Coronavirus: Will Israel's children ever recover from the COVID pandemic?

HEALTH AFFAIRS: The endless agony of the absence of education

STUDENTS WEARING face masks return to school at Gabrieli Carmel School in Tel Aviv in February. (photo credit: AVSHALOM SASSONI/FLASH90)
STUDENTS WEARING face masks return to school at Gabrieli Carmel School in Tel Aviv in February.
(photo credit: AVSHALOM SASSONI/FLASH90)
 When James Brown sang the words “without an education, you might as well be dead” in 1966, he could not have foreseen how the coronavirus crisis of 2020 would force children out of their classrooms.
Today, health and education experts are raising the alarm over the unprecedented educational, medical, social and emotional challenges that children are facing from the pandemic. The experts believe it could take years to fully understand the full effects of closing schools on this generation.
“We know that education is one of the major determinants of health – short- and long-term,” Ora Paltiel, a professor at the Hebrew University-Hadassah Braun School of Public Health and Community Medicine, told The Jerusalem Post.
One of the government’s biggest pandemic failures was its inability to send children back to school this fall.
While in the majority of developed countries, students returned to their classrooms this September, Israeli students remained at home. Between September and the end of January, students of all ages in most Organization for Economic Cooperation and Development-member countries studied at least partially in their classrooms. During that same period, in Israel, not a single day of full schooling took place in schools or preschools.
On September 1, classes were fully opened only in the green and yellow localities. They were then closed on September 15. Students began returning to school again in late October, but middle schoolers – those in grades seven to 10 – started attending school only in December, just before they went on Hanukkah break.
Then, with coronavirus cases rising, classes were again suspended until January. Middle schoolers went back only in March, shortly before they left for the Passover holiday that ends on Monday.
“We found ourselves in a situation where our school system was not really ready for such a pandemic, with really big classes, transportation that takes people from different age groups and regions to one school – and it’s a really challenging situation when you are trying to control infection,” said head of Public Health Services Dr. Sharon Alroy-Preis last week during a Hebrew University webinar on the topic of the impact of COVID-19 on children.
She said that every time Israel tried to reopen schools, infection spread.
“There was a point in time during the third lockdown where we did not close schools, just the rest was closed and schools stayed open, and until we closed schools, we could not bring infection down,” she said. “When we have 1,200 severe cases in hospitals and they are overwhelmed, then you cannot just leave schools open.”
Yet, according to the United Nations Educational, Scientific and Cultural Organization, few countries closed their schools for periods as long as Israel. Instead of modeling after Australia, Finland, France, Iceland, New Zealand or even Japan, Israel’s schooling situation looked more like that of Poland, Turkey or Mexico.
While the Finance Ministry refused to transfer the necessary budgets to allow for safer, small-group study within schools, Israeli students were forced into distance learning, which all studies to date have shown is less effective from an educational standpoint and harmful socially and emotionally.
Research by the United States-based global management consulting firm McKinsey & Company found that “the impact of school closure on outcomes is tied to how long the closure lasts.”
PROLONGED STAYS at home, lack of routine, worries about unemployment and the family’s financial needs led to emotional and mental stress, said Vered Windman, executive director of the Israel National Council for the Child, who also spoke during the webinar. She said a lack of computers, Internet connection – and in some cases Internet infrastructure – as well as parental assistance affected the ability of children to learn.
Children’s educational challenges can be divided into three categories, explained Prof. Yaacov Yablon, head of the Churgin School of Education at Bar-Ilan University. He told the Post that the first group – an estimated 30% of Israel’s students – would have basic communication challenges, having not interacted with others in meaningful ways for the better part of a year. These students will need support to regain or rebuild their learning and relationship skills to become members of the learning community once again.
A second group will be those who struggled to learn on Zoom and started receiving bad marks in school. Now, they might believe they are not good students or cannot succeed in a certain subject. He said these students will need to be built up in whatever area they are lacking. Otherwise, they risk giving up, which could have a long-term impact on their education.
Finally, Yablon said, there will be a group of students who appear “normal” but there are major gaps between them and other students. When observed on their own, everything can seem OK – like they are managing. But when you compare them to their peers, there are major gaps. These students, he said, will be the hardest to spot quickly.
Although distance learning was handled differently by teachers around the world and in local classrooms, according to the McKinsey report, there is one thing on which all educators seem to agree: a computer is no match for a classroom as a place for kids to learn.
The company polled educators in eight countries, and all of them said that the remote learning experienced over the past year is a poor substitute for being back in the classroom, giving it an average score of five out of 10.
The study also found that teachers who taught at public versus private schools gave remote learning lower marks – 4.8 versus 6.2 out 10, with 10 being the highest score. Teachers working in areas in which there were high levels of poverty found virtual classrooms even more ineffective, marking them as low as 3.5.
“Teachers in schools where more than 80% of students live in households under the poverty line reported an average of 2.5 months of learning loss, compared with a reported loss of 1.6 months in schools where more than 80% of students live in households above the poverty line,” McKinsey showed.
In general, studies from several countries suggested that school shutdowns in the second quarter of 2020 put students up to six months behind the academic milestones their cohorts would typically be expected to reach. Losses were greatest in math.
“We talk about resilient children, and we want to believe that many children will get back on track,” Yablon told the Post. “However, it is more likely that we are going to see huge gaps between children, that students will come to universities with lower capabilities and not really ready for higher education.”
THESE CHALLENGES do not end in the classroom. Education has a direct correlation to physical health and even life expectancy, said Prof. Orly Manor, head of the Braun School of Public Health and Community Medicine at the Hebrew University.
Life expectancy rises commensurately to the level of education.
According to the most recent report by the Central Bureau of Statistics, life expectancy at age 30 by education level looks as follows: men who studied for 11 years (until the end of elementary school) are expected to live another 49 years, and females 53. Those who finished high school get another 52 or 56, respectively. And people with tertiary or academic degrees show another 56 or 59 years.
Moreover, the risk of developing dementia or late-life depression also increases for those who are less educated, Manor said.
A study published by the American Medical Association’s JAMA Network earlier this year modeled the expected years of life lost (YLL) in association with primary school closures in early 2020 and compared them to potential YLL, had schools remained open. Based on the authors’ estimates, “there was a 98.9% probability that the decisions to close US primary schools in March of 2020 could be associated with more eventual YLL than would be observed if these schools had remained open, even if schools remaining open had led to a substantial increase in the rate of death observed during the early phase of the pandemic.”
Sleep habits were also harmed by the pandemic, said Alex Gileles-Hillel, a pediatric pulmonologist and sleep physician from Hadassah Medical Center.
He told the Post that in a survey of 4,000 adults worldwide it was discovered that there was a “very significant increase” in symptoms of insomnia, difficulty sleeping, general poor sleep quality, increased consumption of sleeping aids and medication.
It is understood that kids experienced similar challenges.
The result of a combination of lack of sleep, increased screen time, greater junk food consumption and less exercise will likely be weight gain, Gileles-Hillel said.
“Overweight kids turn into fat adolescents and then into obese adults,” he said, though he stressed that there is not yet enough post-pandemic data on this topic.
He said children are reporting more general anxiety behaviors and fears of staying in bed in the dark. Parents report that children are off routine, which ultimately disrupts their daily behaviors.
“Kids who don’t sleep well are prone to acting out, inattentive behavior bordering on attention problems, and I am afraid these issues will become more relevant,” Gileles-Hillel warned.
FINALLY, THERE is emerging evidence that the stress of online learning and social isolation is leading to mental health issues among young people, too – even if they are not immediately obvious, according to Prof. Yuval Bloch of the Shalvata Mental Health Center and Tel Aviv University.
His center helped run a multicenter study comparing mental health emergency and psychiatric admissions by youth during 2019 and 2020. They are now working on data from 2021.
During the Hebrew U. webinar, he showed slides that countered what he said the research team expected to find: emergency room visits, psychiatric center admissions and referrals to certified specialists – including by first-time patients – were all down.
However, he said that he does not believe this is due to a lack of necessity for those visits. Rather, he said, schools are probably the central contributor in referrals of kids going for therapy and other help – and children were not in school.
Bloch also noted that it can take time for mental health issues to reveal themselves – “there is not a one-day or two-week incubation period for these problems.” And he said that short-term findings could look quite different from what the country starts to see as students return to school after Passover.
Windman, who spoke after Bloch, said she agrees. There were less reports of children-at-risk to child protection officers, but there was limited availability of professional services in the community and less youth activities, which increased the difficulty of identifying these youth.
In contrast, however, there was a visible increase in reports of youth on the streets and an increase in inquiries to NGOs and school psychologists regarding loneliness and distress. There was also a reported increased sense of isolation among children and known increases in risky behavior among youth, such as alcohol and substance abuse.
One study showed a 40% increase in the number of children at risk of suicide treated by educational psychologists. There was also a 57% increase in incidents of everything ranging from shaming, bullying and harassment reported by children and youth themselves.
THE MCKINSEY REPORT rolled out a series of recommendations to help support students who were left behind, recommending high-density tutoring or more personalized mastery-based programs. It said that students may need to spend more time in their classrooms, either converting to longer school days or using vacation time to learn.
“Given the breadth and scope of learning loss, there could be a compelling case for a systemic solution as part of the recovery,” the report said.
Shortly before the elections, the government reviewed a NIS 2.5 billion four-stage plan for bridging the educational, social and emotional gaps plaguing Israel’s students.
The first stage involved extending the school year through the end of July. The school year usually ends for middle schoolers on June 20 and elementary schoolers on June 30.
The program would be available for students in preschool through grade 11.
However, the plan never passed, and it will be at least another few months until a new government is formed.
There is no national framework for closing the educational, medical, social and emotional gaps that have developed among students over the past year, Yablon said.
“No one talks about how we should deal with these difficulties,” he said. “Teachers, school counselors – everyone finds themselves dealing with it on their own.”
He said that he has seen many children who have been through tough times grow up and do very well; but without resources and support, “we will see very poor outcomes from this pandemic.”
Alroy-Preis said that the Health Ministry has determined that the traffic-light model does not work for schools, because it changes significantly and quickly and cannot provide stability for kids, parents and schools.
As such, she said there is a professional task force of representatives from the Health, Finance and Education ministries that is meeting now to determine a plan for next year.
“Hopefully, we will come up with a better model to keep kids in school all the time,” she said.
Otherwise, James Brown’s warning about the dangers posed by the lack of education could ring even more true than when he first sang those words 45 years ago.