«Quarantine is worse for children than the lockdown»
Children and adolescents who have to go into quarantine feel isolated, says Professor Susanne Walitza, Director of the Clinic for Child and Adolescent Psychiatry and Psychotherapy in Zurich. And above all, they need to be supported so that they don't lose touch with the school curriculum and their peers.
Mrs Walitza, the number of infections has been rising again for a few weeks now. What does this mean for children and young people?
This means that many children in Switzerland are currently in quarantine again or are afraid of it. For some, this is even more stressful than the first lockdown in spring 2020, which affected all children equally.
Why is quarantine perceived as worse?
The feeling of marginalisation is greater. In addition, the quarantine is constantly looming over everyday school life. The uncertainty as to how long this will last is also stressful. It is important to realise that children and young people have developed far fewer coping strategies against stress than adults. They have much less life experience, are in the midst of important developmental steps and are not yet able to differentiate between real fears and fears of expectation.
for Child and Adolescent Psychiatry and Psychotherapy at the Psychiatric University Hospital Zurich. She is on the board of the Swiss Society for Child and Adolescent Psychiatry and Psychotherapy (SGKJPP) and for Anxiety and Depression (SGAD) and is the author of specialist literature on recognising and treating anxiety disorders.
You are co-head of the first Switzerland-wide study on the psychological impact of the pandemic on children and adolescents, which was published in April. Are there parallels with the current situation?
Apart from the feeling of being excluded, which causes additional stress for children and young people, quarantine has a similar effect to lockdown: children and young people said that it was difficult for them when important plans or events had to be postponed or cancelled and they were unable to take part in social activities in their free time or at school. The uncertainty of waiting and the fear of the test result manifested itself in certain children and adolescents with symptoms such as abdominal pain, irritability or tantrums. Generally speaking, we have also seen significantly more emergencies at our clinic since autumn 2020. Some of these young people would probably not have become so acutely and severely ill without the pandemic. We don't yet know exactly how quickly this group will recover or how long they will need treatment.
Quarantine rules at the schools
In Switzerland, how primary schools deal with mandatory quarantines at school is regulated at cantonal level. Currently, pupils in the canton of Bern, for example, no longer have to go into quarantine class by class in the event of an outbreak.
In the canton of Zurich, each school has its own protection concept and the repetitive testing of children is intended to facilitate quarantine for children without close contact with an infected teacher, for example, or another child.
In the autumn, Christoph Berger, head of vaccination, launched the idea of lifting the quarantine for children completely. What do you propose to improve the situation for children and young people?
For me, the protection of children and young people is paramount. That's why I hope first of all that all adults who come into contact with children are immunised. The more immunisation and testing there is, the less often children will have to go into quarantine. Neighbouring countries that have no or shorter quarantines in schools test much more frequently. There are so-called suck tests, which are more comfortable for children.
And what if quarantine does become necessary?
Then I would like there to be a programme for the children to attend lessons online, but with individual support, as the teachers are once again focused on the classroom on site. I would then recommend institutionalised social integration of these pupils in the form of working groups in which the affected children from the class can meet online. Pupils in quarantine must be motivated to keep up with the school curriculum and supported in maintaining social contact with their peers.
Vaccination: Do children and young people also suffer from the heated debate about vaccination?
Absolutely! Many children and young people find it difficult to understand that there are such different opinions on such an important topic as the fight against coronavirus and that the debate about it is so heated and sometimes extremely polarising. Even adults find it difficult to bear the fact that opinions on this topic clash so violently.
Pupils in quarantine must be supported in maintaining their contacts.
What can parents do?
An important task for carers is to provide children with as much security as possible while remaining sincere and honest. This is not easy, especially at a time when adults themselves find it very stressful. With young people, it is also important to show respect for their autonomous freedom of choice in addition to acting in a caring manner for their well-being. This is also not always easy to realise, especially when there are very different assessments.
Do you have a specific example?
I know of a case of a teenager who was one of the last three pupils in his class not to be vaccinated. He really wanted to be vaccinated so that he could go out more easily. But his parents were against it. The pupil didn't know how to deal with this situation. He trusted his parents and knew that they only wanted what was best for him. So what should he do?
What would be good advice for these parents?
In a situation like this, it would be helpful if sceptical parents could show their children where they can get reliable information about the vaccination. It also helps to convey to the child that mum and dad will respect their wishes regardless of what their son decides.
Media consumption has risen sharply for many young people during the lockdown - and for some it has remained high.
What is known about the long-term psychological impact of the pandemic on children?
These are not yet clearly foreseeable. The resources and risk factors that each individual child has are very likely to play a major role here. Children in disadvantaged families have a much harder time getting through the pandemic. We also know that children were much more alone. And we have seen that media consumption rose sharply among a large proportion of young people during lockdown. For most of them, this has returned to the initial level. For a small group, however, the high level of media consumption has remained. Pathological media consumption will certainly keep us busy for some time to come.
Online teaching has become the norm since coronavirus. A lot of things are also being done virtually for school, regardless of the quarantine. How do you assess this in terms of the psychological development of children and young people?
he personal exchange between children and young people among peers and teachers is hugely important for their social and emotional development. For this reason, a virtual classroom cannot replace lessons at school. It can only be a supplement. But one thing is clear: the pandemic has forced us all - whether in schools, at work or in medicine - to push ahead with digitalisation. The challenge is to recognise the opportunities as well as the dangers and risk developments and to learn how to deal with them.
What do you mean by that?
Personally, I think it's good not to have to travel to every meeting. But digitalisation has made us sluggish and means that people, especially children and young people, are even less active. However, children should pursue leisure activities alongside school, be outdoors a lot and socialise with other children in order to have active, positive experiences and experience self-efficacy. If this is lacking due to isolation and being left to their own devices, there is an increase in concentration disorders, anxiety and a significant increase in media consumption.
Study: Stress and mental health problems during the first Covid-19 lockdown
Agonising uncertainty, social restrictions and postponed plans are the consequences of the lockdown. A third of children and young people experienced mental health problems during the first Covid-19 lockdown in Switzerland. These are the findings of the first nationally representative study on stress and mental health problems in children and adolescents conducted by the University of Zurich and La Source (HES-SO) Lausanne, which was published in April 2021. Study co-leader Susanne Walitza summarises the most important recommendations and statements:
- «The most important recommendation was and is that schools should be open as much and as long as possible. The children obviously missed the daily structure and routine painfully during the first lockdown. For mothers in particular, organising work, family, home office and home schooling was an enormous burden.»
- «Children should pursue leisure activities alongside school, be outdoors a lot and socialise with other children in order to have active, positive experiences and experience self-efficacy. If this is lacking, concentration problems, anxiety and increased media consumption are more likely to occur.»
- «A key message is still that children and young people belong to a particularly vulnerable group, i.e. they are particularly affected by the pandemic. They are suffering themselves (real fear of infection, fear of the future, how long will this last, what does it mean for me), have fewer coping mechanisms and are more dependent on how their parents deal with the situation.»
About the study:
Mohler-Kuo, M.; Dzemaili, S.; Foster, S.; Werlen, L., Walitza, S. Stress and Mental Health among Children/Adolescents, Their Parents, and Young Adults during the First COVID-19 Lockdown in Switzerland. Int. J. Environ. Res. Public Health 2021, 18, 4668. doi.org/10.3390/ijerph18094668