The Benefits & Challenges of In-person Learning During COVID-19

Sep 03, 2021

If you have school-aged children right now, you may be torn between feeling relief at the prospect of finally having a kid-free workday, and anxiety at the thought of the exposure to COVID-19 that they will face at school. In my mind, it’s a balance between risks and benefits. For most children, the risks of missing out on the learning environment of the classroom will dwarf the risks of COVID-19. However, you will have to decide for your family and hopefully this can serve as a guide.

The risks of COVID-19 for children: Over 4.5 million children have tested positive for COVID-19 since the onset of the pandemic. After declining in early summer, child cases have increased exponentially, with over a four-fold increase the past month, rising from about 38,000 cases the week ending July 22nd to 180,000 the past week. For the week ending August 19, children were 22.4% of reported weekly COVID-19 cases. The available data indicates that COVID-19-associated hospitalization and death is uncommon in children. However, a small subset of children will develop complications such as myocarditis or MIS-C syndrome associated with a current or recent COVID-19 infection.

Myocarditis is inflammation of the heart muscle. A viral infection usually causes myocarditis, but it can result from a reaction to a drug or be part of a more general inflammatory condition. Signs and symptoms include chest pain, fatigue, shortness of breath, and arrhythmias. Severe myocarditis weakens your heart so that the rest of your body doesn't get enough blood. Every year there are 1-2 cases of myocarditis per 100,000 children. COVID-19 is too new to understand whether it leads to myocarditis more often or of more severity than other viruses, but researchers are closely studying this.

Myocarditis can also happen as part of MIS-C which is a multi-system inflammatory syndrome usually seen in children younger than age 10 who have had COVID-19. The main symptoms include prolonged fever (longer than five days), rash, red eyes, vomiting, diarrhea, weakness, and fatigue. As of May 2021, there were 3,700 cases of MIS-C. While that may sound like a lot, current data show it happens in less than 0.1% of cases and most children recover fully with treatment. ,

COVID vaccination for children 12 years and older is the best way to protect them against severe illness. Some parents are hesitant to give the vaccine to their children, citing risk of myocarditis related to the vaccine. Current data shows the incident of myocarditis following the vaccine to be around 0.000001%, much lower than the risk of myocarditis from the actual virus! The other argument against the vaccine is that it isn’t 100% effective. While no vaccine is 100% effective, the COVID-19 vaccine has continued to show 91-95% effectiveness at preventing severe disease, even in the face of the more contagious Delta variant. ,

Risks of avoiding in-person environments for children:

While it appears that severe physical illness due to COVID-19 is uncommon among children, its impact on children’s brain development and mental health may be devastating. Many parents have reported poor mental health outcomes in their children throughout the pandemic – research from October 2020 showed that 31% of parents said their child’s mental or emotional health was worse than before the pandemic. Social distancing and stay-at-home orders could lead to loneliness and isolation among children – known risk factors for poor mental health. Additionally, the duration of a child’s experience of loneliness is linked to mental health problems later in life. Pandemic-related isolation and quarantines may also lead to some children experiencing separation anxiety from their parents or caregivers and fear of themselves or family members becoming infected.

Adolescents, young children, LGBTQ youth, and children of color may be particularly vulnerable to negative mental health consequences of the pandemic. Surveys of adolescents show increased rates of solitary substance use and suicidality during the pandemic. Parents of children attending school virtually were more likely to report their children experienced overall worsened mental or emotional health than parents of children attending school in-person (25% vs. 16%, respectively).

Additionally, the impact of the pandemic on K–12 student learning was significant, leaving students on average five months behind in mathematics and four months behind in reading by the end of the school year. The pandemic widened preexisting opportunity and achievement gaps, hitting historically disadvantaged students hardest. In math, students in majority Black schools ended the year with six months of unfinished learning, students in low-income schools with seven. High schoolers have become more likely to drop out of school and high school seniors, especially those from low-income families, are less likely to go on to post-secondary education.

Balancing the scales: For my family, we have considered both sides. The benefits of in-person learning, socialization, and peer support far outweigh the risks of COVID-19 exposure. I have a 14 year-old daughter who is fully vaccinated and 10 year-old twins who are too young for the vaccine – all three will be attending in-person school 100% of the time starting in September. Masking in schools, along with increased sanitary precautions and distancing will prevent the majority of transmission, even in unvaccinated cohorts. Safety tips for returning to school during COVID-19 - Mayo Clinic is a great guide for parents as they prepare for back to school. Obviously, if your child has specific medical conditions that affect their immune system, cardiac or respiratory systems, you may make a different calculation for your family.

The most important thing is to consider all the factors and not to underestimate how much children gain from exposure to their peers and the school environment.


[i] Multisystem inflammatory syndrome in children — what parents need to know - Harvard Health
[ii] Myocarditis and Pericarditis After Vaccination for COVID-19 | Cardiology | JAMA | JAMA Network
[iii] The Possibility of COVID-19 after Vaccination: Breakthrough Infections (
[vi] New COVID-19 Cases and Hospitalizations Among Adults, by Vaccination Status — New York, May 3–July 25, 2021 | MMWR (
[v] Mental Health and Substance Use Considerations Among Children During the COVID-19 Pandemic | KFF
[vi] COVID-19 and education: The lingering effects of unfinished learning | McKinsey
[vii] Safety tips for returning to school during COVID-19 - Mayo Clinic