Opinion: The Next Pandemic

December 14, 2020 submitted by Kristin Boal, Hingham Resident and Nurse Practitioner in the Medical ICU and Biocontainment Unit at Boston Children's Hospital

If you look at any news outlet, you can see the Covid-19 case count rising throughout the U.S. This virus is real and needs to be taken seriously. However, what the news is not covering is the mental health crisis that is raging among children whose worlds have been turned upside down. I'm a Nurse Practitioner in the Medical ICU and Biocontainment Unit at Boston Children's Hospital. In my capacity at Children's Hospital, I see the daily counts of admissions due to suicidal tendencies, anxiety, and depression increasing drastically.

If you walked through an elementary school in Hingham last year, you would see displays in the hallways of the "Toolbox"- the social-emotional learning curriculum that the school has implemented for children K-6. According to the Toolbox project website, it is "a research-based, community-tested kindergarten through sixth grade social and emotional learning (SEL) program that builds and strengthens children's inherent capacity for resilience, self-mastery and empathy for self and others through its curricula, methods, and strategies." Our children's mental health and well-being were given a prominent place in the buildings and in the classroom. However, since March of 2020, it seems the mental health and well-being of our children has taken a back seat at the time when our children have needed it the most.

As school reopening plans were made this summer, there was objective data published in world-renowned medical journals stating that it was safe for children and staff to be back in school following proper protocol. We had months of data from schools in Europe and Israel to access that showed what worked and what didn't so that the administration and school committee could prepare. The American Academy of Pediatrics and Dr. Fauci supported the return to the classroom with proper protocols and guidelines. We have learned that children can get the virus, but young children, in particular, do not transmit the virus.

Why didn't Massachusetts public schools follow the science? Why didn't Hingham follow the science? Why didn't we have children in school when case counts were low, like nearby private schools, parochial schools, and schools in neighboring towns. Just now, as the virus is spiking, we are considering bringing back K-2 when it was immediately obvious in the spring and again in September that remote learning was not working for young children and their teachers. In January, we know we'll face obvious barriers due to the spike of Covid. Our children feel like collateral damage due to the disorganization, lack of transparency, possibly calculated moves, and politically driven decisions of our Hingham Public School system and the Mass Public School system. Something seems amiss, and the constant lack of transparency is upsetting.

I think a lot of us have accepted that this is the way it's going to be for the rest of the school year. We have gone through our stages of grief and are now in the acceptance phase. But we have the data that supports that elementary-age children can be in school safely, so why are we letting so many children struggle? Really struggle. Children who were otherwise thriving and doing well in school are disengaging and acting out. Parents are afraid to speak up for fear of judgment from a neighbor, fear of seeming ungrateful for what our schools have provided, and fear of impacting their children's relationship with their teachers. Now I am speaking up. We can no longer accept the current way our children are learning, especially young children.

While I know that remote learning and hybrid learning may be working for some families, I know it is not working for others. I am speaking up for the kids and their parents who are struggling. Some children are really struggling with the lack of consistency, the lack of interaction, and the lack of a nurturing face other than their parents and guardians. The mental health emergencies are being admitted in an epidemic wave. There are no beds for these psychiatric emergencies. Not only are we short Covid beds for adults in adult hospitals, but we also do NOT have beds for children having psychiatric emergencies. I have seen a dramatic increase in suicidal attempts from ingestions, alcohol intoxication, polysubstance abuse, and cutting, to name a few. I've seen children with no psychiatric history admitted to the hospital for anxiety attacks, depression, and suicidal ideation, and I work very part-time. In my almost 20 year career in pediatrics, I have never witnessed this mental health fallout. Mary Beth Miotto, a Worcester-area pediatrician and the vice president of the Massachusetts chapter of the American Academy of Pediatrics recently stated, "I have lost family to COVID, I take it very seriously, but I also take seriously child and youth suicide, where we have growing data that concerns us." I couldn't agree with her more.

I LOVE my children's teachers, and I LOVE my school's principal. I have so much gratitude for what they have been able to accomplish. Our school principal is a constant warm and nurturing light, and I am so impressed with how the teachers and staff have been able to concurrently teach children in the classroom and teach children remotely. They have been given an impossible task and, in my opinion, have done remarkably well given the constraints put in place by their representation and by Covid protocols. However, I think that the individuals/groups making the decisions for HPS need to really open their eyes to what is unfolding around us.

Our children are entitled to public education. We shouldn't have to pay beyond our taxes to have our children's basic educational and social-emotional needs met. All districts have their own obstacles, but why can't we stand out in Massachusetts and the South Shore? Why can't we prioritize our children's education and mental health like we did a few years ago with the implementation of The Toolbox? Why can't we, as a community, be a leader in following the science and safety of getting our kids back to school? We need more transparency and a concrete plan. We owe it to our children.

We have Covid-19 data in front of us, but we don't have data on the mental health sequelae from children not being in school. I see it now in my home, neighborhood, and work. But while this data is gathered it will be retrospective, and there will be a time delay for disseminating the information. It will be too late by the time this information is published. We, as a community, have to act now to help our children. Not only is their education at stake, but in my opinion, more importantly, their mental health.

It is clear our children's education is in dire straits and will take years to recover, resulting in unmeasured effects throughout our nation. But in my opinion and far more important, our children's mental health is on the brink of a catastrophe that we can prevent if we act. As a parent and as a healthcare provider who is witnessing first-hand the detrimental effects of Covid-19, we see the mental health deterioration of children; I implore the administration, school committee, and union to truly put the needs of our children first.

Please don't get me wrong, the health and well-being of the Hingham Public Schools staff are also of utmost importance to me, and I do not want anyone to get Covid-19. But I want us to really consider and be aware of what else is happening in front of us. Mental health is another important metric that should be considered and measured. Let's not continue to let our children's education and mental health be politicized. We need to act now and be a part of the solution and not part of the problem.

Help save our children's lives before the third pandemic happens. Let's flatten the mental health curve.

Thanks for your time to hear/read my opinion. I'm curious to hear about other people's experiences, including teachers, medical providers and parents.

Kristin Boal is a Hingham Resident, Parent and Nurse Practitioner in the Medical ICU and Biocontainment Unit at Boston Children's Hospital