The Coronavirus Seems to Spare Most Kids From Illness, but Its Effect on Their Mental Health Is Deepening

Pandemics can be indiscriminate, with viruses making no distinctions among the victims they attack and those they spare. If you’re human, you’ll do. COVID-19 has been different, particularly when it comes to age. The disease has shown a special animus for older people, with those 65-plus considered at especially high risk for hospitalization and death, and those 18 and below catching a semblance of an epidemiological break. Though a small share of adolescents have suffered severe cases, most who contract the disease in that age cohort are likelier to experience milder symptoms or none at all.

But if COVID-19 is sparing most kids’ bodies, it’s not being so kind to their minds. Nobody is immune to the stress that comes with a pandemic and related quarantining. Children, however, may be at particular risk. Living in a universe that is already out of their control, they can become especially shaken when the verities they count on to give the world order–the rituals in their lives, the very day-to-dayness of living–get blown to bits.

“I worry that kids will get a double wallop,” says Ezra Golberstein, a health-policy researcher at the University of Minnesota. “There’s the disease itself and the fear of it. On top of that, you’ve got the lock-downs, with kids removed from the school environment and their friends.” As summer approached, many of the 12,000 camps in the U.S. either postponed their seasons or canceled them altogether, further leaving children isolated. “Especially for kids predis-posed to seeing the world in pessimistic terms, there will be more anxiety because they feel so much more out of control,” says Mary Alvord, a Maryland-based psychologist specializing in children, and co-author of Resilience Builder Program for Children and Adolescents. “We’re hearing kids say, ‘I’m afraid for myself, for my parents. What if we get sick?'”

Now, as the next school year approaches, there’s even more uncertainty. The U.S. Centers for Disease Control and Prevention (CDC) has issued guidelines for schools, analyzing the comparative infection risks for three different scenarios: continuing all-remote learning (what it calls “lowest risk”); mixing some remote learning with inperson classes and social distancing (“more risk”); and resuming full-time attendance (“highest risk”). It’s impossible to say which states will choose which approaches, but already, the massive Los Angeles and San Diego school systems have announced that they will begin the school year with remote learning only–a decision that means yet more quarantining for 825,000 students. They surely won’t be the only ones.

For now, there is a dearth of hard research on how the pandemic is affecting children’s mental health, mostly because the virus has been so fast-moving and studies take time. What data does exist is troubling. In one study out of China, published in JAMA Pediatrics, researchers in Hubei province, where the pandemic originated, examined a sample group of 2,330 schoolchildren for signs of emotional distress. The kids had been locked down for what, to quarantine-weary Americans, likely seems like a relatively short period–an average of 33.7 days. Even after that single month, 22.6% of them reported depressive symptoms and 18.9% were experiencing anxiety.

Then too there is the other sickly victim of the pandemic: the economy, which continues to struggle badly. In a 2018 paper published in Health Economics, Golberstein and his co-authors studied economic conditions in the U.S. from 2001 to 2013 and found that during the Great Recession, a 5-percent-age-point increase in the national unemployment rate correlated with an astounding 35% to 50% increase in “clinically meaningful childhood mental-health problems.” With unemployment now exceeding 11%–compared with 3.6% in January–Golberstein expects to see more of the same emotional blowback. “When the economy is in a bad place, kids’ mental health gets worse,” he says. “This time is going to be much worse because it’s also a pandemic.”

Lisa Stanton lives in Houston with her husband and their 9-year-old fraternal twins. Both parents are employed and have been working from home–though Stanton’s husband has been able to go back to his on-site work as a property manager–and both children have been home from school. With their summer camp shuttered for the season, the kids have remained homebound and the household environment has grown … challenging.

“I’m seeing 100% more behavioral problems,” says Stanton. “My son, who has learning issues, has three meltdowns a day. With my daughter, the problem became addiction to the iPad. She has a TikTok account and created an [alias] of an older girl. We took the tablet away, and there were hysterics. She told us, ‘I want to be on the tablet all the time because [when I am] I don’t feel so lonely.'”

Loneliness in lockdown is common for kids separated from their friends. But all children will not be emotionally rattled by the pandemic equally–or even at all; COVID-19 will affect them to different degrees and in different ways. Roxane Cohen Silver, a social psychologist at the University of California, Irvine, specializes in human responses to mass trauma and has most closely studied the Sept. 11 attacks in the U.S. and the 2006 and 2010 earthquakes in Indonesia and Chile, respectively. Though nobody in any culture does especially well in a time of such tragedy, Silver has found that the closer individuals are to a crisis–both geographically and personally–the greater the impact. People in New York City and Washington, D.C., had more acute reactions to 9/11 than people more removed from the terrorist strikes. The coronavirus is similarly hitting some people harder than others.

“The impact on a child’s sense of safety depends on the extent to which the family is affected,” Silver says. “If there is a loss or if the family has a drastic change in their economic consequences, this event would shape the children’s view of the world.”

But being able to avoid personal loss is not the same as avoiding the fear of it, and children are very much aware of what’s at stake. “I have a grandma and a grandpa who are very old, and it can infect them and they may die,” said 4-year-old Benjy Taksa of Houston, in a very brief mom-supervised interview with TIME. Lisa Taksa, Benjy’s mother, says her son doesn’t otherwise seem anxious about the pandemic, and to the extent he does, he is finding ways to cope. “In his play I’ll hear him say, ‘This bear is going to the museum, and he has to wear his mask,'” she says.

Another variable is whether a child came into the crisis with pre-existing mental-health problems. In the U.S., 7.1% of children in the 3-to-17 age group have been diagnosed with anxiety, according to the CDC. An additional 3.2% in the same age group suffer from depression. Then there are the 7.4% with diagnosed behavior problems and the 9.4% with ADHD. Silver found that in the aftermath of 9/11, adolescents’ level of distress closely tracked whether or not they had a history of such conditions. Other experts expect to see that pattern repeated because of COVID-19.

“Children who were struggling before [the pandemic] are at higher risk now,” says psychologist Robin Gurwitch, a professor at Duke University Medical Center. “You have to be careful about kids who were already in mental-health services; we have to make sure services aren’t disrupted.”

Adults and children in therapy with private mental-health professionals may go right ahead Zooming or Skyping their sessions with no interruption in treatment. But some kids don’t have the opportunity. In an April editorial published in JAMA Pediatrics, Golberstein and his co-authors reported that according to an analysis of 2014 data, 13.2% of adolescents received some form of mental-health services in the school setting in the preceding 12 months (a figure that is more or less the same today). Their further analysis of data from 2012 to 2015 showed that among all students who received any mental-health services, 57% got a portion of it at school while 35% received all of it there. With schools shut down, so is the care. And, as things stand, there’s no guarantee which schools will reopen in the fall.

“I worry about what this is doing to kids,” says Golberstein. “The extent to which they are able to access mental-health care is always a challenge. There’s a long-standing shortage, and it’s worse with the school closures.”

Age can also be a big factor in how hard the pandemic hits kids emotionally. Very small children might not notice anything is different except that their parents aren’t going to work, which may seem like all upside. “For younger children, being with their parents full-time is seen as a plus,” says Silver.

But those same younger kids have acutely twitchy antennae when it comes to reading the anxious mood of the older people around them. The ambient stress in a locked-down household in which parents are fretting, perhaps quarreling, and disinfecting everything that doesn’t move does not go unnoticed by children. “In very young children, you might see more clinginess,” says Gurwitch. “Kids are going to have a harder time sleeping. In children who have been potty-trained, you may see regression and accidents. This is not,” she adds, “a recipe for ease or joy.”

For schoolagers and teens, being with parents is all downside, and being with friends is everything. In the case of the pandemic, that essential socializing is out of the question. Silver points out that one of the things that helped Americans rebound after the 9/11 attacks was a sort of great cultural coming together–precisely what can’t happen now.

“People congregated and went to their houses of worship, and there were memorials,” she says. “For children, being restricted from gathering with friends at a time they may most want to spend time with them makes this event very different.”

If there is one thing that’s certain about the impact of the pandemic on the young mind, it’s that it’s not going to stop until the spread of COVID-19 itself does. For parents and other caregivers, that means mitigating the problem, not mending it altogether. One important step: dial back the media–especially TV news. Thomas Cooper, professor of media ethics at Emerson College in Boston, sees an important precedent in the coverage of the Sept. 11 attacks–and it troubles him. “During 9/11, we found that the prime-time coverage of airplanes flying into World Trade Center buildings with people jumping out of windows led to something that you might call emotional poisoning,” he says. “People saw it again and again and again and again, and there was a kind of totally demoralizing effect. When you hear about COVID-19 again and again and again and again, all of that leads to a kind of emotional poisoning too.”

How much coverage any one home should allow depends, again, on the age of the kids. “‘Littles’ shouldn’t be exposed to this at all,” Gurwitch says. “Don’t think that when they’re drawing or playing a game with you while you’re watching TV that they’re not listening.” For older kids who have a greater sense of the unfolding crisis, Gurwitch still recommends a limited TV diet. More important, she argues for open communication in which parents ask their children what they know–or think they know, correct them when they’re wrong and validate their fears. Thinking about precautions like social distancing as ways to behave proactively can also help kids regain some sense of control. “It can be framed as ‘Here’s what we’re doing to keep our families safe and keep others safe, and make sure health care workers don’t have to worry about us,'” Gurwitch says.

Eventually, the pandemic will assume its place in the canon of national traumas, alongside 9/11, the Challenger disaster and the Kennedy assassination. The young generation living through coronavirus now will have the same conversations with their peers as they get older–the do-you-remember and where-were-you-when exchanges–as earlier generations have had about those other tragedies. For some, the memories will be of a more private pain. The goal, for parents and professionals and other caregivers, is to help ease that pain, to make the now more bear-able for kids, so that the memories will be too.