By Dr. Ronald Cohn

The COVID-19 pandemic has caused us all to re-evaluate how and where we care for our patients. From ramping up virtual health visits to contingency planning for a surge of COVID-19 infections to the rapid deployment of assessment centres in communities hit hard by the virus, we have truly shown patient care doesn’t just happen at the bedside. In fact, some of the most important care we provide may not take place on our hospital wards at all.

Throughout the pandemic, we have heard from politicians, public health officials, business owners, economists, frontline workers, among others (I’m sure many of you who are reading this have been participating in the public discourse and I applaud you for doing so!). But there is a group of voices that has gone unheard for many, many months – our children and youth. We have a duty to uphold the highest standards of excellence in care for children. That includes speaking on their behalf at the tables they are often not invited to attend and lifting up the voices of brave youth advocates when they do speak out.

Our greatest opportunity to meet all our children’ health-care needs at this moment is the careful planning of a safe, successful return to daily school. The impact on the mental, behavioural and developmental health of children and teens who are not going to school, not experiencing in-person teaching and not being with their peers, is something many of us are losing sleep over.

Heightened anxiety, lack of social supports, loss of routine and social isolation are all indirect effects of school closures that can have a dramatic impact on the well-being of children and youth. A recent survey by Children’s Mental Health Ontario found one in three Ontario parents reported their child’s mental health has deteriorated from being home from school and more than half of the parents noticed behavioural changes in their child. These ranged from drastic changes in mood, behaviour and personality, to difficulty sleeping and more. Those with pre-existing mental health issues have been hit particularly hard.

The physical health of children and youth is also being negatively impacted by school closures. The meal-delivery and vaccination programs offered in schools are lifelines for many families who would otherwise struggle to access healthy food and preventive medical care. Many are spending prolonged periods of time at home without adequate supervision, resulting in both a reduction of physical activity and increase in preventable injuries. And while we have significantly underestimated the impact school closures have on children of all socioeconomic backgrounds, those who have vulnerable home situations are at particularly high risk without daily, in-person school, where teachers and school staff may be the first to identify cases of abuse or neglect. Let me briefly summarize the literature on COVID-19 and children as we know it in July 2020.

Evidence is mounting that young children may be less susceptible and less likely to transmit COVID-19. There is also strong evidence that the majority of children who become infected with the virus are either asymptomatic or have only mild symptoms. However, it is important to emphasize that children (especially children with complex medical conditions) have largely been isolated, so it is possible that these data may change over time as children attend school and are interacting more with peers and adults. Several countries have reopened schools without triggering a significant increase in cases.

Yet, we must recognize that it will not be possible to remove all risk of infection now that COVID-19 is well established in many communities. Instead, it is time to accept this virus will be with us for some time and put in place effective strategies to ensure the safety of students, their families, teachers and school staff.

This will represent a drastic shift in the mindset of a public who has, correctly, been told to stay home and avoid other people. And ultimately, ministries of education, ministries of health, public health experts, school boards, principals, teachers, parents and students are the most qualified to chart the best course for a September return to school. However, as paediatric health-care providers, we also have a role to play.

We must speak up for our children and demonstrate that continuing to stay home from school has become untenable for children and youth, while providing evidence-based strategies to inform the reopening of schools for everyone’s safety.

I invite you to read our new COVID-19: Updated Recommendations for School Reopening document, which addresses how schools can reopen in a way that maximizes the safety and well-being of students, teachers, school staff and families. This is a living document developed by experts from SickKids, in partnership with other Ontario hospitals  and with input from a wide array of stakeholders on how we may be able to accomplish these goals.