school during covid 19 essay

Writing about COVID-19 in a college admission essay

by: Venkates Swaminathan | Updated: September 14, 2020

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For students applying to college using the CommonApp, there are several different places where students and counselors can address the pandemic’s impact. The different sections have differing goals. You must understand how to use each section for its appropriate use.

The CommonApp COVID-19 question

First, the CommonApp this year has an additional question specifically about COVID-19 :

Community disruptions such as COVID-19 and natural disasters can have deep and long-lasting impacts. If you need it, this space is yours to describe those impacts. Colleges care about the effects on your health and well-being, safety, family circumstances, future plans, and education, including access to reliable technology and quiet study spaces. Please use this space to describe how these events have impacted you.

This question seeks to understand the adversity that students may have had to face due to the pandemic, the move to online education, or the shelter-in-place rules. You don’t have to answer this question if the impact on you wasn’t particularly severe. Some examples of things students should discuss include:

• The student or a family member had COVID-19 or suffered other illnesses due to confinement during the pandemic.
• The candidate had to deal with personal or family issues, such as abusive living situations or other safety concerns
• The student suffered from a lack of internet access and other online learning challenges.
• Students who dealt with problems registering for or taking standardized tests and AP exams.

Jeff Schiffman of the Tulane University admissions office has a blog about this section. He recommends students ask themselves several questions as they go about answering this section:

• Are my experiences different from others’?
• Are there noticeable changes on my transcript?
• Am I aware of my privilege?
• Am I specific? Am I explaining rather than complaining?
• Is this information being included elsewhere on my application?

If you do answer this section, be brief and to-the-point.

Counselor recommendations and school profiles

Second, counselors will, in their counselor forms and school profiles on the CommonApp, address how the school handled the pandemic and how it might have affected students, specifically as it relates to:

• Grading scales and policies
• Graduation requirements
• Instructional methods
• Schedules and course offerings
• Testing requirements
• Your academic calendar
• Other extenuating circumstances

Students don’t have to mention these matters in their application unless something unusual happened.

Writing about COVID-19 in your main essay

Write about your experiences during the pandemic in your main college essay if your experience is personal, relevant, and the most important thing to discuss in your college admission essay. That you had to stay home and study online isn’t sufficient, as millions of other students faced the same situation. But sometimes, it can be appropriate and helpful to write about something related to the pandemic in your essay. For example:

• One student developed a website for a local comic book store. The store might not have survived without the ability for people to order comic books online. The student had a long-standing relationship with the store, and it was an institution that created a community for students who otherwise felt left out.
• One student started a YouTube channel to help other students with academic subjects he was very familiar with and began tutoring others.
• Some students used their extra time that was the result of the stay-at-home orders to take online courses pursuing topics they are genuinely interested in or developing new interests, like a foreign language or music.

Experiences like this can be good topics for the CommonApp essay as long as they reflect something genuinely important about the student. For many students whose lives have been shaped by this pandemic, it can be a critical part of their college application.

Want more? Read 6 ways to improve a college essay , What the &%$! should I write about in my college essay , and Just how important is a college admissions essay? .

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Covid-19’s Impact on Students’ Academic and Mental Well-Being

The pandemic has revealed—and exacerbated—inequities that hold many students back. Here’s how teachers can help.

The pandemic has shone a spotlight on inequality in America: School closures and social isolation have affected all students, but particularly those living in poverty. Adding to the damage to their learning, a mental health crisis is emerging as many students have lost access to services that were offered by schools.

No matter what form school takes when the new year begins—whether students and teachers are back in the school building together or still at home—teachers will face a pressing issue: How can they help students recover and stay on track throughout the year even as their lives are likely to continue to be disrupted by the pandemic?

New research provides insights about the scope of the problem—as well as potential solutions.

The Achievement Gap Is Likely to Widen

A new study suggests that the coronavirus will undo months of academic gains, leaving many students behind. The study authors project that students will start the new school year with an average of 66 percent of the learning gains in reading and 44 percent of the learning gains in math, relative to the gains for a typical school year. But the situation is worse on the reading front, as the researchers also predict that the top third of students will make gains, possibly because they’re likely to continue reading with their families while schools are closed, thus widening the achievement gap.

To make matters worse, “few school systems provide plans to support students who need accommodations or other special populations,” the researchers point out in the study, potentially impacting students with special needs and English language learners.

Of course, the idea that over the summer students forget some of what they learned in school isn’t new. But there’s a big difference between summer learning loss and pandemic-related learning loss: During the summer, formal schooling stops, and learning loss happens at roughly the same rate for all students, the researchers point out. But instruction has been uneven during the pandemic, as some students have been able to participate fully in online learning while others have faced obstacles—such as lack of internet access—that have hindered their progress.

In the study, researchers analyzed a national sample of 5 million students in grades 3–8 who took the MAP Growth test, a tool schools use to assess students’ reading and math growth throughout the school year. The researchers compared typical growth in a standard-length school year to projections based on students being out of school from mid-March on. To make those projections, they looked at research on the summer slide, weather- and disaster-related closures (such as New Orleans after Hurricane Katrina), and absenteeism.

The researchers predict that, on average, students will experience substantial drops in reading and math, losing roughly three months’ worth of gains in reading and five months’ worth of gains in math. For Megan Kuhfeld, the lead author of the study, the biggest takeaway isn’t that learning loss will happen—that’s a given by this point—but that students will come back to school having declined at vastly different rates.

“We might be facing unprecedented levels of variability come fall,” Kuhfeld told me. “Especially in school districts that serve families with lots of different needs and resources. Instead of having students reading at a grade level above or below in their classroom, teachers might have kids who slipped back a lot versus kids who have moved forward.” 

Disproportionate Impact on Students Living in Poverty and Students of Color

Horace Mann once referred to schools as the “great equalizers,” yet the pandemic threatens to expose the underlying inequities of remote learning. According to a 2015 Pew Research Center analysis , 17 percent of teenagers have difficulty completing homework assignments because they do not have reliable access to a computer or internet connection. For Black students, the number spikes to 25 percent.

“There are many reasons to believe the Covid-19 impacts might be larger for children in poverty and children of color,” Kuhfeld wrote in the study. Their families suffer higher rates of infection, and the economic burden disproportionately falls on Black and Hispanic parents, who are less likely to be able to work from home during the pandemic.

Although children are less likely to become infected with Covid-19, the adult mortality rates, coupled with the devastating economic consequences of the pandemic, will likely have an indelible impact on their well-being.

Impacts on Students’ Mental Health

That impact on well-being may be magnified by another effect of school closures: Schools are “the de facto mental health system for many children and adolescents,” providing mental health services to 57 percent of adolescents who need care, according to the authors of a recent study published in JAMA Pediatrics . School closures may be especially disruptive for children from lower-income families, who are disproportionately likely to receive mental health services exclusively from schools.

“The Covid-19 pandemic may worsen existing mental health problems and lead to more cases among children and adolescents because of the unique combination of the public health crisis, social isolation, and economic recession,” write the authors of that study.

A major concern the researchers point to: Since most mental health disorders begin in childhood, it is essential that any mental health issues be identified early and treated. Left untreated, they can lead to serious health and emotional problems. In the short term, video conferencing may be an effective way to deliver mental health services to children.

Mental health and academic achievement are linked, research shows. Chronic stress changes the chemical and physical structure of the brain, impairing cognitive skills like attention, concentration, memory, and creativity. “You see deficits in your ability to regulate emotions in adaptive ways as a result of stress,” said Cara Wellman, a professor of neuroscience and psychology at Indiana University in a 2014 interview . In her research, Wellman discovered that chronic stress causes the connections between brain cells to shrink in mice, leading to cognitive deficiencies in the prefrontal cortex. 

While trauma-informed practices were widely used before the pandemic, they’re likely to be even more integral as students experience economic hardships and grieve the loss of family and friends. Teachers can look to schools like Fall-Hamilton Elementary in Nashville, Tennessee, as a model for trauma-informed practices . 

3 Ways Teachers Can Prepare

When schools reopen, many students may be behind, compared to a typical school year, so teachers will need to be very methodical about checking in on their students—not just academically but also emotionally. Some may feel prepared to tackle the new school year head-on, but others will still be recovering from the pandemic and may still be reeling from trauma, grief, and anxiety. 

Here are a few strategies teachers can prioritize when the new school year begins:

• Focus on relationships first. Fear and anxiety about the pandemic—coupled with uncertainty about the future—can be disruptive to a student’s ability to come to school ready to learn. Teachers can act as a powerful buffer against the adverse effects of trauma by helping to establish a safe and supportive environment for learning. From morning meetings to regular check-ins with students, strategies that center around relationship-building will be needed in the fall.
• Strengthen diagnostic testing. Educators should prepare for a greater range of variability in student learning than they would expect in a typical school year. Low-stakes assessments such as exit tickets and quizzes can help teachers gauge how much extra support students will need, how much time should be spent reviewing last year’s material, and what new topics can be covered.
• Differentiate instruction—particularly for vulnerable students. For the vast majority of schools, the abrupt transition to online learning left little time to plan a strategy that could adequately meet every student’s needs—in a recent survey by the Education Trust, only 24 percent of parents said that their child’s school was providing materials and other resources to support students with disabilities, and a quarter of non-English-speaking students were unable to obtain materials in their own language. Teachers can work to ensure that the students on the margins get the support they need by taking stock of students’ knowledge and skills, and differentiating instruction by giving them choices, connecting the curriculum to their interests, and providing them multiple opportunities to demonstrate their learning.

How is COVID-19 affecting student learning?

Subscribe to the brown center on education policy newsletter, initial findings from fall 2020, megan kuhfeld , megan kuhfeld senior research scientist - nwea @megankuhfeld jim soland , jim soland assistant professor, school of education and human development - university of virginia, affiliated research fellow - nwea @jsoland beth tarasawa , bt beth tarasawa executive vice president of research - nwea @bethtarasawa angela johnson , aj angela johnson research scientist - nwea erik ruzek , and er erik ruzek research assistant professor, curry school of education - university of virginia karyn lewis karyn lewis director, center for school and student progress - nwea @karynlew.

December 3, 2020

The COVID-19 pandemic has introduced uncertainty into major aspects of national and global society, including for schools. For example, there is uncertainty about how school closures last spring impacted student achievement, as well as how the rapid conversion of most instruction to an online platform this academic year will continue to affect achievement. Without data on how the virus impacts student learning, making informed decisions about whether and when to return to in-person instruction remains difficult. Even now, education leaders must grapple with seemingly impossible choices that balance health risks associated with in-person learning against the educational needs of children, which may be better served when kids are in their physical schools.

Amidst all this uncertainty, there is growing consensus that school closures in spring 2020 likely had negative effects on student learning. For example, in an earlier post for this blog , we presented our research forecasting the possible impact of school closures on achievement. Based on historical learning trends and prior research on how out-of-school-time affects learning, we estimated that students would potentially begin fall 2020 with roughly 70% of the learning gains in reading relative to a typical school year. In mathematics, students were predicted to show even smaller learning gains from the previous year, returning with less than 50% of typical gains. While these and other similar forecasts presented a grim portrait of the challenges facing students and educators this fall, they were nonetheless projections. The question remained: What would learning trends in actual data from the 2020-21 school year really look like?

With fall 2020 data now in hand , we can move beyond forecasting and begin to describe what did happen. While the closures last spring left most schools without assessment data from that time, thousands of schools began testing this fall, making it possible to compare learning gains in a typical, pre-COVID-19 year to those same gains during the COVID-19 pandemic. Using data from nearly 4.4 million students in grades 3-8 who took MAP ® Growth™ reading and math assessments in fall 2020, we examined two primary research questions:

• How did students perform in fall 2020 relative to a typical school year (specifically, fall 2019)?
• Have students made learning gains since schools physically closed in March 2020?

To answer these questions, we compared students’ academic achievement and growth during the COVID-19 pandemic to the achievement and growth patterns observed in 2019. We report student achievement as a percentile rank, which is a normative measure of a student’s achievement in a given grade/subject relative to the MAP Growth national norms (reflecting pre-COVID-19 achievement levels).

To make sure the students who took the tests before and after COVID-19 school closures were demographically similar, all analyses were limited to a sample of 8,000 schools that tested students in both fall 2019 and fall 2020. Compared to all public schools in the nation, schools in the sample had slightly larger total enrollment, a lower percentage of low-income students, and a higher percentage of white students. Since our sample includes both in-person and remote testers in fall 2020, we conducted an initial comparability study of remote and in-person testing in fall 2020. We found consistent psychometric characteristics and trends in test scores for remote and in-person tests for students in grades 3-8, but caution that remote testing conditions may be qualitatively different for K-2 students. For more details on the sample and methodology, please see the technical report accompanying this study.

In some cases, our results tell a more optimistic story than what we feared. In others, the results are as deeply concerning as we expected based on our projections.

Question 1: How did students perform in fall 2020 relative to a typical school year?

When comparing students’ median percentile rank for fall 2020 to those for fall 2019, there is good news to share: Students in grades 3-8 performed similarly in reading to same-grade students in fall 2019. While the reason for the stability of these achievement results cannot be easily pinned down, possible explanations are that students read more on their own, and parents are better equipped to support learning in reading compared to other subjects that require more formal instruction.

The news in math, however, is more worrying. The figure below shows the median percentile rank in math by grade level in fall 2019 and fall 2020. As the figure indicates, the math achievement of students in 2020 was about 5 to 10 percentile points lower compared to same-grade students the prior year.

Figure 1: MAP Growth Percentiles in Math by Grade Level in Fall 2019 and Fall 2020

Source: Author calculations with MAP Growth data. Notes: Each bar represents the median percentile rank in a given grade/term.

Question 2: Have students made learning gains since schools physically closed, and how do these gains compare to gains in a more typical year?

To answer this question, we examined learning gains/losses between winter 2020 (January through early March) and fall 2020 relative to those same gains in a pre-COVID-19 period (between winter 2019 and fall 2019). We did not examine spring-to-fall changes because so few students tested in spring 2020 (after the pandemic began). In almost all grades, the majority of students made some learning gains in both reading and math since the COVID-19 pandemic started, though gains were smaller in math in 2020 relative to the gains students in the same grades made in the winter 2019-fall 2019 period.

Figure 2 shows the distribution of change in reading scores by grade for the winter 2020 to fall 2020 period (light blue) as compared to same-grade students in the pre-pandemic span of winter 2019 to fall 2019 (dark blue). The 2019 and 2020 distributions largely overlapped, suggesting similar amounts of within-student change from one grade to the next.

Figure 2: Distribution of Within-student Change from Winter 2019-Fall 2019 vs Winter 2020-Fall 2020 in Reading

Source: Author calculations with MAP Growth data. Notes: The dashed line represents zero growth (e.g., winter and fall test scores were equivalent). A positive value indicates that a student scored higher in the fall than their prior winter score; a negative value indicates a student scored lower in the fall than their prior winter score.

Meanwhile, Figure 3 shows the distribution of change for students in different grade levels for the winter 2020 to fall 2020 period in math. In contrast to reading, these results show a downward shift: A smaller proportion of students demonstrated positive math growth in the 2020 period than in the 2019 period for all grades. For example, 79% of students switching from 3 rd to 4 th grade made academic gains between winter 2019 and fall 2019, relative to 57% of students in the same grade range in 2020.

Figure 3: Distribution of Within-student Change from Winter 2019-Fall 2019 vs. Winter 2020-Fall 2020 in Math

It was widely speculated that the COVID-19 pandemic would lead to very unequal opportunities for learning depending on whether students had access to technology and parental support during the school closures, which would result in greater heterogeneity in terms of learning gains/losses in 2020. Notably, however, we do not see evidence that within-student change is more spread out this year relative to the pre-pandemic 2019 distribution.

The long-term effects of COVID-19 are still unknown

In some ways, our findings show an optimistic picture: In reading, on average, the achievement percentiles of students in fall 2020 were similar to those of same-grade students in fall 2019, and in almost all grades, most students made some learning gains since the COVID-19 pandemic started. In math, however, the results tell a less rosy story: Student achievement was lower than the pre-COVID-19 performance by same-grade students in fall 2019, and students showed lower growth in math across grades 3 to 8 relative to peers in the previous, more typical year. Schools will need clear local data to understand if these national trends are reflective of their students. Additional resources and supports should be deployed in math specifically to get students back on track.

In this study, we limited our analyses to a consistent set of schools between fall 2019 and fall 2020. However, approximately one in four students who tested within these schools in fall 2019 are no longer in our sample in fall 2020. This is a sizeable increase from the 15% attrition from fall 2018 to fall 2019. One possible explanation is that some students lacked reliable technology. A second is that they disengaged from school due to economic, health, or other factors. More coordinated efforts are required to establish communication with students who are not attending school or disengaging from instruction to get them back on track, especially our most vulnerable students.

Finally, we are only scratching the surface in quantifying the short-term and long-term academic and non-academic impacts of COVID-19. While more students are back in schools now and educators have more experience with remote instruction than when the pandemic forced schools to close in spring 2020, the collective shock we are experiencing is ongoing. We will continue to examine students’ academic progress throughout the 2020-21 school year to understand how recovery and growth unfold amid an ongoing pandemic.

Thankfully, we know much more about the impact the pandemic has had on student learning than we did even a few months ago. However, that knowledge makes clear that there is work to be done to help many students get back on track in math, and that the long-term ramifications of COVID-19 for student learning—especially among underserved communities—remain unknown.

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How to Write About the Impact of the Coronavirus in a College Essay

The global impact of COVID-19, the disease caused by the novel coronavirus, means colleges and prospective students alike are in for an admissions cycle like no other. Both face unprecedented challenges and questions as they grapple with their respective futures amid the ongoing fallout of the pandemic.

Colleges must examine applicants without the aid of standardized test scores for many -- a factor that prompted many schools to go test-optional for now . Even grades, a significant component of a college application, may be hard to interpret with some high schools adopting pass-fail classes last spring due to the pandemic. Major college admissions factors are suddenly skewed.

"I can't help but think other (admissions) factors are going to matter more," says Ethan Sawyer, founder of the College Essay Guy, a website that offers free and paid essay-writing resources.

College essays and letters of recommendation , Sawyer says, are likely to carry more weight than ever in this admissions cycle. And many essays will likely focus on how the pandemic shaped students' lives throughout an often tumultuous 2020.

[ Read: How to Write a College Essay. ]

But before writing a college essay focused on the coronavirus, students should explore whether it's the best topic for them.

Writing About COVID-19 for a College Application

Much of daily life has been colored by the coronavirus. Virtual learning is the norm at many colleges and high schools, many extracurriculars have vanished and social lives have stalled for students complying with measures to stop the spread of COVID-19.

"For some young people, the pandemic took away what they envisioned as their senior year," says Robert Alexander, dean of admissions, financial aid and enrollment management at the University of Rochester in New York. "Maybe that's a spot on a varsity athletic team or the lead role in the fall play. And it's OK for them to mourn what should have been and what they feel like they lost, but more important is how are they making the most of the opportunities they do have?"

That question, Alexander says, is what colleges want answered if students choose to address COVID-19 in their college essay.

But the question of whether a student should write about the coronavirus is tricky. The answer depends largely on the student.

"In general, I don't think students should write about COVID-19 in their main personal statement for their application," Robin Miller, master college admissions counselor at IvyWise, a college counseling company, wrote in an email.

"Certainly, there may be exceptions to this based on a student's individual experience, but since the personal essay is the main place in the application where the student can really allow their voice to be heard and share insight into who they are as an individual, there are likely many other topics they can choose to write about that are more distinctive and unique than COVID-19," Miller says.

[ Read: What Colleges Look for: 6 Ways to Stand Out. ]

Opinions among admissions experts vary on whether to write about the likely popular topic of the pandemic.

"If your essay communicates something positive, unique, and compelling about you in an interesting and eloquent way, go for it," Carolyn Pippen, principal college admissions counselor at IvyWise, wrote in an email. She adds that students shouldn't be dissuaded from writing about a topic merely because it's common, noting that "topics are bound to repeat, no matter how hard we try to avoid it."

Above all, she urges honesty.

"If your experience within the context of the pandemic has been truly unique, then write about that experience, and the standing out will take care of itself," Pippen says. "If your experience has been generally the same as most other students in your context, then trying to find a unique angle can easily cross the line into exploiting a tragedy, or at least appearing as though you have."

But focusing entirely on the pandemic can limit a student to a single story and narrow who they are in an application, Sawyer says. "There are so many wonderful possibilities for what you can say about yourself outside of your experience within the pandemic."

He notes that passions, strengths, career interests and personal identity are among the multitude of essay topic options available to applicants and encourages them to probe their values to help determine the topic that matters most to them -- and write about it.

That doesn't mean the pandemic experience has to be ignored if applicants feel the need to write about it.

Writing About Coronavirus in Main and Supplemental Essays

Students can choose to write a full-length college essay on the coronavirus or summarize their experience in a shorter form.

To help students explain how the pandemic affected them, The Common App has added an optional section to address this topic. Applicants have 250 words to describe their pandemic experience and the personal and academic impact of COVID-19.

[ Read: The Common App: Everything You Need to Know. ]

"That's not a trick question, and there's no right or wrong answer," Alexander says. Colleges want to know, he adds, how students navigated the pandemic, how they prioritized their time, what responsibilities they took on and what they learned along the way.

If students can distill all of the above information into 250 words, there's likely no need to write about it in a full-length college essay, experts say. And applicants whose lives were not heavily altered by the pandemic may even choose to skip the optional COVID-19 question.

"This space is best used to discuss hardship and/or significant challenges that the student and/or the student's family experienced as a result of COVID-19 and how they have responded to those difficulties," Miller notes. Using the section to acknowledge a lack of impact, she adds, "could be perceived as trite and lacking insight, despite the good intentions of the applicant."

To guard against this lack of awareness, Sawyer encourages students to tap someone they trust to review their writing , whether it's the 250-word Common App response or the full-length essay.

Experts tend to agree that the short-form approach to this as an essay topic works better, but there are exceptions. And if a student does have a coronavirus story that he or she feels must be told, Alexander encourages the writer to be authentic in the essay.

"My advice for an essay about COVID-19 is the same as my advice about an essay for any topic -- and that is, don't write what you think we want to read or hear," Alexander says. "Write what really changed you and that story that now is yours and yours alone to tell."

Sawyer urges students to ask themselves, "What's the sentence that only I can write?" He also encourages students to remember that the pandemic is only a chapter of their lives and not the whole book.

Miller, who cautions against writing a full-length essay on the coronavirus, says that if students choose to do so they should have a conversation with their high school counselor about whether that's the right move. And if students choose to proceed with COVID-19 as a topic, she says they need to be clear, detailed and insightful about what they learned and how they adapted along the way.

"Approaching the essay in this manner will provide important balance while demonstrating personal growth and vulnerability," Miller says.

Pippen encourages students to remember that they are in an unprecedented time for college admissions.

"It is important to keep in mind with all of these (admission) factors that no colleges have ever had to consider them this way in the selection process, if at all," Pippen says. "They have had very little time to calibrate their evaluations of different application components within their offices, let alone across institutions. This means that colleges will all be handling the admissions process a little bit differently, and their approaches may even evolve over the course of the admissions cycle."

Searching for a college? Get our complete rankings of Best Colleges.

Mission: Recovering Education in 2021

THE CONTEXT

The COVID-19 pandemic has caused abrupt and profound changes around the world.  This is the worst shock to education systems in decades, with the longest school closures combined with looming recession.  It will set back progress made on global development goals, particularly those focused on education. The economic crises within countries and globally will likely lead to fiscal austerity, increases in poverty, and fewer resources available for investments in public services from both domestic expenditure and development aid. All of this will lead to a crisis in human development that continues long after disease transmission has ended.

Disruptions to education systems over the past year have already driven substantial losses and inequalities in learning. All the efforts to provide remote instruction are laudable, but this has been a very poor substitute for in-person learning.  Even more concerning, many children, particularly girls, may not return to school even when schools reopen. School closures and the resulting disruptions to school participation and learning are projected to amount to losses valued at $10 trillion in terms of affected children’s future earnings.  Schools also play a critical role around the world in ensuring the delivery of essential health services and nutritious meals, protection, and psycho-social support. Thus, school closures have also imperilled children’s overall wellbeing and development, not just their learning.   

It’s not enough for schools to simply reopen their doors after COVID-19. Students will need tailored and sustained support to help them readjust and catch-up after the pandemic. We must help schools prepare to provide that support and meet the enormous challenges of the months ahead. The time to act is now; the future of an entire generation is at stake.

THE MISSION

Mission objective:  To enable all children to return to school and to a supportive learning environment, which also addresses their health and psychosocial well-being and other needs.

Timeframe : By end 2021.

Scope : All countries should reopen schools for complete or partial in-person instruction and keep them open. The Partners - UNESCO , UNICEF , and the World Bank - will join forces to support countries to take all actions possible to plan, prioritize, and ensure that all learners are back in school; that schools take all measures to reopen safely; that students receive effective remedial learning and comprehensive services to help recover learning losses and improve overall welfare; and their teachers are prepared and supported to meet their learning needs. 

Three priorities:

1.    All children and youth are back in school and receive the tailored services needed to meet their learning, health, psychosocial wellbeing, and other needs. 

Challenges : School closures have put children’s learning, nutrition, mental health, and overall development at risk. Closed schools also make screening and delivery for child protection services more difficult. Some students, particularly girls, are at risk of never returning to school. 

Areas of action : The Partners will support the design and implementation of school reopening strategies that include comprehensive services to support children’s education, health, psycho-social wellbeing, and other needs. 

Targets and indicators

2.    All children receive support to catch up on lost learning.

Challenges : Most children have lost substantial instructional time and may not be ready for curricula that were age- and grade- appropriate prior to the pandemic. They will require remedial instruction to get back on track. The pandemic also revealed a stark digital divide that schools can play a role in addressing by ensuring children have digital skills and access.

Areas of action : The Partners will (i) support the design and implementation of large-scale remedial learning at different levels of education, (ii) launch an open-access, adaptable learning assessment tool that measures learning losses and identifies learners’ needs, and (iii) support the design and implementation of digital transformation plans that include components on both infrastructure and ways to use digital technology to accelerate the development of foundational literacy and numeracy skills. Incorporating digital technologies to teach foundational skills could complement teachers’ efforts in the classroom and better prepare children for future digital instruction.   

While incorporating remedial education, social-emotional learning, and digital technology into curricula by the end of 2021 will be a challenge for most countries, the Partners agree that these are aspirational targets that they should be supporting countries to achieve this year and beyond as education systems start to recover from the current crisis.

3.   All teachers are prepared and supported to address learning losses among their students and to incorporate  digital technology into their teaching.

Challenges : Teachers are in an unprecedented situation in which they must make up for substantial loss of instructional time from the previous school year and teach the current year’s curriculum. They must also protect their own health in school. Teachers will need training, coaching, and other means of support to get this done. They will also need to be prioritized for the COVID-19 vaccination, after frontline personnel and high-risk populations.  School closures also demonstrated that in addition to digital skills, teachers may also need support to adapt their pedagogy to deliver instruction remotely. 

Areas of action : The Partners will advocate for teachers to be prioritized in COVID-19 vaccination campaigns, after frontline personnel and high-risk populations, and provide capacity-development on pedagogies for remedial learning and digital and blended teaching approaches. 

Country level actions and global support

UNESCO, UNICEF, and World Bank are joining forces to support countries to achieve the Mission, leveraging their expertise and actions on the ground to support national efforts and domestic funding.

Country Level Action

1.  Mobilize team to support countries in achieving the three priorities

The Partners will collaborate and act at the country level to support governments in accelerating actions to advance the three priorities.

2.  Advocacy to mobilize domestic resources for the three priorities

The Partners will engage with governments and decision-makers to prioritize education financing and mobilize additional domestic resources.

Global level action

1.  Leverage data to inform decision-making

The Partners will join forces to   conduct surveys; collect data; and set-up a global, regional, and national real-time data-warehouse.  The Partners will collect timely data and analytics that provide access to information on school re-openings, learning losses, drop-outs, and transition from school to work, and will make data available to support decision-making and peer-learning.

2.  Promote knowledge sharing and peer-learning in strengthening education recovery

The Partners will join forces in sharing the breadth of international experience and scaling innovations through structured policy dialogue, knowledge sharing, and peer learning actions.

The time to act on these priorities is now. UNESCO, UNICEF, and the World Bank are partnering to help drive that action.

Last Updated: Mar 30, 2021

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The Effect of COVID-19 on Education

Jacob hoofman.

a Wayne State University School of Medicine, 540 East Canfield, Detroit, MI 48201, USA

Elizabeth Secord

b Department of Pediatrics, Wayne Pediatrics, School of Medicine, Pediatrics Wayne State University, 400 Mack Avenue, Detroit, MI 48201, USA

COVID-19 has changed education for learners of all ages. Preliminary data project educational losses at many levels and verify the increased anxiety and depression associated with the changes, but there are not yet data on long-term outcomes. Guidance from oversight organizations regarding the safety and efficacy of new delivery modalities for education have been quickly forged. It is no surprise that the socioeconomic gaps and gaps for special learners have widened. The medical profession and other professions that teach by incrementally graduated internships are also severely affected and have had to make drastic changes.

• • Virtual learning has become a norm during COVID-19.
• • Children requiring special learning services, those living in poverty, and those speaking English as a second language have lost more from the pandemic educational changes.
• • For children with attention deficit disorder and no comorbidities, virtual learning has sometimes been advantageous.
• • Math learning scores are more likely to be affected than language arts scores by pandemic changes.
• • School meals, access to friends, and organized activities have also been lost with the closing of in-person school.

The transition to an online education during the coronavirus disease 2019 (COVID-19) pandemic may bring about adverse educational changes and adverse health consequences for children and young adult learners in grade school, middle school, high school, college, and professional schools. The effects may differ by age, maturity, and socioeconomic class. At this time, we have few data on outcomes, but many oversight organizations have tried to establish guidelines, expressed concerns, and extrapolated from previous experiences.

General educational losses and disparities

Many researchers are examining how the new environment affects learners’ mental, physical, and social health to help compensate for any losses incurred by this pandemic and to better prepare for future pandemics. There is a paucity of data at this juncture, but some investigators have extrapolated from earlier school shutdowns owing to hurricanes and other natural disasters. 1

Inclement weather closures are estimated in some studies to lower middle school math grades by 0.013 to 0.039 standard deviations and natural disaster closures by up to 0.10 standard deviation decreases in overall achievement scores. 2 The data from inclement weather closures did show a more significant decrease for children dependent on school meals, but generally the data were not stratified by socioeconomic differences. 3 , 4 Math scores are impacted overall more negatively by school absences than English language scores for all school closures. 4 , 5

The Northwest Evaluation Association is a global nonprofit organization that provides research-based assessments and professional development for educators. A team of researchers at Stanford University evaluated Northwest Evaluation Association test scores for students in 17 states and the District of Columbia in the Fall of 2020 and estimated that the average student had lost one-third of a year to a full year's worth of learning in reading, and about three-quarters of a year to more than 1 year in math since schools closed in March 2020. 5

With school shifted from traditional attendance at a school building to attendance via the Internet, families have come under new stressors. It is increasingly clear that families depended on schools for much more than math and reading. Shelter, food, health care, and social well-being are all part of what children and adolescents, as well as their parents or guardians, depend on schools to provide. 5 , 6

Many families have been impacted negatively by the loss of wages, leading to food insecurity and housing insecurity; some of loss this is a consequence of the need for parents to be at home with young children who cannot attend in-person school. 6 There is evidence that this economic instability is leading to an increase in depression and anxiety. 7 In 1 survey, 34.71% of parents reported behavioral problems in their children that they attributed to the pandemic and virtual schooling. 8

Children have been infected with and affected by coronavirus. In the United States, 93,605 students tested positive for COVID-19, and it was reported that 42% were Hispanic/Latino, 32% were non-Hispanic White, and 17% were non-Hispanic Black, emphasizing a disproportionate effect for children of color. 9 COVID infection itself is not the only issue that affects children’s health during the pandemic. School-based health care and school-based meals are lost when school goes virtual and children of lower socioeconomic class are more severely affected by these losses. Although some districts were able to deliver school meals, school-based health care is a primary source of health care for many children and has left some chronic conditions unchecked during the pandemic. 10

Many families report that the stress of the pandemic has led to a poorer diet in children with an increase in the consumption of sweet and fried foods. 11 , 12 Shelter at home orders and online education have led to fewer exercise opportunities. Research carried out by Ammar and colleagues 12 found that daily sitting had increased from 5 to 8 hours a day and binge eating, snacking, and the number of meals were all significantly increased owing to lockdown conditions and stay-at-home initiatives. There is growing evidence in both animal and human models that diets high in sugar and fat can play a detrimental role in cognition and should be of increased concern in light of the pandemic. 13

The family stress elicited by the COVID-19 shutdown is a particular concern because of compiled evidence that adverse life experiences at an early age are associated with an increased likelihood of mental health issues as an adult. 14 There is early evidence that children ages 6 to 18 years of age experienced a significant increase in their expression of “clinginess, irritability, and fear” during the early pandemic school shutdowns. 15 These emotions associated with anxiety may have a negative impact on the family unit, which was already stressed owing to the pandemic.

Another major concern is the length of isolation many children have had to endure since the pandemic began and what effects it might have on their ability to socialize. The school, for many children, is the agent for forming their social connections as well as where early social development occurs. 16 Noting that academic performance is also declining the pandemic may be creating a snowball effect, setting back children without access to resources from which they may never recover, even into adulthood.

Predictions from data analysis of school absenteeism, summer breaks, and natural disaster occurrences are imperfect for the current situation, but all indications are that we should not expect all children and adolescents to be affected equally. 4 , 5 Although some children and adolescents will likely suffer no long-term consequences, COVID-19 is expected to widen the already existing educational gap from socioeconomic differences, and children with learning differences are expected to suffer more losses than neurotypical children. 4 , 5

Special education and the COVID-19 pandemic

Although COVID-19 has affected all levels of education reception and delivery, children with special needs have been more profoundly impacted. Children in the United States who have special needs have legal protection for appropriate education by the Individuals with Disabilities Education Act and Section 504 of the Rehabilitation Act of 1973. 17 , 18 Collectively, this legislation is meant to allow for appropriate accommodations, services, modifications, and specialized academic instruction to ensure that “every child receives a free appropriate public education . . . in the least restrictive environment.” 17

Children with autism usually have applied behavioral analysis (ABA) as part of their individualized educational plan. ABA therapists for autism use a technique of discrete trial training that shapes and rewards incremental changes toward new behaviors. 19 Discrete trial training involves breaking behaviors into small steps and repetition of rewards for small advances in the steps toward those behaviors. It is an intensive one-on-one therapy that puts a child and therapist in close contact for many hours at a time, often 20 to 40 hours a week. This therapy works best when initiated at a young age in children with autism and is often initiated in the home. 19

Because ABA workers were considered essential workers from the early days of the pandemic, organizations providing this service had the responsibility and the freedom to develop safety protocols for delivery of this necessary service and did so in conjunction with certifying boards. 20

Early in the pandemic, there were interruptions in ABA followed by virtual visits, and finally by in-home therapy with COVID-19 isolation precautions. 21 Although the efficacy of virtual visits for ABA therapy would empirically seem to be inferior, there are few outcomes data available. The balance of safety versus efficacy quite early turned to in-home services with interruptions owing to illness and decreased therapist availability owing to the pandemic. 21 An overarching concern for children with autism is the possible loss of a window of opportunity to intervene early. Families of children and adolescents with autism spectrum disorder report increased stress compared with families of children with other disabilities before the pandemic, and during the pandemic this burden has increased with the added responsibility of monitoring in-home schooling. 20

Early data on virtual schooling children with attention deficit disorder (ADD) and attention deficit with hyperactivity (ADHD) shows that adolescents with ADD/ADHD found the switch to virtual learning more anxiety producing and more challenging than their peers. 22 However, according to a study in Ireland, younger children with ADD/ADHD and no other neurologic or psychiatric diagnoses who were stable on medication tended to report less anxiety with at-home schooling and their parents and caregivers reported improved behavior during the pandemic. 23 An unexpected benefit of shelter in home versus shelter in place may be to identify these stressors in face-to-face school for children with ADD/ADHD. If children with ADD/ADHD had an additional diagnosis of autism or depression, they reported increased anxiety with the school shutdown. 23 , 24

Much of the available literature is anticipatory guidance for in-home schooling of children with disabilities rather than data about schooling during the pandemic. The American Academy of Pediatrics published guidance advising that, because 70% of students with ADHD have other conditions, such as learning differences, oppositional defiant disorder, or depression, they may have very different responses to in home schooling which are a result of the non-ADHD diagnosis, for example, refusal to attempt work for children with oppositional defiant disorder, severe anxiety for those with depression and or anxiety disorders, and anxiety and perseveration for children with autism. 25 Children and families already stressed with learning differences have had substantial challenges during the COVID-19 school closures.

High school, depression, and COVID-19

High schoolers have lost a great deal during this pandemic. What should have been a time of establishing more independence has been hampered by shelter-in-place recommendations. Graduations, proms, athletic events, college visits, and many other social and educational events have been altered or lost and cannot be recaptured.

Adolescents reported higher rates of depression and anxiety associated with the pandemic, and in 1 study 14.4% of teenagers report post-traumatic stress disorder, whereas 40.4% report having depression and anxiety. 26 In another survey adolescent boys reported a significant decrease in life satisfaction from 92% before COVID to 72% during lockdown conditions. For adolescent girls, the decrease in life satisfaction was from 81% before COVID to 62% during the pandemic, with the oldest teenage girls reporting the lowest life satisfaction values during COVID-19 restrictions. 27 During the school shutdown for COVID-19, 21% of boys and 27% of girls reported an increase in family arguments. 26 Combine all of these reports with decreasing access to mental health services owing to pandemic restrictions and it becomes a complicated matter for parents to address their children's mental health needs as well as their educational needs. 28

A study conducted in Norway measured aspects of socialization and mood changes in adolescents during the pandemic. The opportunity for prosocial action was rated on a scale of 1 (not at all) to 6 (very much) based on how well certain phrases applied to them, for example, “I comforted a friend yesterday,” “Yesterday I did my best to care for a friend,” and “Yesterday I sent a message to a friend.” They also ranked mood by rating items on a scale of 1 (not at all) to 5 (very well) as items reflected their mood. 29 They found that adolescents showed an overall decrease in empathic concern and opportunity for prosocial actions, as well as a decrease in mood ratings during the pandemic. 29

A survey of 24,155 residents of Michigan projected an escalation of suicide risk for lesbian, gay, bisexual, transgender youth as well as those youth questioning their sexual orientation (LGBTQ) associated with increased social isolation. There was also a 66% increase in domestic violence for LGBTQ youth during shelter in place. 30 LGBTQ youth are yet another example of those already at increased risk having disproportionate effects of the pandemic.

Increased social media use during COVID-19, along with traditional forms of education moving to digital platforms, has led to the majority of adolescents spending significantly more time in front of screens. Excessive screen time is well-known to be associated with poor sleep, sedentary habits, mental health problems, and physical health issues. 31 With decreased access to physical activity, especially in crowded inner-city areas, and increased dependence on screen time for schooling, it is more difficult to craft easy solutions to the screen time issue.

During these times, it is more important than ever for pediatricians to check in on the mental health of patients with queries about how school is going, how patients are keeping contact with peers, and how are they processing social issues related to violence. Queries to families about the need for assistance with food insecurity, housing insecurity, and access to mental health services are necessary during this time of public emergency.

Medical school and COVID-19

Although medical school is an adult schooling experience, it affects not only the medical profession and our junior colleagues, but, by extrapolation, all education that requires hands-on experience or interning, and has been included for those reasons.

In the new COVID-19 era, medical schools have been forced to make drastic and quick changes to multiple levels of their curriculum to ensure both student and patient safety during the pandemic. Students entering their clinical rotations have had the most drastic alteration to their experience.

COVID-19 has led to some of the same changes high schools and colleges have adopted, specifically, replacement of large in-person lectures with small group activities small group discussion and virtual lectures. 32 The transition to an online format for medical education has been rapid and impacted both students and faculty. 33 , 34 In a survey by Singh and colleagues, 33 of the 192 students reporting 43.9% found online lectures to be poorer than physical classrooms during the pandemic. In another report by Shahrvini and colleagues, 35 of 104 students surveyed, 74.5% students felt disconnected from their medical school and their peers and 43.3% felt that they were unprepared for their clerkships. Although there are no pre-COVID-19 data for comparison, it is expected that the COVID-19 changes will lead to increased insecurity and feelings of poor preparation for clinical work.

Gross anatomy is a well-established tradition within the medical school curriculum and one that is conducted almost entirely in person and in close quarters around a cadaver. Harmon and colleagues 36 surveyed 67 gross anatomy educators and found that 8% were still holding in-person sessions and 34 ± 43% transitioned to using cadaver images and dissecting videos that could be accessed through the Internet.

Many third- and fourth-year medical students have seen periods of cancellation for clinical rotations and supplementation with online learning, telemedicine, or virtual rounds owing to the COVID-19 pandemic. 37 A study from Shahrvini and colleagues 38 found that an unofficial document from Reddit (a widely used social network platform with a subgroup for medical students and residents) reported that 75% of medical schools had canceled clinical activities for third- and fourth-year students for some part of 2020. In another survey by Harries and colleagues, 39 of the 741 students who responded, 93.7% were not involved in clinical rotations with in-person patient contact. The reactions of students varied, with 75.8% admitting to agreeing with the decision, 34.7% feeling guilty, and 27.0% feeling relieved. 39 In the same survey, 74.7% of students felt that their medical education had been disrupted, 84.1% said they felt increased anxiety, and 83.4% would accept the risk of COVID-19 infection if they were able to return to the clinical setting. 39

Since the start of the pandemic, medical schools have had to find new and innovative ways to continue teaching and exposing students to clinical settings. The use of electronic conferencing services has been critical to continuing education. One approach has been to turn to online applications like Google Hangouts, which come at no cost and offer a wide variety of tools to form an integrative learning environment. 32 , 37 , 40 Schools have also adopted a hybrid model of teaching where lectures can be prerecorded then viewed by the student asynchronously on their own time followed by live virtual lectures where faculty can offer question-and-answer sessions related to the material. By offering this new format, students have been given more flexibility in terms of creating a schedule that suits their needs and may decrease stress. 37

Although these changes can be a hurdle to students and faculty, it might prove to be beneficial for the future of medical training in some ways. Telemedicine is a growing field, and the American Medical Association and other programs have endorsed its value. 41 Telemedicine visits can still be used to take a history, conduct a basic visual physical examination, and build rapport, as well as performing other aspects of the clinical examination during a pandemic, and will continue to be useful for patients unable to attend regular visits at remote locations. Learning effectively now how to communicate professionally and carry out telemedicine visits may better prepare students for a future where telemedicine is an expectation and allow students to learn the limitations as well as the advantages of this modality. 41

Pandemic changes have strongly impacted the process of college applications, medical school applications, and residency applications. 32 For US medical residencies, 72% of applicants will, if the pattern from 2016 to 2019 continues, move between states or countries. 42 This level of movement is increasingly dangerous given the spread of COVID-19 and the lack of currently accepted procedures to carry out such a mass migration safely. The same follows for medical schools and universities.

We need to accept and prepare for the fact that medial students as well as other learners who require in-person training may lack some skills when they enter their profession. These skills will have to be acquired during a later phase of training. We may have less skilled entry-level resident physicians and nurses in our hospitals and in other clinical professions as well.

The COVID-19 pandemic has affected and will continue to affect the delivery of knowledge and skills at all levels of education. Although many children and adult learners will likely compensate for this interruption of traditional educational services and adapt to new modalities, some will struggle. The widening of the gap for those whose families cannot absorb the teaching and supervision of education required for in-home education because they lack the time and skills necessary are not addressed currently. The gap for those already at a disadvantage because of socioeconomic class, language, and special needs are most severely affected by the COVID-19 pandemic school closures and will have the hardest time compensating. As pediatricians, it is critical that we continue to check in with our young patients about how they are coping and what assistance we can guide them toward in our communities.

Clinics care points

• • Learners and educators at all levels of education have been affected by COVID-19 restrictions with rapid adaptations to virtual learning platforms.
• • The impact of COVID-19 on learners is not evenly distributed and children of racial minorities, those who live in poverty, those requiring special education, and children who speak English as a second language are more negatively affected by the need for remote learning.
• • Math scores are more impacted than language arts scores by previous school closures and thus far by these shutdowns for COVID-19.
• • Anxiety and depression have increased in children and particularly in adolescents as a result of COVID-19 itself and as a consequence of school changes.
• • Pediatricians should regularly screen for unmet needs in their patients during the pandemic, such as food insecurity with the loss of school meals, an inability to adapt to remote learning and increased computer time, and heightened anxiety and depression as results of school changes.

The authors have nothing to disclose.

Read these 12 moving essays about life during coronavirus

Artists, novelists, critics, and essayists are writing the first draft of history.

by Alissa Wilkinson

The world is grappling with an invisible, deadly enemy, trying to understand how to live with the threat posed by a virus . For some writers, the only way forward is to put pen to paper, trying to conceptualize and document what it feels like to continue living as countries are under lockdown and regular life seems to have ground to a halt.

So as the coronavirus pandemic has stretched around the world, it’s sparked a crop of diary entries and essays that describe how life has changed. Novelists, critics, artists, and journalists have put words to the feelings many are experiencing. The result is a first draft of how we’ll someday remember this time, filled with uncertainty and pain and fear as well as small moments of hope and humanity.

• The Vox guide to navigating the coronavirus crisis

At the New York Review of Books, Ali Bhutto writes that in Karachi, Pakistan, the government-imposed curfew due to the virus is “eerily reminiscent of past military clampdowns”:

Beneath the quiet calm lies a sense that society has been unhinged and that the usual rules no longer apply. Small groups of pedestrians look on from the shadows, like an audience watching a spectacle slowly unfolding. People pause on street corners and in the shade of trees, under the watchful gaze of the paramilitary forces and the police.

His essay concludes with the sobering note that “in the minds of many, Covid-19 is just another life-threatening hazard in a city that stumbles from one crisis to another.”

Writing from Chattanooga, novelist Jamie Quatro documents the mixed ways her neighbors have been responding to the threat, and the frustration of conflicting direction, or no direction at all, from local, state, and federal leaders:

Whiplash, trying to keep up with who’s ordering what. We’re already experiencing enough chaos without this back-and-forth. Why didn’t the federal government issue a nationwide shelter-in-place at the get-go, the way other countries did? What happens when one state’s shelter-in-place ends, while others continue? Do states still under quarantine close their borders? We  are  still one nation, not fifty individual countries. Right?

• A syllabus for the end of the world

Award-winning photojournalist Alessio Mamo, quarantined with his partner Marta in Sicily after she tested positive for the virus, accompanies his photographs in the Guardian of their confinement with a reflection on being confined :

The doctors asked me to take a second test, but again I tested negative. Perhaps I’m immune? The days dragged on in my apartment, in black and white, like my photos. Sometimes we tried to smile, imagining that I was asymptomatic, because I was the virus. Our smiles seemed to bring good news. My mother left hospital, but I won’t be able to see her for weeks. Marta started breathing well again, and so did I. I would have liked to photograph my country in the midst of this emergency, the battles that the doctors wage on the frontline, the hospitals pushed to their limits, Italy on its knees fighting an invisible enemy. That enemy, a day in March, knocked on my door instead.

In the New York Times Magazine, deputy editor Jessica Lustig writes with devastating clarity about her family’s life in Brooklyn while her husband battled the virus, weeks before most people began taking the threat seriously:

At the door of the clinic, we stand looking out at two older women chatting outside the doorway, oblivious. Do I wave them away? Call out that they should get far away, go home, wash their hands, stay inside? Instead we just stand there, awkwardly, until they move on. Only then do we step outside to begin the long three-block walk home. I point out the early magnolia, the forsythia. T says he is cold. The untrimmed hairs on his neck, under his beard, are white. The few people walking past us on the sidewalk don’t know that we are visitors from the future. A vision, a premonition, a walking visitation. This will be them: Either T, in the mask, or — if they’re lucky — me, tending to him.

Essayist Leslie Jamison writes in the New York Review of Books about being shut away alone in her New York City apartment with her 2-year-old daughter since she became sick:

The virus.  Its sinewy, intimate name. What does it feel like in my body today? Shivering under blankets. A hot itch behind the eyes. Three sweatshirts in the middle of the day. My daughter trying to pull another blanket over my body with her tiny arms. An ache in the muscles that somehow makes it hard to lie still. This loss of taste has become a kind of sensory quarantine. It’s as if the quarantine keeps inching closer and closer to my insides. First I lost the touch of other bodies; then I lost the air; now I’ve lost the taste of bananas. Nothing about any of these losses is particularly unique. I’ve made a schedule so I won’t go insane with the toddler. Five days ago, I wrote  Walk/Adventure!  on it, next to a cut-out illustration of a tiger—as if we’d see tigers on our walks. It was good to keep possibility alive.

At Literary Hub, novelist Heidi Pitlor writes about the elastic nature of time during her family’s quarantine in Massachusetts:

During a shutdown, the things that mark our days—commuting to work, sending our kids to school, having a drink with friends—vanish and time takes on a flat, seamless quality. Without some self-imposed structure, it’s easy to feel a little untethered. A friend recently posted on Facebook: “For those who have lost track, today is Blursday the fortyteenth of Maprilay.” ... Giving shape to time is especially important now, when the future is so shapeless. We do not know whether the virus will continue to rage for weeks or months or, lord help us, on and off for years. We do not know when we will feel safe again. And so many of us, minus those who are gifted at compartmentalization or denial, remain largely captive to fear. We may stay this way if we do not create at least the illusion of movement in our lives, our long days spent with ourselves or partners or families.

• What day is it today?

Novelist Lauren Groff writes at the New York Review of Books about trying to escape the prison of her fears while sequestered at home in Gainesville, Florida:

Some people have imaginations sparked only by what they can see; I blame this blinkered empiricism for the parks overwhelmed with people, the bars, until a few nights ago, thickly thronged. My imagination is the opposite. I fear everything invisible to me. From the enclosure of my house, I am afraid of the suffering that isn’t present before me, the people running out of money and food or drowning in the fluid in their lungs, the deaths of health-care workers now growing ill while performing their duties. I fear the federal government, which the right wing has so—intentionally—weakened that not only is it insufficient to help its people, it is actively standing in help’s way. I fear we won’t sufficiently punish the right. I fear leaving the house and spreading the disease. I fear what this time of fear is doing to my children, their imaginations, and their souls.

At ArtForum , Berlin-based critic and writer Kristian Vistrup Madsen reflects on martinis, melancholia, and Finnish artist Jaakko Pallasvuo’s 2018 graphic novel  Retreat , in which three young people exile themselves in the woods:

In melancholia, the shape of what is ending, and its temporality, is sprawling and incomprehensible. The ambivalence makes it hard to bear. The world of  Retreat  is rendered in lush pink and purple watercolors, which dissolve into wild and messy abstractions. In apocalypse, the divisions established in genesis bleed back out. My own Corona-retreat is similarly soft, color-field like, each day a blurred succession of quarantinis, YouTube–yoga, and televized press conferences. As restrictions mount, so does abstraction. For now, I’m still rooting for love to save the world.

At the Paris Review , Matt Levin writes about reading Virginia Woolf’s novel The Waves during quarantine:

A retreat, a quarantine, a sickness—they simultaneously distort and clarify, curtail and expand. It is an ideal state in which to read literature with a reputation for difficulty and inaccessibility, those hermetic books shorn of the handholds of conventional plot or characterization or description. A novel like Virginia Woolf’s  The Waves  is perfect for the state of interiority induced by quarantine—a story of three men and three women, meeting after the death of a mutual friend, told entirely in the overlapping internal monologues of the six, interspersed only with sections of pure, achingly beautiful descriptions of the natural world, a day’s procession and recession of light and waves. The novel is, in my mind’s eye, a perfectly spherical object. It is translucent and shimmering and infinitely fragile, prone to shatter at the slightest disturbance. It is not a book that can be read in snatches on the subway—it demands total absorption. Though it revels in a stark emotional nakedness, the book remains aloof, remote in its own deep self-absorption.

• Vox is starting a book club. Come read with us!

In an essay for the Financial Times, novelist Arundhati Roy writes with anger about Indian Prime Minister Narendra Modi’s anemic response to the threat, but also offers a glimmer of hope for the future:

Historically, pandemics have forced humans to break with the past and imagine their world anew. This one is no different. It is a portal, a gateway between one world and the next. We can choose to walk through it, dragging the carcasses of our prejudice and hatred, our avarice, our data banks and dead ideas, our dead rivers and smoky skies behind us. Or we can walk through lightly, with little luggage, ready to imagine another world. And ready to fight for it. 

From Boston, Nora Caplan-Bricker writes in The Point about the strange contraction of space under quarantine, in which a friend in Beirut is as close as the one around the corner in the same city:

It’s a nice illusion—nice to feel like we’re in it together, even if my real world has shrunk to one person, my husband, who sits with his laptop in the other room. It’s nice in the same way as reading those essays that reframe social distancing as solidarity. “We must begin to see the negative space as clearly as the positive, to know what we  don’t do  is also brilliant and full of love,” the poet Anne Boyer wrote on March 10th, the day that Massachusetts declared a state of emergency. If you squint, you could almost make sense of this quarantine as an effort to flatten, along with the curve, the distinctions we make between our bonds with others. Right now, I care for my neighbor in the same way I demonstrate love for my mother: in all instances, I stay away. And in moments this month, I have loved strangers with an intensity that is new to me. On March 14th, the Saturday night after the end of life as we knew it, I went out with my dog and found the street silent: no lines for restaurants, no children on bicycles, no couples strolling with little cups of ice cream. It had taken the combined will of thousands of people to deliver such a sudden and complete emptiness. I felt so grateful, and so bereft.

And on his own website, musician and artist David Byrne writes about rediscovering the value of working for collective good , saying that “what is happening now is an opportunity to learn how to change our behavior”:

In emergencies, citizens can suddenly cooperate and collaborate. Change can happen. We’re going to need to work together as the effects of climate change ramp up. In order for capitalism to survive in any form, we will have to be a little more socialist. Here is an opportunity for us to see things differently — to see that we really are all connected — and adjust our behavior accordingly.  Are we willing to do this? Is this moment an opportunity to see how truly interdependent we all are? To live in a world that is different and better than the one we live in now? We might be too far down the road to test every asymptomatic person, but a change in our mindsets, in how we view our neighbors, could lay the groundwork for the collective action we’ll need to deal with other global crises. The time to see how connected we all are is now.

The portrait these writers paint of a world under quarantine is multifaceted. Our worlds have contracted to the confines of our homes, and yet in some ways we’re more connected than ever to one another. We feel fear and boredom, anger and gratitude, frustration and strange peace. Uncertainty drives us to find metaphors and images that will let us wrap our minds around what is happening.

Yet there’s no single “what” that is happening. Everyone is contending with the pandemic and its effects from different places and in different ways. Reading others’ experiences — even the most frightening ones — can help alleviate the loneliness and dread, a little, and remind us that what we’re going through is both unique and shared by all.

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Classroom Q&A

With larry ferlazzo.

In this EdWeek blog, an experiment in knowledge-gathering, Ferlazzo will address readers’ questions on classroom management, ELL instruction, lesson planning, and other issues facing teachers. Send your questions to [email protected]. Read more from this blog.

Students Share How COVID Has Changed Their Lives

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(This is the final post in a two-part series. You can see Part One here .)

The new questions-of-the-week (directed toward students) is:

What is the best thing about school this year? Why?

What is the worst thing about school this year? Why?

Several students from our school shared their responses to these questions in Part One .

Here are even more:

Disrupted Plans

Pachia Xiong is a junior at Luther Burbank High School in Sacramento, Calif.:

The best thing about school this year is being able to hang out with my friends again. I think this is the best thing for me this year because I don’t have to use social media or Zoom to contact them. As the previous school year was spent through distance learning, I had little contact with my friends because I was not someone who frequented my social media back then. Now, I am able to, with ease, talk to them in person. It feels much nicer that way.

The worst thing about school this year is being unable to do everything I planned because of COVID-19. Over last year, during distance learning, I was highly hopeful of returning to school in person. Following those hopes came the goals I wanted to achieve upon our return. Some of which involved holding club events and activities that could be enjoyed by both club members and outsiders. However, the rise in COVID-19 cases put a lid over those goals, and now, everything feels as though it’s come to a stop.

‘Classes Are Easier’

Brenda Lin is a senior at Luther Burbank High School:

The best thing about this year is that most of my classes are easier because of the pandemic. For example, most of my finals for first semester were really easy because a lot of it was stress-free assignments. The teachers are more understanding about missing work and absences, and overall, I get sick less when I’m at school because I’m wearing a mask all the time. Overall, it’s a good way to end my high school years.

The worst thing about this year is that we have to be in school during the pandemic. When we were in distance learning, it was definitely a lot easier in terms of difficulty of assignments, but my motivation was very low. It is about the same in in-person school, but now, I have to worry about getting sick and bringing it back to all my family members. Not only that, but some of my teachers assign difficult assignments and require a lot of time and work to complete, and it’s not something I’m willing to do.

‘Being Able to Learn New Things’

Abby Funez is a senior at Luther Burbank High School:

The best thing about school this year is being able to learn new things every day that benefit me later on in life. This is the best thing because I am able to grow in knowledge and mature a lot more. For example, I am learning how to write essays while being timed and under pressure. This will help me in my admissions for classes in college and to be a better writer, which will benefit me long term throughout my life.

The worst thing about school this year is wearing masks. This is the worst thing because it makes it harder to hear our teachers and students within our area. In my Spanish class, my teacher is unable to hear other students even when they are standing by her because of the masks. This makes my life difficult because I miss important concepts of the lesson being taught at times.

‘Teachers Are More Lenient’

Julianna Eakle is a junior at Luther Burbank High School:

The best thing about this school year is how the teachers are more lenient of our absences or our missing assignments. For example, our principal put out an email saying that he understands if parents would like to keep us home due to our safety, for students just to continue doing our work online. My teachers were very concerned about me not attending class but did everything to help me stay on top of my grades.

The worst thing about this school year is people not having their masks over their nose and mouths. There are at least 3 teachers a day telling one of their students to put their mask over their nose and mouth. It’s a serious problem, and because of that one person, COVID cases start to spike fast.

‘We Can’t Eat or Drink Water in Class’

Van Bui is a senior at Luther Burbank High School:

The best thing about school this year is meeting new people and joining different sports like volleyball and track and field. This is the best thing because it taught me to enjoy life and take risks as I go. For example, I get to know a lot of people and hang out with them to do fun activities with, and joining different sports allowed me to step out of my boundaries and improve my health especially during these times. This makes my life better because I was always scared to talk to people and do different sports.

The worst thing about school this year is having COVID-19 going on still. This is the worst thing because I always have to wear a mask and there are limited activities that we can do in school. For example, we can’t eat or drink water in class, waking up early in the morning, and before getting fresh air, it’s blocked by wearing a mask for 8 hours straight. This makes my life worse because I find it very difficult to breathe or eat in class.

‘We Are Back in Person’

Lakeyah Roots is a junior at Luther Burbank High School:

The best thing about school this year is being able to learn in person. When we were doing distance learning, being able to learn the information being taught to me and my ability to do my schoolwork was not good. But now that we are back in person, I feel like I can do more work more efficiently and really get the help I need. Distance learning has taught me that doing school online does not suit me.

The worst thing about school is COVID cases. Students were getting sick, and that caused the class to be empty sometimes. The classroom does not feel the same when it is not filled with the students you normally see every day. It is not fun not being able to do certain activities because of COVID. It’s best to keep our distance from one another, but sometimes I miss the days when we were able to do certain class activities before COVID hit.

Seeing Friends

Joanna Medrano-Gutierrez is a junior at Luther Burbank High School:

The best thing about this school year is being able to see my friends again. This is the best thing about this school year because I haven’t seen most of them since the pandemic started. For example, I haven’t seen a certain friend since March 2020, but now, this school year, we are closer than we were before.

The worst thing about this school year is adapting back into waking up early again. This is the worst thing about the pandemic because I got so used to sleeping late and sleeping in, and then I had to get used to waking up early. For example, before I woke up at 9 a.m.-12 p.m., but now I wake up at 6 a.m.-7 a.m.

Thanks to Pachia, Brenda, Abby, Julianna, Van, Lakeyah, and Joanna for contributing their thoughts.

Consider contributing a question to be answered in a future post. You can send one to me at [email protected] . When you send it in, let me know if I can use your real name if it’s selected or if you’d prefer remaining anonymous and have a pseudonym in mind.

You can also contact me on Twitter at @Larryferlazzo .

Education Week has published a collection of posts from this blog, along with new material, in an e-book form. It’s titled Classroom Management Q&As: Expert Strategies for Teaching .

Just a reminder; you can subscribe and receive updates from this blog via email (The RSS feed for this blog, and for all Ed Week articles, has been changed by the new redesign—new ones are not yet available). And if you missed any of the highlights from the first 10 years of this blog, you can see a categorized list below.

• The 11 Most Popular Classroom Q&A Posts of the Year
• Race & Racism in Schools
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I am also creating a Twitter list including all contributors to this column .

The opinions expressed in Classroom Q&A With Larry Ferlazzo are strictly those of the author(s) and do not reflect the opinions or endorsement of Editorial Projects in Education, or any of its publications.

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Covid 19 Essay in English

Essay on Covid -19: In a very short amount of time, coronavirus has spread globally. It has had an enormous impact on people's lives, economy, and societies all around the world, affecting every country. Governments have had to take severe measures to try and contain the pandemic. The virus has altered our way of life in many ways, including its effects on our health and our economy. Here are a few sample essays on ‘CoronaVirus’.

100 Words Essay on Covid 19

200 words essay on covid 19, 500 words essay on covid 19.

COVID-19 or Corona Virus is a novel coronavirus that was first identified in 2019. It is similar to other coronaviruses, such as SARS-CoV and MERS-CoV, but it is more contagious and has caused more severe respiratory illness in people who have been infected. The novel coronavirus became a global pandemic in a very short period of time. It has affected lives, economies and societies across the world, leaving no country untouched. The virus has caused governments to take drastic measures to try and contain it. From health implications to economic and social ramifications, COVID-19 impacted every part of our lives. It has been more than 2 years since the pandemic hit and the world is still recovering from its effects.

Since the outbreak of COVID-19, the world has been impacted in a number of ways. For one, the global economy has taken a hit as businesses have been forced to close their doors. This has led to widespread job losses and an increase in poverty levels around the world. Additionally, countries have had to impose strict travel restrictions in an attempt to contain the virus, which has resulted in a decrease in tourism and international trade. Furthermore, the pandemic has put immense pressure on healthcare systems globally, as hospitals have been overwhelmed with patients suffering from the virus. Lastly, the outbreak has led to a general feeling of anxiety and uncertainty, as people are fearful of contracting the disease.

My Experience of COVID-19

I still remember how abruptly colleges and schools shut down in March 2020. I was a college student at that time and I was under the impression that everything would go back to normal in a few weeks. I could not have been more wrong. The situation only got worse every week and the government had to impose a lockdown. There were so many restrictions in place. For example, we had to wear face masks whenever we left the house, and we could only go out for essential errands. Restaurants and shops were only allowed to operate at take-out capacity, and many businesses were shut down.

In the current scenario, coronavirus is dominating all aspects of our lives. The coronavirus pandemic has wreaked havoc upon people’s lives, altering the way we live and work in a very short amount of time. It has revolutionised how we think about health care, education, and even social interaction. This virus has had long-term implications on our society, including its impact on mental health, economic stability, and global politics. But we as individuals can help to mitigate these effects by taking personal responsibility to protect themselves and those around them from infection.

Effects of CoronaVirus on Education

The outbreak of coronavirus has had a significant impact on education systems around the world. In China, where the virus originated, all schools and universities were closed for several weeks in an effort to contain the spread of the disease. Many other countries have followed suit, either closing schools altogether or suspending classes for a period of time.

This has resulted in a major disruption to the education of millions of students. Some have been able to continue their studies online, but many have not had access to the internet or have not been able to afford the costs associated with it. This has led to a widening of the digital divide between those who can afford to continue their education online and those who cannot.

The closure of schools has also had a negative impact on the mental health of many students. With no face-to-face contact with friends and teachers, some students have felt isolated and anxious. This has been compounded by the worry and uncertainty surrounding the virus itself.

The situation with coronavirus has improved and schools have been reopened but students are still catching up with the gap of 2 years that the pandemic created. In the meantime, governments and educational institutions are working together to find ways to support students and ensure that they are able to continue their education despite these difficult circumstances.

Effects of CoronaVirus on Economy

The outbreak of the coronavirus has had a significant impact on the global economy. The virus, which originated in China, has spread to over two hundred countries, resulting in widespread panic and a decrease in global trade. As a result of the outbreak, many businesses have been forced to close their doors, leading to a rise in unemployment. In addition, the stock market has taken a severe hit.

Effects of CoronaVirus on Health

The effects that coronavirus has on one's health are still being studied and researched as the virus continues to spread throughout the world. However, some of the potential effects on health that have been observed thus far include respiratory problems, fever, and coughing. In severe cases, pneumonia, kidney failure, and death can occur. It is important for people who think they may have been exposed to the virus to seek medical attention immediately so that they can be treated properly and avoid any serious complications. There is no specific cure or treatment for coronavirus at this time, but there are ways to help ease symptoms and prevent the virus from spreading.

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The link between poor housing conditions and COVID-19 infection

Robb, Katharine, Rowana Ahmed, John Wong, Elissa Ladd, and Jorrit de Jong. “ Substandard housing and the risk of COVID-19 infection and disease severity: A retrospective cohort study. ” SSM - Population Health 25 (March 2024): 101629.

Faculty Authors

Jorrit de Jong

What’s the issue.

Following the peak of the COVID-19 pandemic, researchers continue to investigate the factors related to the spread of disease—and how city leaders can better respond before, during, and after such crises. Housing conditions, for example, can play a role in infectious disease risk. Substandard housing—which might feature poor ventilation, overcrowding, and dampness—can create an environment favorable to respiratory disease.

So, did poor housing conditions lead to more—and more severe—cases of COVID-19 infection during the pandemic?  

What does the research say?

Researchers from the Bloomberg Center for Cities at Harvard University and the MGH Institute of Health Professions studied the connections between poor housing conditions and COVID-19 infection and severity during the first year of the pandemic. They combined city housing data with healthcare data for residents of Chelsea, Massachusetts—a densely populated city with high levels of substandard housing.

The researchers found that:

• Living in substandard housing was linked to higher COVID-19 infection risk, even after adjusting for factors like age, income, and race.
• This increased risk was only observed during lockdown and early reopening; after stay-at-home restrictions lifted there was no difference in COVID-19 risk between residents of substandard versus adequate housing.
• Substandard housing was not linked to greater risk of severe COVID-19 disease.
• Leaders can leverage city housing data for pandemic response and longer-term solutions.

They conclude, “The results demonstrate the value of combining cross-sector datasets to yield new insights and solutions. Existing city data can be leveraged to identify and prioritize 1) high-risk areas for future pandemic response activities, and 2) for longer-term solutions that address social determinants of health through safe and affordable housing.”  

More from HKS

Media narratives have generally blamed democrats for housing crises in cities. research suggests that is not the full story., advancing progress in cities around the globe, doctors’ political beliefs influence covid-19 treatment recommendations, study suggests.

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The Changing Political Geography of COVID-19 Over the Last Two Years

Over the past two years, the official count of coronavirus deaths in the United States has risen and is now approaching 1 million lives. Large majorities of Americans say they personally know someone who has been hospitalized or died of the coronavirus , and it has impacted – in varying degrees – nearly every aspect of life .

A new Pew Research Center analysis of official reports of COVID-19-related deaths across the country, based on mortality data collected by The New York Times, shows how the dynamics of the pandemic have shifted over the past two years.

A timeline of the shifting geography of the pandemic

Pew Research Center conducted this analysis to understand how the geography of the coronavirus outbreak has changed over its course. For this analysis, we relied on official reports of deaths attributed to the novel coronavirus collected and maintained by The New York Times .

The estimates provided in this report are subject to several sources of error. There may be significant differences between the true number of deaths due to COVID-19 and the official reported counts of those deaths. There may also be variation across the states in the quality and types of data reported. For example, most states report deaths based on the residency of the deceased person rather than the location where they died. The New York Times collects data from many different local health agencies, and this likely leads to some additional measurement error.

This analysis relies on county-level data. Counties in the United States vary widely in their population sizes, so in many places in the essay, we divide counties into approximately equal-sized groups (in terms of their population) for comparability or report on population adjusted death rates rather than total counts of deaths.

The pandemic has rolled across the U.S. unevenly and in waves. Today, the death toll of the pandemic looks very different from how it looked in the early part of 2020 . The first wave (roughly the first 125,000 deaths from March 2020 through June 2020) was largely geographically concentrated in the Northeast and in particular the New York City region. During the summer of 2020, the largest share of the roughly 80,000 deaths that occurred during the pandemic’s second wave were in the southern parts of the country.

The fall and winter months of 2020 and early 2021 were the deadliest of the pandemic to date. More than 370,000 Americans died of COVID-19 between October 2020 and April 2021; the geographic distinctions that characterized the earlier waves became much less pronounced.

By the spring and summer of 2021, the nationwide death rate had slowed significantly, and vaccines were widely available to all adults who wanted them. But starting at the end of the summer, the fourth and fifth waves (marked by new variants of the virus, delta and then omicron) came in quick succession and claimed more than 300,000 lives.

In many cases, the characteristics of communities that were associated with higher death rates at the beginning of the pandemic are now associated with lower death rates (and vice versa). Early in the pandemic, urban areas were disproportionately impacted. During the first wave, the coronavirus death rate in the 10% of the country that lives in the most densely populated counties was more than nine times that of the death rate among the 10% of the population living in the least densely populated counties. In each subsequent wave, however, the nation’s least dense counties have registered higher death rates than the most densely populated places.

Despite the staggering death toll in densely populated urban areas during the first months of the pandemic (an average 36 monthly deaths per 100,000 residents), the overall death rate over the course of the pandemic is slightly higher in the least populated parts of the country (an average monthly 15 deaths per 100,000 among the 10% living in the least densely populated counties vs. 13 per 100,000 among the 10% in the most densely populated counties).

As the relationship between population density and coronavirus death rates has changed over the course of the pandemic, so too has the relationship between counties’ voting patterns and their death rates from COVID-19.

In the spring of 2020, the areas recording the greatest numbers of deaths were much more likely to vote Democratic than Republican. But by the third wave of the pandemic, which began in fall 2020, the pattern had reversed: Counties that voted for Donald Trump over Joe Biden were suffering substantially more deaths from the coronavirus pandemic than those that voted for Biden over Trump. This reversal is likely a result of several factors including differences in mitigation efforts and vaccine uptake, demographic differences, and other differences that are correlated with partisanship at the county level.

During this third wave – which continued into early 2021 – the coronavirus death rate among the 20% of Americans living in counties that supported Trump by the highest margins in 2020 was about 170% of the death rate among the one-in-five Americans living in counties that supported Biden by the largest margins.

As vaccines became more widely available, this discrepancy between “blue” and “red” counties became even larger as the virulent delta strain of the pandemic spread across the country during the summer and fall of 2021, even as the total number of deaths fell somewhat from its third wave peak.

During the fourth wave of the pandemic, death rates in the most pro-Trump counties were about four times what they were in the most pro-Biden counties. When the highly transmissible omicron variant began to spread in the U.S. in late 2021, these differences narrowed substantially. However, death rates in the most pro-Trump counties were still about 180% of what they were in the most pro-Biden counties throughout late 2021 and early 2022.

The cumulative impact of these divergent death rates is a wide difference in total deaths from COVID-19 between the most pro-Trump and most pro-Biden parts of the country. Since the pandemic began, counties representing the 20% of the population where Trump ran up his highest margins in 2020 have experienced nearly 70,000 more deaths from COVID-19 than have the counties representing the 20% of population where Biden performed best. Overall, the COVID-19 death rate in all c ounties Trump won in 2020 is substantially higher than it is in counties Biden won (as of the end of February 2022, 326 per 100,000 in Trump counties and 258 per 100,000 in Biden counties).

Partisan divide in COVID-19 deaths widened as more vaccines became available

Partisan differences in COVID-19 death rates expanded dramatically after the availability of vaccines increased. Unvaccinated people are at far higher risk of death and hospitalization from COVID-19, according to the Centers for Disease Control and Prevention, and vaccination decisions are strongly associated with partisanship . Among the large majority of counties for which reliable vaccination data exists, counties that supported Trump at higher margins have substantially lower vaccination rates than those that supported Biden at higher margins.

Counties with lower rates of vaccination registered substantially greater death rates during each wave in which vaccines were widely available.

During the fall of 2021 (roughly corresponding to the delta wave), about 10% of Americans lived in counties with adult vaccination rates lower than 40% as of July 2021. Death rates in these low-vaccination counties were about six times as high as death rates in counties where 70% or more of the adult population was vaccinated.

More Americans were vaccinated heading into the winter of 2021 and 2022 (roughly corresponding to the omicron wave), but nearly 10% of the country lived in areas where less than half of the adult population was vaccinated as of November 2021. Death rates in these low-vaccination counties were roughly twice what they were in counties that had 80% or more of their population vaccinated. ( Note: The statistics here reflect the death rates in the county as a whole, not rates for vaccinated and unvaccinated individuals, though individual-level data finds that death rates among unvaccinated people are far higher than among vaccinated people.)

This analysis relies on official reports of deaths attributed to COVID-19 in the United States collected and reported by The New York Times .

COVID-19 deaths in Puerto Rico and other U.S. territories are not included in this analysis. Additionally, deaths without a specific geographic location have been excluded.

Data was pulled from the GitHub repository maintained by The New York Times on March 1, 2022, and reflects reported coronavirus deaths through Feb. 28.

There are several anomalies in the deaths data. Many locales drop off their reporting on the weekends and holidays. In addition to the rhythm of the reporting cycle, there are many instances where a locality will revise the count of its deaths downward (usually only by a small amount) or release a large batch of previously unreported deaths on a single day. The downward revisions were identified and retroactively applied to earlier days.

Large batches of cases were identified by finding days that increased by more than 10 deaths and were 10 standard deviations above the norm for a county within a 30-day window. Deaths reported in these anomalous batches were then evenly distributed across the days leading up to when they were released.

Population data for U.S. counties comes from the 2015-2019 American Community Survey estimates published by the Census Bureau (accessed through the tidycensus package in R on Feb. 21). The 2020 vote share for each county was purchased from Dave Leip’s Election Atlas (downloaded on Nov. 21, 2021).

The analysis looks at deaths among counties based on their 2020 vote. Counties were grouped into five groups with approximately equal population. For analyses that include 2020 vote, Alaskan counties are excluded because Alaska does not report its election results at the county level. The table below provides more details.

This essay benefited greatly from thoughtful comments and consultation with many individuals around Pew Research Center. Jocelyn Kiley, Carroll Doherty and Jeb Bell provided invaluable editorial guidance. Peter Bell and Alissa Scheller contributed their expertise in visualization, Ben Wormald built the map animation, and Reem Nadeem did the digital production. Andrew Daniller provided careful attention to the quality check process, and David Kent’s watchful copy editing eye brought clarity to some difficult concepts.

Lead photo: Kent Nishimura/Los Angeles Times via Getty Images

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The future of work after COVID-19

The COVID-19 pandemic disrupted labor markets globally during 2020. The short-term consequences were sudden and often severe: Millions of people were furloughed or lost jobs, and others rapidly adjusted to working from home as offices closed. Many other workers were deemed essential and continued to work in hospitals and grocery stores, on garbage trucks and in warehouses, yet under new protocols to reduce the spread of the novel coronavirus.

This report on the future of work after COVID-19 is the first of three MGI reports that examine aspects of the postpandemic economy. The others look at the pandemic’s long-term influence on consumption and the potential for a broad recovery led by enhanced productivity and innovation. Here, we assess the lasting impact of the pandemic on labor demand, the mix of occupations, and the workforce skills required in eight countries with diverse economic and labor market models: China, France, Germany, India, Japan, Spain, the United Kingdom, and the United States. Together, these eight countries account for almost half the global population and 62 percent of GDP.

Jobs with the highest physical proximity are likely to be most disrupted

Before COVID-19, the largest disruptions to work involved new technologies and growing trade links. COVID-19 has, for the first time, elevated the importance of the physical dimension of work. In this research, we develop a novel way to quantify the proximity required in more than 800 occupations by grouping them into ten work arenas according to their proximity to coworkers and customers, the number of interpersonal interactions involved, and their on-site and indoor nature.

This offers a different view of work than traditional sector definitions. For instance, our medical care arena includes only caregiving roles requiring close interaction with patients, such as doctors and nurses. Hospital and medical office administrative staff fall into the computer-based office work arena, where more work can be done remotely. Lab technicians and pharmacists work in the indoor production work arena because those jobs require use of specialized equipment on-site but have little exposure to other people (Exhibit 1).

We find that jobs in work arenas with higher levels of physical proximity are likely to see greater transformation after the pandemic, triggering knock-on effects in other work arenas as business models shift in response.

The short- and potential long-term disruptions to these arenas from COVID-19 vary. During the pandemic, the virus most severely disturbed arenas with the highest overall physical proximity scores: medical care, personal care, on-site customer service, and leisure and travel. In the longer term, work arenas with higher physical proximity scores are also likely to be more unsettled, although proximity is not the only explanation. For example:

• The on-site customer interaction arena includes frontline workers who interact with customers in retail stores, banks, and post offices, among other places. Work in this arena is defined by frequent interaction with strangers and requires on-site presence. Some work in this arena migrated to e-commerce and other digital transactions, a behavioral change that is likely to stick.
• The leisure and travel arena is home to customer-facing workers in hotels, restaurants, airports, and entertainment venues. Workers in this arena interact daily with crowds of new people. COVID-19 forced most leisure venues to close in 2020 and airports and airlines to operate on a severely limited basis. In the longer term, the shift to remote work  and related reduction in business travel, as well as automation of some occupations, such as food service roles, may curtail labor demand in this arena.
• The computer-based office work arena includes offices of all sizes and administrative workspaces in hospitals, courts, and factories. Work in this arena requires only moderate physical proximity to others and a moderate number of human interactions. This is the largest arena in advanced economies, accounting for roughly one-third of employment. Nearly all potential remote work is within this arena.
• The outdoor production and maintenance arena includes construction sites, farms, residential and commercial grounds, and other outdoor spaces. COVID-19 had little impact here as work in this arena requires low proximity and few interactions with others and takes place fully outdoors. This is the largest arena in China and India, accounting for 35 to 55 percent of their workforces.

COVID-19 has accelerated three broad trends that may reshape work after the pandemic recedes

The pandemic pushed companies and consumers to rapidly adopt new behaviors that are likely to stick, changing the trajectory of three groups of trends. We consequently see sharp discontinuity between their impact on labor markets before and after the pandemic.

Remote work and virtual meetings are likely to continue, albeit less intensely than at the pandemic’s peak

Perhaps the most obvious impact of COVID-19 on the labor force is the dramatic increase in employees working remotely. To determine how extensively remote work might persist after the pandemic, we analyzed its potential  across more than 2,000 tasks used in some 800 occupations in the eight focus countries. Considering only remote work that can be done without a loss of productivity, we find that about 20 to 25 percent of the workforces in advanced economies could work from home between three and five days a week. This represents four to five times more remote work than before the pandemic and could prompt a large change in the geography of work, as individuals and companies shift out of large cities into suburbs and small cities. We found that some work that technically can be done remotely is best done in person. Negotiations, critical business decisions, brainstorming sessions, providing sensitive feedback, and onboarding new employees are examples of activities that may lose some effectiveness when done remotely.

Some companies are already planning to shift to flexible workspaces after positive experiences with remote work during the pandemic, a move that will reduce the overall space they need and bring fewer workers into offices each day. A survey of 278 executives by McKinsey in August 2020 found that on average, they planned to reduce office space by 30 percent. Demand for restaurants and retail in downtown areas and for public transportation may decline as a result.

Remote work may also put a dent in business travel as its extensive use of videoconferencing during the pandemic has ushered in a new acceptance of virtual meetings and other aspects of work. While leisure travel and tourism are likely to rebound after the crisis, McKinsey’s travel practice estimates that about 20 percent of business travel, the most lucrative segment for airlines, may not return. This would have significant knock-on effects on employment in commercial aerospace, airports, hospitality, and food service. E-commerce and other virtual transactions are booming.

Many consumers discovered the convenience of e-commerce and other online activities during the pandemic. In 2020, the share of e-commerce grew at two to five times the rate before COVID-19 (Exhibit 2). Roughly three-quarters of people using digital channels for the first time during the pandemic say they will continue using them when things return to “normal,” according to McKinsey Consumer Pulse  surveys conducted around the world.

Other kinds of virtual transactions such as telemedicine, online banking, and streaming entertainment have also taken off. Online doctor consultations through Practo, a telehealth company in India, grew more than tenfold between April and November 2020 . These virtual practices may decline somewhat as economies reopen but are likely to continue well above levels seen before the pandemic.

This shift to digital transactions has propelled growth in delivery, transportation, and warehouse jobs. In China, e-commerce, delivery, and social media jobs grew by more than 5.1 million during the first half of 2020.

COVID-19 may propel faster adoption of automation and AI, especially in work arenas with high physical proximity

Two ways businesses historically have controlled cost and mitigated uncertainty during recessions are by adopting automation and redesigning work processes, which reduce the share of jobs involving mainly routine tasks. In our global survey of 800 senior executives  in July 2020, two-thirds said they were stepping up investment in automation and AI either somewhat or significantly. Production figures for robotics in China exceeded prepandemic levels by June 2020.

Many companies deployed automation and AI in warehouses, grocery stores, call centers, and manufacturing plants to reduce workplace density and cope with surges in demand. The common feature of these automation use cases is their correlation with high scores on physical proximity, and our research finds the work arenas with high levels of human interaction are likely to see the greatest acceleration in adoption of automation and AI.

The mix of occupations may shift, with little job growth in low-wage occupations

The trends accelerated by COVID-19 may spur greater changes in the mix of jobs within economies than we estimated before the pandemic.

We find that a markedly different mix of occupations may emerge after the pandemic across the eight economies. Compared to our pre-COVID-19 estimates, we expect the largest negative impact of the pandemic to fall on workers in food service and customer sales and service roles, as well as less-skilled office support roles. Jobs in warehousing and transportation may increase as a result of the growth in e-commerce and the delivery economy, but those increases are unlikely to offset the disruption of many low-wage jobs. In the United States, for instance, customer service and food service jobs could fall by 4.3 million, while transportation jobs could grow by nearly 800,000. Demand for workers in the healthcare and STEM occupations may grow more than before the pandemic, reflecting increased attention to health as populations age and incomes rise as well as the growing need for people who can create, deploy, and maintain new technologies (Exhibit 3).

Before the pandemic, net job losses were concentrated in middle-wage occupations in manufacturing and some office work, reflecting automation, and low- and high-wage jobs continued to grow. Nearly all low-wage workers who lost jobs could move into other low-wage occupations—for instance, a data entry worker could move into retail or home healthcare. Because of the pandemic’s impact on low-wage jobs, we now estimate that almost all growth in labor demand will occur in high-wage jobs. Going forward, more than half of displaced low-wage workers may need to shift to occupations in higher wage brackets and requiring different skills to remain employed.

As many as 25 percent more workers may need to switch occupations than before the pandemic

Given the expected concentration of job growth in high-wage occupations and declines in low-wage occupations, the scale and nature of workforce transitions required in the years ahead will be challenging, according to our research. Across the eight focus countries, more than 100 million workers, or 1 in 16, will need to find a different occupation by 2030 in our post-COVID-19 scenario, as shown in Exhibit 4. This is 12 percent more than we estimated before the pandemic, and up to 25 percent more in advanced economies (Exhibit 4).

Before the pandemic, we estimated that just 6 percent of workers would need to find jobs in higher wage occupations. In our post-COVID-19 research, we find not only that a larger share of workers will likely need to transition out of the bottom two wage brackets but also that roughly half of them overall will need new, more advanced skills to move to occupations one or even two wage brackets higher.

The skill mix required among workers who need to shift occupations has changed. The share of time German workers spend using basic cognitive skills, for example, may shrink by 3.4 percentage points, while time spend using social and emotional skills will increase by 3.2 percentage points. In India, the share of total work hours expended using physical and manual skills will decline by 2.2 percentage points, while time devoted to technological skills will rise 3.3 percentage points. Workers in occupations in the lowest wage bracket use basic cognitive skills and physical and manual skills 68 percent of the time, while in the middle wage bracket, use of these skills occupies 48 percent of time spent. In the highest two brackets, those skills account for less than 20 percent of time spent. The most disadvantaged workers may have the biggest job transitions ahead, in part because of their disproportionate employment in the arenas most affected by COVID-19. In Europe and the United States, workers with less than a college degree, members of ethnic minority groups, and women are more likely to need to change occupations after COVID-19 than before. In the United States, people without a college degree are 1.3 times more likely to need to make transitions compared to those with a college degree, and Black and Hispanic workers are 1.1 times more likely to have to transition between occupations than white workers. In France, Germany, and Spain, the increase in job transitions required due to trends influenced by COVID-19 is 3.9 times higher for women than for men. Similarly, the need for occupational changes will hit younger workers more than older workers, and individuals not born in the European Union more than native-born workers.

Companies and policymakers can help facilitate workforce transitions

The scale of workforce transitions set off by COVID-19’s influence on labor trends increases the urgency for businesses and policymakers to take steps to support additional training and education programs for workers. Companies and governments exhibited extraordinary flexibility and adaptability in responding to the pandemic with purpose and innovation that they might also harness to retool the workforce in ways that point to a brighter future of work.

Businesses can start with a granular analysis of what work can be done remotely by focusing on the tasks involved rather than whole jobs. They can also play a larger role in retraining workers, as Walmart, Amazon, and IBM have done. Others have facilitated occupational shifts by focusing on the skills they need, rather than on academic degrees. Remote work also offers companies the opportunity to enrich their diversity by tapping workers who, for family and other reasons, were unable to relocate to the superstar cities where talent, capital, and opportunities concentrated before the pandemic.

Policymakers could support businesses by expanding and enhancing the digital infrastructure. Even in advanced economies, almost 20 percent of workers in rural households lack access to the internet. Governments could also consider extending benefits and protections to independent workers and to workers working to build their skills and knowledge mid-career.

Both businesses and policymakers could collaborate to support workers migrating between occupations. Under the Pact for Skills established in the European Union during the pandemic, companies and public authorities have dedicated €7 billion to enhancing the skills of some 700,000 automotive workers, while in the United States, Merck and other large companies have put up more than $100 million to burnish the skills of Black workers without a college education and create jobs that they can fill.

The reward of such efforts would be a more resilient, more talented, and better-paid workforce—and a more robust and equitable society.

Go behind the scenes and get more insights with “ Where the jobs are: An inside look at our new Future of Work research ” from our New at McKinsey blog.

Susan Lund and Anu Madgavkar are partners of the McKinsey Global Institute, where James Manyika and Sven Smit are co-chairs and directors. Kweilin Ellingrud is a senior partner in McKinsey’s Minneapolis office. Mary Meaney is a senior partner in the Paris office. Olivia Robinson is a consultant in the London office.

This report was edited by Stephanie Strom, a senior editor with the McKinsey Global Institute, and Peter Gumbel, MGI editorial director.

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COVID-19 pandemic triggers 25% increase in prevalence of anxiety and depression worldwide

Wake-up call to all countries to step up mental health services and support.

In the first year of the COVID-19 pandemic, global prevalence of anxiety and depression increased by a massive 25%, according to a scientific brief released by the World Health Organization (WHO) today. The brief also highlights who has been most affected and summarizes the effect of the pandemic on the availability of mental health services and how this has changed during the pandemic.

Concerns about potential increases in mental health conditions had already prompted 90% of countries surveyed to include mental health and psychosocial support in their COVID-19 response plans, but major gaps and concerns remain.

“The information we have now about the impact of COVID-19 on the world’s mental health is just the tip of the iceberg,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This is a wake-up call to all countries to pay more attention to mental health and do a better job of supporting their populations’ mental health.”

Multiple stress factors

One major explanation for the increase is the unprecedented stress caused by the social isolation resulting from the pandemic. Linked to this were constraints on people’s ability to work, seek support from loved ones and engage in their communities.

Loneliness, fear of infection, suffering and death for oneself and for loved ones, grief after bereavement and financial worries have also all been cited as stressors leading to anxiety and depression. Among health workers, exhaustion has been a major trigger for suicidal thinking.

Young people and women worst hit

The brief, which is informed by a comprehensive review of existing evidence about the impact of COVID-19 on mental health and mental health services, and includes estimates from the latest Global Burden of Disease study, shows that the pandemic has affected the mental health of young people and that they are disproportionally at risk of suicidal and self-harming behaviours. It also indicates that women have been more severely impacted than men and that people with pre-existing physical health conditions, such as asthma, cancer and heart disease, were more likely to develop symptoms of mental disorders.

Data suggests that people with pre-existing mental disorders do not appear to be disproportionately vulnerable to COVID-19 infection. Yet, when these people do become infected, they are more likely to suffer hospitalization, severe illness and death compared with people without mental disorders. People with more severe mental disorders, such as psychoses, and young people with mental disorders, are particularly at risk.

Gaps in care

This increase in the prevalence of mental health problems has coincided with severe disruptions to mental health services, leaving huge gaps in care for those who need it most. For much of the pandemic, services for mental, neurological and substance use conditions were the most disrupted among all essential health services reported by WHO Member States. Many countries also reported major disruptions in life-saving services for mental health, including for suicide prevention.

By the end of 2021 the situation had somewhat improved but today too many people remain unable to get the care and support they need for both pre-existing and newly developed mental health conditions.

Unable to access face-to-face care, many people have sought support online, signaling an urgent need to make reliable and effective digital tools available and easily accessible. However, developing and deploying digital interventions remains a major challenge in resource-limited countries and settings.

WHO and country action

Since the early days of the pandemic, WHO and partners have worked to develop and disseminate resources in multiple languages and formats to help different groups cope with and respond to the mental health impacts of COVID-19. For example, WHO produced a story book for 6-11-year-olds, My Hero is You, now available in 142 languages and 61 multimedia adaptations, as well as a toolkit for supporting older adults available in 16 languages.

At the same time, the Organization has worked with partners, including other United Nations agencies, international nongovernmental organizations and the Red Cross and Red Crescent Societies, to lead an interagency mental health and psychosocial response to COVID-19. Throughout the pandemic, WHO  has also worked to promote the integration of mental health and psychosocial support across and within all aspects of the global response. 

WHO Member States have recognized the impact of COVID-19 on mental health and are taking action. WHO’s most recent pulse survey on continuity of essential health services indicated that 90% of countries are working to provide mental health and psychosocial support to COVID-19 patients and responders alike. Moreover, at last year’s World Health Assembly, countries emphasized the need to develop and strengthen mental health and psychosocial support services as part of strengthening preparedness, response and resilience to COVID-19 and future public health emergencies. They adopted the updated Comprehensive Mental Health Action Plan 2013-2030, which includes an indicator on preparedness for mental health and psychosocial support in public health emergencies.

Step up investment

However, this commitment to mental health needs to be accompanied by a global step up in investment. Unfortunately, the situation underscores a chronic global shortage of mental health resources that continues today. WHO’s most recent Mental Health Atlas showed that in 2020, governments worldwide spent on average just over 2% of their health budgets on mental health and many low-income countries reported having fewer than 1 mental health worker per 100 000 people.

Dévora Kestel, Director of the Department of Mental Health and Substance Use at WHO, sums up the situation: ”While the pandemic has generated interest in and concern for mental health, it has also revealed historical under-investment in mental health services. Countries must act urgently to ensure that mental health support is available to all.”

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The diagram matches primary care patients (n = 4755) with appropriate birth dates and living within district to school district Kindergarten Readiness Assessment (KRA) scores for school years 2018, 2019, and 2021 (n = 8167). ASQ indicates Ages & Stages Questionnaire; PCP, primary care practice.

This figure compares the mean KRA scores by year taken (no KRA administered in 2020 due to the COVID-19 pandemic) and by population. 95% CIs are displayed in error bars. The mean KRA scores for the clinical population were significantly lower than the overall school district population ( P  < .001). KRA scores in 2021 were significantly lower than those obtained pre–COVID-19 pandemic in 2018 and 2019 in both the clinical populations and school districts population ( P  < .001). There was no significant difference in mean KRA scores of the clinical population between 2018 and 2019 ( P  = .17).

eFigure . Flowchart of Selection for Retrospective Study of Combined KRA-EMR Data

Data Sharing Statement.

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Copeland KA , Porter L , Gorecki MC , Reyner A , White C , Kahn RS. Early Correlates of School Readiness Before and During the COVID-19 Pandemic Linking Health and School Data. JAMA Pediatr. 2024;178(3):294–303. doi:10.1001/jamapediatrics.2023.6458

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Early Correlates of School Readiness Before and During the COVID-19 Pandemic Linking Health and School Data

• 1 Fisher Child Health Equity Center, James M. Anderson Center for Health Systems Excellence, Division of General and Community Pediatrics, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
• 2 James M. Anderson Center for Health Systems Excellence, Cincinnati, Ohio
• 3 General Pediatrics Research Program, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
• 4 Fisher Child Health Equity Center, Division of General and Community Pediatrics, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio

Question   What well-child visit data in the first 5 years of life are significantly associated with subsequent kindergarten readiness?

Findings   In this cohort study, 3204 primary care patients were matched with school district Kindergarten Readiness Assessment (KRA) scores. After adjusting for covariates, lower KRA scores were significantly associated with the following variables: child ever failed developmental screening after 18 months, child was ever rarely read to, family reported food insecurity, Medicaid insured, Hispanic ethnicity, family required an interpreter, late COVID-19 pandemic school year, and child male sex.

Meaning   Results suggest that there is an identifiable population of children who may benefit substantially from early systematic collaboration between clinicians and educators.

Importance   Many known correlates of kindergarten readiness are captured in developmental and social screenings in primary care; little is known about how primary care data predicts school readiness.

Objective   To identify early Kindergarten Readiness Assessment (KRA) correlates by linking electronic health record (EHR) data with school district KRA data and to examine potential outcomes of the COVID-19 pandemic using KRA scores between 2018 and 2021.

Design, Setting, and Participants   This was a retrospective cohort study linking a large primary care practice (PCP) with school assessment data. Linkage used patient name, date of birth, and address. The setting was an urban school district and PCP affiliated with an academic medical center. Students had a KRA score from fall of 2018, 2019, or 2021 (no 2020 KRA due to the COVID-19 pandemic) and at least 1 prior well-child visit at the PCP.

Exposures   Exposures included year KRA administered, reported child race and ethnicity, child sex, interpreter for medical visits, child ever failed Ages & Stages Questionnaire (ASQ) 18 to 54 months, ever rarely read to, Medicaid status, food insecurity, housing insecurity, problems with benefits, and caregiver depressive symptoms.

Main Outcomes and Measures   KRA score (continuous), with a possible range of 0 to 300 (passing score = 270).

Results   A total of 3204 PCP patients (mean [SD] age, 67 [4] months; 1612 male [50.3%]; 2642 Black [82.5%]; 94 Hispanic [2.9%]; 244 White [7.6%]) were matched to their KRA score. Mean (SD) KRA scores were significantly lower in 2021 (mean [SD], 260.0 [13.0]; 214 of 998 [21.4%]) compared with 2019 (mean [SD], 262.7 [13.5]; 317 of 1114 [28.5%]) and 2018 (mean [SD], 263.5 [13.6]; 351 of 1092 [32.1%]), a pattern mirrored in the larger school district. In the linear regression final model (n = 2883), the following binary variables significantly lowered the child’s KRA score (points lowered [95% CI]) below a mean passing score of 270.8: child ever failed ASQ after 18 months (−6.7; 95% CI, −7.7 to −5.6), Medicaid insured (−5.7; 95% CI, −9.0 to −2.3), Hispanic ethnicity (−3.8; 95% CI, −6.9 to −0.6), requires interpreter (−3.6; 95% CI, −7.1 to −0.1), 2021 year (−3.5; 95% CI, −4.7 to −2.3), male sex (−2.7; 95% CI, −3.7 to −1.8), ever rarely read to (−1.5; 95% CI, −2.6 to −0.4), and food insecurity (−1.2; 95% CI, −2.4 to −0.1). Race, caregiver depression, housing insecurity, and problems receiving benefits were not associated with KRA scores in final model.

Conclusions and Relevance   Findings of this cohort study suggest a deleterious association of the COVID-19 pandemic with early learning and development. There may be potential for PCPs and school districts to collaborate to identify and mitigate risks much earlier.

Early experiences, relationships, and socioeconomic conditions are foundational for early brain development, school readiness, and health outcomes. 1 - 4 Racial and socioeconomic opportunity gaps 5 - 7 in the skills necessary to learn and succeed in school (including language, preliteracy, math and socioemotional skills such as executive function and self-regulation) start before kindergarten. 8 , 9 These gaps can be linked to structural racism, redlining, local property tax funding of public schools 10 and disinvestment in large, urban, primarily Black and/or Hispanic school districts. 11 , 12 In Cincinnati, with a 37% child poverty rate and a history of disinvestment in Black neighborhoods, before the COVID-19 pandemic, only 40% of kindergarteners entered kindergarten demonstrating readiness to learn before 2018. 13

Most children younger than 5 years regularly see pediatric clinicians for well-child care 14 and undergo screening for development and social determinants of health. 15 Kindergarten readiness promotion has been proposed as a meaningful measure in pediatric care. 16 However, little is known about how these screening results translate into school performance because health care and educational data are rarely directly linked. Furthermore, although prospective studies have identified correlates for kindergarten readiness, little is known about which risk factors are most impactful and modifiable in a high-risk clinical population. 9 , 17 - 21

The COVID-19 pandemic had a negative impact on the learning of school-aged children. 22 - 25 Less well documented is the pandemic’s effect on developing children younger than 5 years.

We sought to understand the association between the COVID-19 pandemic and the primary care population by comparing their Kindergarten Readiness Assessment (KRA) scores before and during the pandemic. We also sought to identify modifiable early predictors of kindergarten readiness in the clinical population by linking electronic health record (EHR) data to KRA scores in a large public school district. 26 - 29

In this retrospective cohort study, we matched developmental and social screening data captured in the EHR within the 6 primary care clinics of an academic medical center’s primary care practice (PCP) to student KRA scores from a large school district. The study period spanned from 2018 to 2021 and included 2 school years before the COVID-19 pandemic (2018, 2019) and 1 during the pandemic (2021). We matched the datasets based on patient name, date of birth, and address. A memorandum of understanding was obtained from the school district and Cincinnati Children’s Hospital Medical Center. The study was approved by the institutional review board of the Cincinnati Children’s Hospital Medical Center with waiver of consent, as all data were aggregated and presented with no cell sizes smaller than 10. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology ( STROBE ) reporting guidelines. 30

The setting used in this study is a large (approximately 36 000 students) Midwestern urban school district (61% Black, 23% White, 8% Hispanic, 6.5% multiracial 64% eligible for free/reduced lunch 31 ) and a large PCP (approximately 17 000 patients younger than 6 years; 88% Medicaid insured, 70% Black, 7% Hispanic) consisting of 2 urban, 1 suburban, and 3 school-based clinics.

Eligible students entered the district’s public schools with KRA scores from school years 2018, 2019, or 2021 (no KRA was administered in 2020 due to the COVID-19 pandemic). Eligible patients had at least 1 well-child check in our PCP.

The main outcome variable was the KRA score, which is significantly correlated with third-grade reading. 32 The KRA consists of 27 items administered by the child’s kindergarten teacher to assess preliteracy, premath, motor, and social-emotional skills. Ohio public school districts must administer this by November first; 2 of the other 16 states that explicitly require children 6 years and older to attend kindergarten also administer the KRA. 33 , 34 The KRA has a possible range of 0 to 300. It can be used as a continuous score or categorically, with a score of 270 or above indicating “demonstrating readiness” for kindergarten, scores of 258 to 269 indicating “approaching readiness,” and scores of 0 to 257 indicating “emerging readiness.” The KRA dataset also contained child name, date of birth, current address, and parent-reported child race and ethnicity.

Developmental screening was performed using the Ages & Stages Questionnaire (ASQ-3). The ASQ-3 is a caregiver-completed, age-specific (adjusted for prematurity) screening questionnaire assessing communication, gross motor, fine motor, problem solving, and personal-social skills. 35 Psychometric evaluations of the ASQ-3 have demonstrated adequate reliability, sensitivity, specificity, concurrent validity, and association with diagnosed developmental delay. 36 From 2013 until March 30, 2021 37 family caregivers in general pediatric clinics were asked to complete an ASQ-3 on paper to align with Bright Futures guidance (9, 18, 24 months), at 48 months (to screen for kindergarten readiness), and if a child was overdue for a screening. After reviewing the ASQ-3 results, the physician entered a categorization of pass, fail, or borderline into the EHR. For this analysis, we considered only the ASQ-3 results from children aged 18 to 65 months (approximately 5 years) given that this is the period of the most robust development for prefrontal cortex needed for kindergarten. 38 Operationalized child-level developmental results were coded as (1) any fail during this time period, (2) all pass/borderline, or (3) missing.

Parent-reported reading to the child, another variable linked to kindergarten readiness, 39 , 40 was measured at the 1 month through 5-year-old well-child visits via the question “How often did you and other family members read stories or look at books with your child in the past week?” Response options recorded in the EHR were as follows: “Most (5-7) days of the week,” “Some (2-4) days of the week,” or “Rarely have time (0-1 days of the week).” Based on prior research demonstrating the potential harm of reading rarely, 41 we operationalized this variable as “child ever reported as rarely read to” vs “never rarely read to” vs “missing.”

We also examined several social determinants of health that have previously been linked to kindergarten readiness 40 , 42 - 44 that were also captured in the EHR. These included child sex, preferred language at home, and needs interpreter for medical visits (yes or no). Caregiver depression was measured by a positive response to the Patient Health Questionnaire 2 (PHQ-2). 45 Food insecurity was measured by a positive response to 1 of the 2 Hunger Vital Sign questions or to the question “Are you currently having any problems with your Women, Infants & Children (WIC), Supplemental Nutrition Assistance Program (SNAP)/food stamps?” 46 Housing insecurity was denoted by a positive response to “Are you having any housing problems such as overcrowding, roaches, rodents, utilities, mold, lead that your landlord is not helping you with?” or “Are you currently being threatened with eviction or losing your home?” Because these variables are rare and assessed at more than just well-child checks, we operationalized them into 3 categories: never, infrequently (1%-24%), and sometimes/often (≥25%) true. Medicaid status was operationalized as a visit-level variable (>80% of visits, 1%-80% of visits, or 0% of visits covered by Medicaid) because most of the population was covered by Medicaid. We used parent-reported ethnicity (Hispanic, non-Hispanic, or unknown) from the EHR as this question is asked separately from race. For race, we compared both datasets with operationalized racial data into 3 categories: White, Black, and other, with inputs from both the EHR and KRA, and recognizing that racial identities can change over time and context. 47 , 48 The social constructs of race and ethnicity were included in our study due to their association with kindergarten readiness. 39 , 40 , 42 - 44 The other category was operationalized to include races other than Black or White, multiracial, and instances when the child’s reported race differed between databases.

Matching of the KRA and EHR datasets was done Using FastLink, Probabilistic Matching package in R (R Project for Statistical Computing). The default posterior probability for matching within this package is greater than 0.85 49 ; we elected to use a more conservative threshold of 0.9, using first name, last name, date of birth, and address. After matching, we visually inspected a 50% subsample and found no false matches, thus increasing our confidence in match quality. Each participant was then given a unique identification (students only contribute to 1 year of data), and names and medical record numbers were removed from the dataset. Incomplete cases (<10% of cases) were removed; these cases lacked our primary independent variable, ASQ scores. KRA scores were not meaningfully different for cases removed from analytic sample. The distribution of KRA scores is slightly leptokurtic, however, it meets the standard of normality. 50

Analysis of variance was used to compare continuous KRA score by predictor category. KRA scores from each year were compared using pairwise t tests. A post hoc analysis was performed comparing the KRA scores of the whole district to that of the children seen in the PCP using pairwise t tests. Linear regression with continuous KRA score as the outcome was performed with all candidate covariates a priori.

Figure 1 shows a simplified diagram of the matched cohort and final analytic sample. Of the 4755 patients in the school district’s catchment area and with appropriate birth dates, 2615 (55% of clinic patients living in the school district) had a KRA score, and an additional 589 clinic patients living outside the school district had a KRA score. There were a total of 3204 matched student patients (mean [SD] age, 67 [4] months as of November 1 of their kindergarten year; 1612 male [50.3%]; 1592 female [49.7%]; 2642 Black [82.5%]; 94 Hispanic [2.9%]; 244 White [7.6%]) in the shared population. These 3204 shared students represented 38.6% of the total school district’s 8167 KRA scores for these 3 school years. Of the 3204 matched population, 2917 children (91%) had at least 1 ASQ score, only 48 (1.5%) of these did not have information on other key social determinants of health, leaving a final analytic sample of 2883 shared students. A flowchart of selection for the combined KRA-EMR data used in this study is available in the eFigure in Supplement 1 .

Table 1 lists the demographics of the final matched sample of 3204 children. Approximately 110 children (3.4%) reported speaking a language other than English at home, and 83 children (2.6%) required an interpreter.

Kindergarten readiness rates in the PCP practice were significantly lower in 2021 (mean [SD], 260.0 [13.0]; 214 of 998 [21.4%]) compared with 2019 (mean [SD], 262.7 [13.5]; 317 of 1114 [28.5%]) and 2018 (mean [SD], 263.5 [13.6]; 351 of 1092 [32.1%])( Table 2 ), a pattern that was mirrored in the school district (780 of 2695 [29.5%], 1010 of 2816 [35.9%], and 1072 of 2706 [39.6%], respectively). The PCP practice also had significantly lower KRA scores than the district as a whole ( Figure 2 ).

A total of 817 parents (25.5%) reported reading to their child rarely (0-1 day a week) at least once during the study period, and 865 children (27.0%) did not pass the age-appropriate parent-completed and clinician-reviewed ASQ screening questionnaire at least once during the study period ( Table 1 ). A total of 2675 children (83.5%) were insured by Medicaid most of the time, 384 (12.0%) reported food insecurity sometimes, and 855 (26.7%) reported housing insecurity.

The unadjusted and adjusted associations of demographic, social, and developmental screening variables collected in primary care with the outcome of KRA scores (modeled continuously) are presented in Table 3 . In the final adjusted analysis (n = 2883), the following binary variables significantly lowered the child’s KRA score (points lowered [95% CI]) below a mean passing score of 270.8: child ever failed ASQ after 18 months (−6.7; 95% CI, −7.7 to −5.6), Medicaid insured (−5.7; 95% CI, −9.0 to −2.3), Hispanic ethnicity (−3.8; 95% CI, −6.9 to −0.6), requires interpreter (−3.6; 95% CI, −7.1 to −0.1), 2021 year (−3.5; 95% CI, −4.7 to −2.3), male sex (−2.7; 95% CI, −3.7 to −1.8), ever rarely read to (−1.5; 95% CI, −2.6 to −0.4), and food insecurity (−1.2; 95% CI, −2.4 to −0.1). Race, caregiver depression, housing insecurity, and family-reported problems receiving benefits were not associated with KRA scores in the model. To interpret our findings using a hypothetical clinical example, starting with the expected score of 270.8 in the adjusted model (equivalent to demonstrating readiness): a boy who is Medicaid insured, who once failed an ASQ, who infrequently reported food insecurity, and was not read to as an infant lost an average of 15 points on the KRA, placing him in bottom category of emerging readiness (score below 257).

Results of this cohort study suggest a significant worsening in kindergarten readiness 51 , 52 during the COVID-19 pandemic compared with years before the pandemic. Further, lower KRA performance was significantly associated with failing developmental screening after 18 months (approximately 1.5 years), child ever rarely read to, family-reported food insecurity, Medicaid insurance, Hispanic ethnicity, family required an interpreter, and child male sex. The study is among the first, to our knowledge, to document the association of the COVID-19 pandemic with kindergarten readiness and among the largest studies to link primary care data to public school outcomes. 53

Literature on the effects of the COVID-19 pandemic on early childhood development is in its infancy. A recent study 54 showed gains in numeracy and executive function among children enrolled in Head Start, yet others found COVID-19 pandemic–associated declines in young children’s social-emotional development, 55 communication, 56 motor development, and attitudes toward learning. 57 With closures and remote delivery of early childhood education (ECE) and developmental therapies, fewer families, and particularly fewer Black families, 58 used these services. 59 Many parents chose not to enroll their children in ECE out of fear of COVID-19 and difficulties navigating the arduous enrollment process. 60 Although our results cannot be directly generalized to other localities, other cities faced similar closures of ECE settings, thus the results are concerning for school readiness. 61

The associations between kindergarten readiness and previous reading exposure and developmental screening results 37 , 41 are established, although few have linked school district to health care data, with 1 exception. 53 For children failing a developmental screen, primary care is well positioned to intervene through referrals to speech/language specialists, early intervention, developmental specialists, and promotion and/or navigational assistance with enrollment in high-quality learning. For the modifiable risk factor of infrequent shared reading, PCPs could facilitate library card access, refer or promote enrollment in high quality ECE, 62 and more reliably implement literacy enrichment programs, such as Reach Out and Read 63 and Imagination Library. 64

The demonstrated association between kindergarten readiness and family reported food insecurity contributes to growing literature that food insecurity is a critical social determinant of health. Prior studies highlight the link between food insecurity and child behavior and reading/math readiness. 65 Insufficient essential micronutrients and macronutrients (iron, 66 folate, iodine, and vitamins B 12 and D, 67 long-chain and omega fatty acids, 68 ) can also impair child brain development and school performance. 69

The lack of association with caregiver depression was unexpected given prior literature showing that maternal stress and depression are linked to lower reading and math scores. 70 The PHQ-2 may be insufficient to assess clinically meaningful depressive symptoms in this population, or these symptoms may have been underreported by those experiencing them because of stigma, fear of negative repercussions, or concern about the paucity of available mental health services for adults.

The lack of association of kindergarten readiness with housing problems was also unexpected. Some patients experiencing housing insecurity may not have reported it because they did not realize that remedies may be available. Alternatively, the lack of association may be attributed to patients who did raise housing concerns and benefited from our partnership with Legal Aid. 27 The housing shortage crisis is unabated, underscoring a need to continue to assess the impact of this risk factor on children’s school readiness.

This study had several considerable strengths. Real-world data were used to examine protective and risk factors among a less advantaged population who is understudied and understandably reluctant to participate in research studies. The study provides an important example of cross-sector linkage. Such linkage can help refocus child health outcomes toward healthy development and highlight the urgency for primary care efforts to promote equitable early child development, such as identifying and mitigating early social risks and promoting early universal strategies for development. Finally, a linkage between primary care and education could help local school districts prepare for and enhance their strategies for children who had limited high-quality early childhood education opportunities.

The methods in this study are the result of a multiyear clinical-school partnership that built the trust needed to share data. Through this analysis, we could quantify the number and proportion of our large clinical population that may not be ready to learn. There are limitations to the data quality and the ability to infer causality. However, the findings are consistent with prior literature and directly inform how primary care can better support children and families for kindergarten readiness. 71

Although findings of salient risk factors for kindergarten readiness may not be applicable to other clinic populations with different demographics or distributions of strengths and social risk factors, our approach of linking school readiness scores to electronically captured social and developmental screening results may be replicable in other communities to drive shared goals and actions toward improving school readiness.

This study has some limitations. There is measurement error in both outcome and exposure variables. The KRA is an imperfect measure of school readiness and has a subjective observational component. There is no ability to account for who administered the KRA. Brief social screening questions, asked intermittently at health care encounters, provide only a limited window on the lived experiences of patients and their families. There is the further challenge of under-reporting given potential stigma and social desirability. We were unable to use repeated measures of developmental screening, as the population had varying degrees of interaction with the health care system. Also, given how the ASQ screener was documented in the EHR, we were unable to determine which domain(s) the child failed.

There were important variables that we were unable to capture in the EHR. We had no measure of family structure, educational attainment, or strengths other than reported shared reading. We also were unable to reliably capture preschool and high-quality childcare exposure and attendance, a known positive predictor of kindergarten readiness. 62 , 70 , 72 , 73 Additionally, although we had hoped to capture socioemotional screening data, the screener was captured on paper during the study time period and was not as reliably completed. Lastly, we cannot assume that health screening data were missing at random (in fact, ASQ screens are not available in many languages).

Findings of this cohort study suggest a negative association of the COVID-19 pandemic with kindergarten readiness in a large population of children compared with years before the pandemic. We also identified several modifiable correlates of kindergarten readiness that are captured in primary care. The study was among the first to document the association of the COVID-19 pandemic with kindergarten readiness and among the largest studies to link primary care data to public school outcomes. These findings suggest substantial untapped potential for primary care pediatrics and school districts to work more closely together given that risks for kindergarten readiness are evident much earlier in primary care.

Accepted for Publication: December 1, 2023.

Published Online: February 5, 2024. doi:10.1001/jamapediatrics.2023.6458

Corresponding Author: Kristen A. Copeland, MD, Fisher Child Health Equity Center, James M. Anderson Center for Health Systems Excellence, Division of General and Community Pediatrics, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave, MLC 7035, Cincinnati, OH 45229 ( [email protected] ).

Author Contributions: Dr Porter had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Copeland, White, Kahn.

Acquisition, analysis, or interpretation of data: Copeland, Porter, Gorecki, Reyner, White.

Drafting of the manuscript: Copeland, Porter.

Critical review of the manuscript for important intellectual content: Porter, Gorecki, Reyner, White, Kahn.

Statistical analysis: Copeland, Porter, Gorecki, Reyner, Kahn.

Obtained funding: Kahn.

Administrative, technical, or material support: Copeland, Gorecki, White, Kahn.

Supervision: Copeland, Kahn.

Conflict of Interest Disclosures: None reported.

Data Sharing Statement: See Supplement 2 .

Additional Contributions: We thank the Office of Research and Evaluation and the Department of Early Childhood Education at Cincinnati Public Schools for their assistance in this work and their ongoing partnership and Lindsey Speed, BA (Cincinnati Public Schools), for her assistance in understanding how the Kindergarten Readiness Assessment tool is administered in classrooms. Beyond usual salary, no one was financially compensated for their contribution.

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