Empty classroom

Out of all the adults charged with taking care of children, pediatricians have been among the most vocal in calling for schools to reopen now. (Dreamstime/TNS)

Pediatricians across San Diego County say they are deeply troubled by what they see school closures doing to children.

Dr. Janet Crow, a pediatrician at UC San Diego, talks every day with middle and high school kids who are heading toward depression or are flat-out depressed, she said.

One of her high school patients can't bring himself to do Zoom school, she said. His mom isn't there to help him because she is an essential worker with two jobs. The 16-year-old also is working at a tire shop to support his family.

He used to have a school counselor and a teacher who were working hard to motivate him, Crow said, but now he doesn't see them because his school is closed.

"For all intents and purposes, he's dropped out," Crow said. "It's so heartbreaking for me because I've known this kid since he was born."

Another pediatrician, Dr. Leah Kern at UC San Diego, says some of her patients' development and academic progress are regressing.

One patient with cerebral palsy is supposed to be getting physical therapy at school. Instead he's getting it via Zoom — and now his ability to walk is regressing, she said.

And a high school-age patient who had straight A's for years now is getting C's because he has to help his second-grade brother with online school. He is the only one at home who speaks English, she said.

Vista pediatrician Dr. Veronica Naudin's patients are no longer going to school. They're logging in to Zoom, but they've lost the will to actually participate, she said.

One patient, a high schooler, did nothing but stare at her computer screen for the first hour and a half of a two-hour final exam, until her mom pushed her to complete at least some of the test.

Another, a senior, used to be high-achieving but now is so depressed she no longer sees why she has to graduate. She stopped participating online, and her mom has been telling the school her daughter is sick for months.

"What we're seeing is frightening, because it's hard to see these faces. They are just empty," Naudin said of her patients. "When you talk about school, it's like an emptiness to them, like school is just something that they're enduring. I miss seeing those kids who would talk about school with joy.

"What are we doing here? Why are we making kids pay this price?"

Out of all the adults charged with taking care of children, pediatricians have been among the most vocal in calling for schools to reopen now.

After almost 11 months of the pandemic, four out of five San Diego County K-12 students are in distance learning. Some of the county's largest school districts, including San Diego Unified and all South County districts, remain closed with no indication they will reopen soon.

Closed San Diego County schools are barred from reopening until the county case rate falls below 25 per 100,000 residents for elementary schools and 7 per 100,000 for middle and high schools.

At least two dozen San Diego pediatricians from the local American Academy of Pediatrics chapter recently mobilized a committee with one goal: helping schools to open again, immediately.

"Somebody needs to think about these kids who don't have a vote," Crow said. "Children never get to advocate for themselves. We have to advocate for them."

Lost connectionsSchools provide much more than academics to children; they are central to the development of their identity, independence and their sense of right and wrong, said Dr. Maya Kumar, an adolescent medicine specialist at Rady Children's Hospital.

School is where children learn how to interact with other people and develop such life skills as empathy, negotiation and respect.

"When you isolate into a Zoom, you don't have that," Crow said.

Without in-person interactions with teachers, counselors, principals, or other adults at school who encourage them or ask how they're doing, children are losing their will to learn. And without school, without friends, without fun and constructive activities like sports and clubs, children are losing their happiness and sense of purpose, Kumar said.

"In the same way people who are unemployed might feel depressed and uneasy when they're not going out achieving something purposeful, school is the job of an adolescent, and we've basically put them all out of work," Kumar said.

The harm to children of being cooped up at home goes beyond depression and poor academics.

Children are getting heavier. Kern has patients who have gained 20 to 25 pounds during school closures because they are no longer walking to school, playing at recess or participating in P.E. They're stuck at home, snacking more and spending much more time sitting and looking at screens.

"Gaining that weight and being that inactive so young … that can affect them for the rest of their lives," Kern said.

Kumar, who works in an eating disorder unit at Rady Children's, said the unit has become so overwhelmed with patients during the pandemic that it has moved patients to other parts of the hospital.

Kumar said more patients also are becoming victims of online sexual predators and are engaging in inappropriate behaviors like exchanging sexual photos or conversations online, because they are spending more time on screens, mainly social media and online gaming, she said.

Some patients have become so addicted to online gaming that they are neglecting eating, sleeping and showering, let alone homework.

"It looks exactly like a substance use disorder," Kumar said.

Kern said some of her patients who have ADHD may have to increase their medication because, even though they used to do well at school on a low dose, they're struggling more to sit and focus on online school.

"The parent and I really agree that the real treatment would be to get their child back in person at school," Kern said.

Experts say the health consequences of school closures today can change children's lives for the worse long after the pandemic ends. One November study in the Journal of the American Medical Association suggested the decision to close public primary schools will lead to a decrease in life expectancy for U.S. children.

School district leaders and teachers have given many reasons to keep schools closed throughout the pandemic.

They said COVID-19 case rates have been disproportionately higher in socioeconomically disadvantaged communities, so there is a higher risk of COVID spreading in schools there.

While most children do not get seriously sick from COVID, adults do, and school leaders said they don't want to risk COVID spreading from students to adults.

They also noted that San Diego County has yet to start vaccinating teachers. If they open schools and have to close them again due to positive COVID cases, that would be too disruptive to students, they said.

Kisha Borden, president of the San Diego Unified teachers union, said she and other educators are well aware of the trauma students are facing during the pandemic. But student mental health has long been an issue before the pandemic, she said, and school closures are not responsible alone for traumatizing students — the pandemic is.

Borden also said she thinks the pediatricians' recommendation to reopen schools now contradicts state guidance and guidance from the national American Academy of Pediatrics, both of which say the rate of community spread of coronavirus must be considered before determining whether schools can reopen.

She also pointed out that students and educators have lost family members to COVID, and many families do not want to return to school because COVID has devastated their communities.

"The arguments by the pediatricians erases these families' experiences, and that's not okay," Borden said.

Safe openingsThe pediatrician group is trying to alleviate these fears by pointing to several recent studies showing schools can and have reopened safely.

There is growing evidence that suggests schools do not significantly contribute to community spread of COVID-19 and that cases are rarely transmitted within schools as long as they follow basic safety measures such as masking and social distancing.

A study of 11 North Carolina school districts that had reopened with more than 90,000 students and staff found that, over nine weeks of in-person school, there were 32 COVID-19 infections that were transmitted within the schools, compared to 773 cases among staff and students that were acquired from outside school. Not one of the 32 in-school infections was transmitted from child to adult, according to the study.

Other studies also have suggested that children are more likely to get COVID-19 out in the community than in school.

The pediatricians, like other essential workers, have been working in-person and up close with children throughout the pandemic. They believe schools can and should do the same.

"We've figured out ways to make other small places safe. I think that's what can happen in schools," Crow said.

The pediatricians pointed out that several school districts and most private schools in the county have been open for months. Kern said she has some patients happily attending public and private schools in person in places like El Cajon, Santee and Lakeside.

"They feel safe and supported," she said, and parents are grateful that their child is in school.

"We want to share data that in other countries, in the other states, even in San Diego County, this has been done and it's been done safely and we really want them to know that they can go back and be safe."

There have been 27 outbreaks at K-12 schools in San Diego county, although outbreaks don't necessarily mean the cases were transmitted at school. The county says an outbreak is where three or more confirmed COVID-19 cases occur among people from different households within a two week period.

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