Kids and Covid-19: The urgency of equity should outweigh the urgency of normal

Across the United States, there’s a universal longing for the day when children no longer need to follow Covid-19 precautions, when they can go to school without wearing masks or social distancing or isolating — in short, when they can return to normal. And though this day hasn’t yet come for all children, a small group of physicians is gaining widespread media attention by declaring otherwise and promoting a vision of normalcy that disregards equity in health care for all children.

The Urgency of Normal “advocacy toolkit” has made quite a splash, its ideas having seeped into the national discourse about the pandemic. But it fails to address an important truth: although Covid-19 affects everyone, it does not affect everyone equally. Children from minoritized groups are disproportionally suffering from the physical and emotional impacts of the pandemic.

Claiming that vaccinated children have almost no risk of severe disease, the toolkit fails to consider the barriers to vaccination faced by many children from minoritized groups and low-income households, such as lack of access to care and language barriers.

And though the toolkit claims that Covid-19 poses only a flu-like risk for unvaccinated children, that isn’t supported by the evidence. More than 1,200 children in the U.S. have died from Covid-19 during the pandemic. Fewer than 200 children, by contrast, have died from the flu during the same time frame. In addition, children who have contracted Covid-19 also face associated health consequences like multisystem inflammatory syndrome and long Covid, risks not associated with the seasonal flu.

The Urgency of Normal proposal also argues that eliminating Covid-19 precautions in schools is needed to protect the mental and emotional health of children. It claims that these public health measures cause mental distress to students because they “increase fear and falsely convey that schools are unsafe,” causing more harm than good. Ironically, this claim fails to consider the devastating mental health impact that pandemic-related death and dying are causing children.

A recent National Institutes of Health study found that more than 140,000 U.S. children have lost a parent or caregiver to Covid-19; of these, 65% are from racial or ethnic minority groups. In the words of the CDC, this life-changing loss is “linked to mental health problems; shorter schooling; lower self-esteem; risky sexual behavior; and increased risks of substance abuse, suicide, violence, sexual abuse, and exploitation.”

Indeed, the impact of orphanhood and grief from the pandemic is just beginning to be understood. The Children’s Grief Center of El Paso, for example, has tracked an increase in demand for its services since the pandemic started. Its work documents a simple truth: children grieve differently than adults.

In short, they grieve developmentally. When a child experiences important milestones — the first day of school, making a sports team, getting a driver’s license, attending the high school prom — a parent’s absence is felt most strongly. The fixation with “normal” will be no match for the coming wave of childhood and juvenile grief the pandemic will leave in its wake.

I have no doubt that the physicians who created the Urgency of Normal toolkit are well intentioned and are sincerely concerned with the mental and physical well-being of children. But they are advocating for a return to normal that disregards the disproportionate impacts of the pandemic on children from minoritized groups and economically disadvantaged communities.

By downplaying the serious and ongoing risks that Covid-19 poses to the physical and mental health of vulnerable children, the Urgency of Normal approach exclusively addresses the interests of children in privileged communities who have largely been spared the pandemic’s most damaging impacts.

Covid-19 is a public health threat that affects everyone, but it does not affect everyone equally. Another way forward is possible. Unlike the Urgency of Normal, the Urgency of Equity recognizes the desire for normalcy without giving short shrift to society’s shared destiny. Following its lead, the prudent path forward is one that recognizes the disproportionate impact of the pandemic and continues to use public health precautions in schools and elsewhere to address the common good, rather than individualistic concerns.

Just as children develop and adapt, Americans and all global citizens must as well and recognize we cannot go back to “normal.” Instead, we need to move forward to a new normal with the knowledge and experience gained from the pandemic.

Octavio N. Martinez, Jr. is a psychiatrist, executive director of the Hogg Foundation for Mental Health, a clinical professor of psychiatry at the Steve Hicks School of Social Work, and a professor of psychiatry at Dell Medical School.