"Think of the Children," COVID Edition: Lockdowns, School Closures, and Mask Mandates Negatively Impacted Children

Children have been used as political pawns on numerous occasions. Think of how much the argument "think of the children" has been used to push a political agenda. The Religious Right used it to incorrectly argue that same-sex couples are incapable of raising children. It has been used to advance universal preschool and bans on violent video games. It is an argument that does not die because of the emotions that children can invoke invoke in voters. Look at the recent news cycle. The mass shooting at a school in Uvalde, Texas has revitalized the call for more gun control. Those who are upset of the overturning of Roe v. Wade criticize the other side for not caring about children once they are out of the womb. This argument, of course, erroneously assumes that the only way to care about people is if you are in favor of government largesse, but I digress. 

When it comes to public health policy related to the pandemic, it becomes more and more clear over time that there was little to no foresight, cost-benefit analysis, risk assessment, or empirical evidence involved with the response to COVID in most countries. As much as COVID policy impacted adults, I really wish that politicians, especially those on the Left in the United States, thought of the children and the policy implications before proceeding because children got walloped as a result of poorly planned COVID health measures. 

It was evident from the beginning that children were not at high risk for COVID. In June 2021, the New York Times posted death rates based on CDC data (see below). They show that children are less likely to die from COVID than they are other causes of death, including drowning, car accidents, and homicide. 

If that were not enough, we can compare COVID deaths to the deaths from a previous pandemic: the H1N1 flu. From April 2009 to April 2010, there were 19.5 million infections and 1,282 deaths for those aged 0-17 (Shrestha et al., 2011). This would make the H1N1 mortality rate for children to be 0.0066 percent. What about COVID? According to CDC data, there were an estimated 25.8 million infections and 645 deaths between February 2020 and September 2021. This would make the COVID infection fatality rate for children 0-17 (as opposed to case fatality rate) to be 0.0025 percent. This would mean that COVID is about 62 percent less lethal than H1N1 for children aged 0-17 years. In 2022, the Lancet published an article showing that COVID has been much less deadly for children than it has been for older demographics, especially those over 75 years of age. 

The fact that children were less likely to suffer and die from COVID makes the costs that children had to undergo more unconscionable. The benefit of COVID policy to children was therefore less than it was for adults. Let us examine how these policies affected children specifically. 

Lockdowns

I first expressed my concerns about lockdown in March 2020. I detailed in May 2020 a list of potential problems, ranging from economy to physical health to mental to not doing much to save lives. As the data come in, we have seen that lockdowns actually caused greater excess death while coming with social costs, which puts a dent into the argument that we needed lockdowns and school closures to protect the elderly or teachers. What were the costs of lockdown to children? 

The United Nation's International Children's Emergency Fund, better known as UNICEF, released a report in October 2021 answering this very question. The results were unflattering for lockdowns. Children experienced higher rates of anxiety and depression. Those who were exposed to pre-existing childhood abuse and neglect experienced higher levels of stress. There is also concern of higher risk of trauma, suicide, loss of family and friends, violence, loneliness, isolation, and sleep deprivation. A longitudinal study from Cambridge University confirms these adverse impacts by showing that children's mental health deteriorated substantially as a result of lockdown (Bignardi et al., 2020). A February 2022 analysis from the British Broadcasting Network (BBC) found a 77 percent increase in self-harm and suicidal ideation as a result of lockdowns. Harvard University has acknowledged the effects that the lockdowns had on the mental health of children. 

If that were not enough, a UNICEF technical note from September 2020 estimated that lockdowns attributed to the 150 million children that were pushed into poverty as a result of everything that has happened. Given how millions of families were teetering on the financial edge prior to the pandemic, it makes sense how shutting down large swathes of the economy and depriving people of their employment had effects for their children, including in health, education, and social development. One peer-reviewed study looked at how the lockdowns reduced the access to housing, nutrition, sanitation, and health services (Cardona et al., 2022). Their global estimate is that 253,500 to 1,157,000 children under five died as a result of the economic downturn in which lockdowns played a major role. 

School Closures

It was not only businesses that ended up shutting down during the pandemic, but also schools. In 2020, the CDC Director Robert Redfield pointed out that it was not their recommendation to close schools, but it happened throughout much of the United States. The Chief Medical Officer of the United Kingdom also said that it was worse for children to miss school than it is to get COVID. I covered the topic of school closures in July 2020 and illustrated how the costs of school closure exceeded the benefits, but I think the topic is worth revisiting. School closures were part of the overall lockdown policy, but school closures came with their own specific costs. 

One major cost was in terms of academic delay. As this 2022 report from the Government Accountability Office (GAO) on pandemic learning illustrates, 52 percent of teachers had more students start the 2020-21 school year behind compared to a pre-pandemic year. 45 percent of teachers had at least half of their students end the academic year behind. The impact of school closures disproportionately impacted vulnerable students, including those who were high-poverty, English learners, or in special education. To quote UNESCO, "School closures carry high social and economic costs for people across communities. Their impact however is particularly severe for the most vulnerable and marginalized boys and girls and their families." 

None of this gets into the challenges facing teachers (including burnout) or how school closures increased childcare obligations for millions of parents. The increased childcare obligations becomes increasingly apparent for parents who work in the healthcare sector and need to be attentive to help fight COVID and other ailments. With all the trauma from the lockdowns, it is no wonder that academic achievement fell behind. These academic and social-economic delays are not merely short-term. They are going to have a ripple effect years out into the future. Here are a few studies:

• The Organization for Economic Cooperation and Development (OECD) found that the loss of three months is the equivalent of losing 2.5 to 4 percent of one's life income (Hanushek and Woessmann, 2020, p. 9). 
• A joint report from UNESCO, UNICEF, and the World Bank put the estimate at $17 trillion in lifetime earning in present value, which 14 percent of today's GDP (2021, p. 5). 
• Consulting firm McKinsey calculated that by 2040, the economic impact of these learning delays could lead to annual losses of $1.6 trillion, or 0.9 percent of the global GDP. 
• One study from JAMA found that it is not about economic impact or a diminishment of wages, but a matter of diminished life expectancy for our current children (Christakis et al., 2020). Their decision analytical model calculated that missed instruction during 2020 caused an estimated 13.8 million years of life lost in the United States. 
• A report from the United Kingdom's Office for Standards in Education shows how the restrictions resulted in the delay of babies' physical development, babies struggling to crawl and communicate, infants having issues in facial recognition, and a regression in children's independence. No doubt that the impact will be more pronounced as these infants get older and develop.  
• A May 2022 World Bank report found that children experienced a learning loss the average of 0.17 of a standard deviation, or a half a year's worth (Patrinos et al., 2022). One of the authors in this paper also found that a half year's loss in education translates into future earnings being 4 to 5 percent lower (Patrinos and Psacharopoulos, 2018). 
• A study from the National Bureau of Economic Research concluded that 10.1 of the 14.2 percentage point decline in passing rates for mathematics courses was due to school closures (Halloran et al., 2021).

Face Masks

Face masks have been politically contentious since the beginning of the pandemic in no small part due to their symbolism. I have written on face masks a number of times, most recently in a two-part analysis (see here and here). The long and short is that face masks did very little to nothing to mitigate the spread of COVID. Maybe masking children was different, especially given all the hullabaloo with masking children at schools. Alas, it was not any different. Arguably, it is less effective given how COVID is much less likely to adversely affect children in the first place. 

The Left-of-Center The Atlantic called children wearing masks "an intervention that provides little discernible benefit" in which we do not have evidence that they work. A preprint report with The Lancet replicated the CDC's methodology using a more robust and longitudinal data set. Their multivariate regression analysis demonstrates that there is not a relationship between school masking and pediatric COVID cases (Chandra and Høeg, 2022). A study from the United Kingdom government similarly found that face coverings in education settings found no statistically significant impact on COVID transmission.

Not only do I want to hammer the point that face masks did nothing statistically significant to protect children, I have to wonder if there was any harm done by face masks in the process. 

• A German-wide study that used a database of over 25,000 German parents (Schwartz et al., 2021), a study that admittedly has methodological limits, pointed out a number of concerns for children wearing masks, including irritability, headaches, difficulty concentrating, less happiness, more reluctance to attend schools, malaise, impaired learning, and drowsiness. The "still face experiment" shows us that children need facial expressions. The lack thereof causes emotional distress (e.g., Weinberg et al., 2008).
• A case study published in the Journal of Infectious Diseases and Epidemiology examined the effects of prolonged mask usage on healthcare workers in New York City (Rosner, 2020). Some of the causes of concern include headaches, acne, skin breakdown, and impaired cognition. 
• A preprint study from Italy (Martellucci et al., 2022) expresses concern about what happens when people inhale their own carbon dioxide and have a reduction in blood oxygen saturation as a result.  
• It is not only the physical aspects of wearing face masks that bother me. In my previous piece on the topic of face masks, I cover the social and emotional costs of face masks. Since children are more impressionable and are in their formative stages of development, the social and emotional costs for face masks are more pronounced with children. I worry that face masks keep children trapped in fear and anxiety, adversely affect how they perceive themselves (e.g., "there must be something intrinsically wrong with me"), make it difficult to communicate, sullies or deprives human interactions that are vital for development, and dehumanizes others by making people more suspicious of others (e.g., "they are vectors of disease, not human beings"). Given what we know about child development, it is not exactly a stretch to find that face masks negatively impacted children of having a normal, emotionally healthy childhood. 

The challenge of determining harm of face masks is not simply because it is a more subtle public health measure than lockdowns or school closures. It is that the evidence base for "face masks and children" is quite limited and not strong, which is why I hesitate to say anything conclusive about actual harm caused by face masks to children. Even so, everything in life has tradeoffs and that at least some of the aforementioned issues are quite plausible given the nature of face masks and children. Furthermore, given the lack of evidence that masks do anything significant to help people generally or children specifically when it comes to COVID, we should be safe rather than sorry and not force face masks on children. 

Conclusion

The more evidence that we come across, the more evident it becomes that the toll COVID policy exacted on children was tremendous. Children had to deal with greater anxiety, depression, and overall stress, as well as lower quality of life, physical health, academic achievement, and life expectancy. This did not need to happen, especially since children are 99.999 percent likely to survive COVID if contracted. The moral failing for how children were treated as a result of subpar and poorly-executed COVID policy cannot be overstated. It is going to take years to reverse the damage COVID policies inflicted upon children. My hope is that we learn for the next time and actually follow the science instead of peddling fear and being needlessly strict to no avail.