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Health experts are urging schools to ease COVID-19 restrictions and instead focus on those most vulnerable rather than continue to enforce blanket mandates for all children. Alto Images/Stocksy United
  • A group of doctors is urging a “return to normalcy” for children who’ve returned to in-person learning.
  • They say pandemic upheaval has led to increasing suicides and overdoses among young people.
  • Children’s risk from COVID-19, which was already low, has become even lower due to the availability of vaccines for children ages 5 and older.
  • Experts say it is important to strike a balance as we return children to more familiar environments.
  • It is important to protect those who are vulnerable to COVID-19 while also remembering that children need to feel that the world is safe and predictable.

Several states are taking steps to lift mask mandates in schools and other public spaces, a move that is likely to be lauded by at least one group of doctors and scientists.

Their team has put together what they say is “an open call to restore normalcy for U.S. children.”

Their website, Urgency of Normal, provides an advocacy toolkit and webinar that aims to educate parents, teachers, and other interested parties about the unintended effects that pandemic restrictions have had on young people, including suicides and drug overdoses.

The team has reviewed the evidence and feels that mental and physical health risks from the restrictions are now greater than the risk of COVID-19.

They note that children’s risk from COVID-19, which was already low, has become even lower due to vaccines for children ages 5 and older.

In addition, they say, the Omicron variant is causing milder disease.

Based on these facts, they suggest an immediate return to pre-pandemic norms. Masks should be optional by Feb. 15, they say, and people should stay home when sick.

They acknowledge that vulnerable children and adults should be protected from the virus, adding that society would be better served by applying targeted protection strategies aimed at the individual.

Their website provides the information they base their recommendations on and offers suggestions on how to achieve a return to “normalcy.”

Over 1,000 medical and health professionals have signed on to support the Urgency of Normal initiative.

Dr. Jeanne Ann Noble is one of them.

Noble is the director of UCSF’s residency program for physicians training in emergency medicine at Zuckerberg San Francisco General Hospital and Trauma Center.

“Targeted protection is more effective in protecting the most vulnerable than blanket mandates because we have finite resources,” she said.

“With the selective strategy of focusing on the most vulnerable, we can invest more resources on this relatively small group, less than 1 percent of our entire population, and increase the quality of our risk mitigation protections for this group,” Noble said.

“Similarly, investing in mask upgrades for the vulnerable rather than masking children and young adults is more likely to prevent serious illness without the collateral damage from stunting young people’s social and emotional development,” she added.

Jessica Borelli, PhD, an associate professor of Psychological Science at the University of California, Irvine, who is not a part of the project, said that a sense of “normalcy” is important for children to feel safe and secure.

“A sense of stability and calm,” said Borelli, “conveys to children that all is right in the world and that they do not have to worry about things falling down around them.”

She said that, in her experience, most children could adapt to new rules within a short time. For example, children over the age of 5 are fairly compliant with mask-wearing.

What is more difficult for them, however, is when circumstances change frequently or the adults around them enforce rules with a great deal of anxiety or frustration.

“This leads them to be on high alert or to become aware that the rules mean that something is wrong,” she explained.

Borelli said she recommends avoiding the frequent change of rules and restrictions.

“Keeping a sense of constancy in place helps children feel safe. It helps them know what to expect from their environment,” she said.

Then, when it is time to change rules, it should be explained to children why this is important, Borelli said.

She added that it is important for adults to convey a sense of calm and confidence to children so that they know the adults around them know what they are doing and are working to take care of them.

According to the doctors who created Urgency of Normal, the mental health fallout of the pandemic has been increased suicides and drug overdoses.

Borelli agreed that children’s mental health has worsened even before COVID-19, and these effects have been exacerbated during the pandemic.

“We have observed increases in mental health problems and suicidality that are alarming,” she said.

Borelli added that it is difficult to determine the precise causes of their worsening mental health because they have experienced stressors at an unprecedented level these past few years.

They have been exposed to death, trauma, illness in self and others, risk of infection, financial stress, job loss in the family, political upheaval, racism, school closures, disruption of routines and normalcy, and loss of connection with family and friends, she said.

“So, in addition to the stress of the restrictive measures, children also experienced the stress of the pandemic. It is difficult to disentangle these influences on their mental health.”

While Emma Maynard, PhD, a researcher and senior lecturer in Childhood Studies at the University of Portsmouth, Portsmouth, U.K., who is also not a part of the project, noted that the effects seen weren’t always negative, however.

Some previously disadvantaged children gained benefit from having a better teacher-to-student ratio or less formal learning environments, she said.

“So, while the links between increasing disadvantage and disproportionate impact in some groups are very well established,” said Maynard, “this suggests that the impact on individual children and young people will be determined by their particular experience and the capacity of those close to them to guide them through this experience.”

Dr. Mutiat Onigbanjo, a pediatrician at the University of Maryland Children’s Hospital and assistant professor of Pediatrics at the University of Maryland School of Medicine, who is not a part of the project, said that while social distancing is effective in decreasing the spread of disease, it has also led to the isolation of children from family and friends, which can be linked to poor mental health and substance misuse.

“It is too early to know if there will be irreparable harm to children’s mental health,” she said. “We do know that children can be very resilient.”

Onigbanjo is not in favor of widely relaxing COVID-19 precautions in schools at this time, citing the danger the SARS-CoV-2 virus still poses to children, “particularly if they are unvaccinated.”

She stressed that it is important to stay home when you are sick, wear a mask, and get vaccinated to decrease the risk of infection and spread.

As far as the “Return to Normalcy” proposal, Onigbanjo said it’s important to find a balance rather than to widely ease precautions across the board.

“Children are at risk of long-term complications of being infected with COVID-19. It is important to identify ways to return to normalcy while taking appropriate measures to prevent the spread of COVID-19,” she said.

She feels that getting vaccinated and taking other appropriate precautions to protect the most vulnerable is possible while still allowing a return to day-to-day activities that closely resemble a pre-pandemic way of life.