-based-violence-female-genital