Three years since the Trump administration first declared the COVID-19 pandemic a national emergency, children and teenagers are still experiencing the lasting effects of pandemic-era lockdowns and disruptions to daily life, from exacerbated mental health problems to increased vulnerabilities to other diseases.
Health providers are warning that trends, such as a drop in coverage among kindergartners for state-required vaccines, unusual surges in respiratory syncytial virus or RSV, and mental health problems among children aren’t subsiding even as pandemic disruptions move further into the past.
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“We already knew that there was growth in the need for mental health care among children and adolescents in our country, and even back then we were thinking about different influences like social media, increased time spent online, school and social pressures that seemed to be already increasing,” said Karin Price, chief of psychology at Texas Children’s Hospital, the largest children’s hospital in the country. “COVID really took all of those things that we were already seeing as risk factors and kind of put them into high gear and then added increased pressure on top, of course, in terms of adapting to virtual schooling, dealing with illness and death in their families and in their communities, and really withdrawing them from social supports.”
Prior to the pandemic, Texas Children’s Hospital would see anywhere from 50 to 100 children in mental health crisis come into the hospital’s emergency centers in Houston per month. Since 2020, the hospital has seen between 400 to 500 patients coming in each month, and in January, they surpassed 500 patients for the first time, according to Price.
Numerous reports have documented the toll that the pandemic disruptions had on children’s mental health nationally, though concerns were present prior to the pandemic. In 2021, nearly three in five teenage girls felt persistently sad or hopeless, a rate that increased nearly 60% over the 10-year period from 2011 to 2021, according to a recent report by the Centers for Disease Control and Prevention.
“When we think about this getting better as the impact of the pandemic recedes a little bit, as kids are back connected to their social networks, we’re really not seeing the mental health concerns decrease in the way that we would hope,” Price said.
It comes as COVID-19 cases and hospitalizations have remained relatively stable for months after spiking in early 2022 from a surge in the highly transmissible omicron variant. As of March 1, there were over 226,000 new COVID-19 cases weekly, lower than the more than 370,000 new cases reported during the same period last year, according to CDC data. The Biden administration recently announced it plans to let the public health emergency expire in May.
As COVID-19 cases have trended down, it has opened up room for other respiratory viruses, including RSV, to gain a foothold, especially among young children in the United States who may not have been exposed to the viruses in recent years.
A surge in cases of RSV, flu, and COVID-19, deemed the “tripledemic,” strained children’s hospitals in many states last fall as inpatient beds filled up and emergency rooms were overwhelmed with patients.
“The COVID-19 pandemic caused atypical respiratory virus circulation, including for RSV, for the last two years. That means children — especially those ages two years and younger — may not have been exposed to these viruses before,” a CDC spokesperson said in a statement to the Washington Examiner. “As people congregate more and let up on mitigation efforts that they used during the pandemic, it’s not surprising to see an increase in respiratory disease circulation.”
The Children’s Hospital Association and the American Academy of Pediatrics had urged President Joe Biden last November to issue an emergency declaration due to the uptick in respiratory viruses.
The COVID-19 pandemic and the later surge in respiratory viruses among children last fall has also had a downstream effect on the vaccination coverage of kindergartners across the country. Coverage of four state-required vaccines for public and private schools, including the measles, mumps, and rubella vaccine (MMR); diphtheria, tetanus, and acellular pertussis vaccine (DTaP); poliovirus vaccine (polio); and varicella vaccine (chickenpox) fell by 1 percentage point to roughly 93% in the 2021-2022 school year among kindergartners compared to the prior school year, according to CDC data.
The latest data show that despite most schools returning to in-person learning, vaccination rates have yet to catch up with pre-pandemic levels. Health officials and the CDC have indicated that vaccine hesitancy toward the COVID-19 vaccine may have had an impact on routine childhood immunizations. States have also reported that lower response rates from schools, extensions or grace periods for enrollment requirements, and reduced access to vaccination appointments due to the COVID-19 pandemic affected immunization rates and data collection.
“When we look at the fall of 2021 when kids were coming into school, if they were coming into school, the school nurses that are usually the ones in charge of ensuring that kids are meeting those vaccination requirements were completely overwhelmed with contact tracing and case investigation and just trying to help kids be able to stay in school,” said Dr. Michelle Fiscus, chief medical officer at the Association of Immunization Managers. “There was just no capacity for school nurses to be able to look at those records, to make sure everyone is up to date, to make sure that kids didn’t come to school if they weren’t fully vaccinated. “
While the CDC has noted that vaccination coverage still remains high, recent outbreaks of vaccine-preventable diseases have raised concerns that more could pop up in the future if vaccination coverage continues to decline. A recent measles outbreak in Ohio infected more than 80 children, with the majority of cases being among unvaccinated school-aged children, per state data.
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“We haven’t seen a lot of cases of measles or mumps or chickenpox in the last years because of vaccines, and so parents have forgotten how children suffer when they get infected with these vaccine-preventable diseases,” said Fiscus.
Fiscus noted that there is hope that vaccination numbers will rise in the coming year if the number of COVID-19 cases and other respiratory viruses continues to wane.
