6 top questions about COVID-19: What a child psychiatrist has to say

A lot of my work was focused on early childhood development and childhood disabilities; the health of young people, particularly in school populations; and improving the quality of care for people with mental health problems.

Most of this work is being conducted in India, in partnership with Sangath, a nonprofit committed to improving human health.

I think the most important thing to keep in mind is that science is still learning a lot about this virus, and people shouldn’t rush to conclusions about a particular finding reported by a single study. Every finding requires replication—one must never interpret a single discovery as fact until it has been proven through subsequent scientific research.

So I would advise the general population to listen to and act on facts that have been proven.

For example, we know that masks are probably one of the most important pieces of personal virus protection that people can use because we know COVID-19 is a respiratory illness that spreads through droplets. Wearing a mask is a known effective strategy from previous coronavirus epidemics, and it is the most important step people can take to protect themselves and others.

And while we know the odds that a child or an adolescent will fall seriously ill with the virus are low, I think it’s really important for kids and young people to have a sense of altruism—to recognize that, in protecting themselves from the virus, they are also protecting their parents. These are the sorts of ideas that we should invoke in our kids, rather than fear.

“When will it end?” And, honestly, that’s the question that I ask the most as well.

No one knows the answer right now, and anyone who says they do is simply making a lot of assumptions. Those assumptions are important, but they need to come with the caveat that there is so much uncertainty.

Young people, especially, are facing high levels of uncertainty. For kids, it can be disturbing to hear conflicts about COVID-19 on television and in the media—these debates between different sections of society are fracturing the solidarity of communities and the sense of certainty that kids would like to have about the future of their world.

And for those who are just graduating from school, the drying up of the job market can be very troubling. If you put all of this together, it is no surprise that fear and anxiety is sweeping young people.

Local action is what works. It worked during the 1918 Spanish Flu pandemic 100 years ago, and not surprisingly, it’s what works in 2020.

That is, wearing masks, contact tracing, helping people quarantine at home, and localized micro-containments and lock-downs are effective.

If you look at East Asia—like China and South Korea—this is what they’ve done. They have basically taken from a playbook that’s been around for decades—and these measures have shown to be effective.

It’s important to first acknowledge that the mental health of children is profoundly affected by the environments they inhabit. For younger children, the primary environment is the home, but as they grow older, schools also play a very important role. And both of these environments have been utterly disrupted by the pandemic.

We, as a community, must review every aspect of this issue. Will school closures help reduce COVID-19 transmission rates? The answer is yes. But is that the right question?

The right question is: What, also, is the impact of closing schools on society—for kids and parents alike?

In answering that, we can begin to acknowledge many other consequences, such as the real potential for increased stress, anxiety and depression for children and their parents that continued isolation may cause. Schools aren’t just places where you learn math and science; they are also where you shape your social personality. And being at home poses new burdens on parents too, especially women, who have to manage their kids and their work simultaneously.

We need to make a decision that is based on a balanced understanding of the gains and losses of school closures, and I don’t believe we’ve really done that yet. And this decision needs to include input from children.

What’s really of great concern to me is the complete absence of young people’s voices in this conversation. I have yet to see a compelling survey that has asked children: How do you feel?

Above all, parents should ask their kids how they’re feeling about what’s going on, then discuss their fears and doubts and reassure them the world will eventually return to normal.

What I do with my son, who is a young adult now, is we sit down over dinner every evening and discuss what we’ve heard on the news to make sense of it, as well as focus on positive news, like about therapeutics and vaccines. Filtering information and having conversations with your kids about the epidemic is essential. You can’t leave them completely vulnerable to what they’re picking up on the internet.

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Compared to other large and diverse countries, the U.S. is unique in that every state can devise its own policy, which means you are seeing 52 different experiments happening in the same county.

Some states, like Massachusetts, have done remarkably well, but others have not, and it comes down to variations in state policies.

All this is to say that it’s difficult to predict when normalcy will return to the country as a whole.