What Do Children Really Understand About Covid?

In early March 2020 – yes, it seems like a century ago — in most places the first lockdowns made clear the chilling reality of what would soon be declared a worldwide pandemic.

The rollercoaster ride of one wave followed by a reprieve followed by another surge has left us all exhausted and drained.

Vaccines have raised hopes (for most of us, at least) but the Delta variant, and the specter of yet more deadly and contagious future variants, have dashed those hopes once again.

We began by seeing the most elderly and the most infirm, succumb in nursing homes. Then, with the success of mitigation measures and ultimately, vaccination, risks shifted to younger adults who are unvaccinated. At the same time, the lure of normality has led many of us, vaccinated or not, to jettison measures like masks and physical distancing.

As social beings, we yearn to gather in large, tightly packed crowds to cheer on our team, sing along to a rock concert, or raise our voices in unison as congregations.

In a dangerously divided society, every element of a public health crisis has become politicized, making concerted common efforts nearly impossible. Increasingly, public health experts warn that Covid may be with us for the foreseeable future—endemic rather than pandemic—controlled but still taking its daily toll of victims.

Alarmingly, rates of infection, severe disease, hospitalization and death have begun to rise in children. Those under 12 are currently ineligible for vaccination. For children over 12, vaccination rates remain stubbornly low. As of mid-July 2021, just 25 percent of children ages 12-18 were fully vaccinated, the lowest percentage of any eligible age group.

At the same time, the most effective mitigation measure—wearing a surgical grade mask—has become, for many, a politically toxic symbol. As a result, pediatric ICUs are filling to capacity, especially in areas where most eligible teens and adults are unvaccinated.

The American Academy of Pediatrics has urged the FDA to approve emergency use authorization of vaccines for children under 12. The Covid conversation has shifted from: “Kids don’t really get sick from Covid, not to worry” to “Children are at risk, and it’s serious.”

And now, another school year opens in the Age of Covid. For parents, caregivers, and family members, the nagging question is: “How safe will my child be in the classroom?” More broadly, as we move toward the third year of Covid, with no end in sight, we confront an unsettling thought: Our children are growing up in a Covid world. Even if we can keep them safe from infection and disease—a big IF—we cannot shield them from the larger reality.

As a developmental psychologist, I wonder what children make of this new, troubling world. We already have data documenting increased levels of stress as a result of school closures, inadequate remote learning (where little is learned), parental job loss and economic dislocation, not to mention illness and death from Covid itself among loved ones, neighbors, and acquaintances.

At the same time, children are resilient and adaptable. We know too little about how children understand what Covid is, how it spreads, and how it can be conquered or at least contained.

Deeper, more psychological questions remain unanswered: How do children feel about what adults, especially their caregivers, are doing to protect them? How do kids envision their Covid present and future?

Understanding Covid

While we have little empirical evidence for how children of different ages and circumstances are processing what Covid is, research on children’s broader understanding of infection, contagion, and illness is relevant.

Children are curious about what makes them sick. Germs and their transmission through microscopic droplets can’t be seen. That makes it challenging for children to understand infectious diseases, especially respiratory ones.

Nonetheless, study results suggest that even young, preschool-aged children are more savvy than we think. For example, in research by Raman and Gelman in 2005, children from 4-10 years of age were asked about symptoms like runny nose, high temperature, sore throat, and stomach ache. Most of the children thought about these symptoms as something you could “catch,” as opposed to permanent symptoms like “can’t eat peanuts.”

The researchers also asked the children about a novel illness. When described as temporary, rather than permanent, most children viewed it as contagious.

In addition, this study found that most children understood how infectious disease might be spread. When presented with scenarios like: “sneezed and coughed all over friend,” even preschoolers labelled that as a way to “catch” an illness. To be sure, understanding of contagion and disease transmission increased with age, but even young children grasp the fundamentals.

These results, and others like them, suggest that children can understand the basic mechanisms of infectious respiratory diseases. By implication, then, they also probably readily grasp the utility of measures that interrupt modes of transmission. If you can “catch” a novel disease when a friend sneezes and coughs all over you, then preventing that through masking, sanitation, and distancing should be easily understood as well.

There are also encouraging results from previous studies evaluating interventions designed to help children become more proactive in reducing the spread of infectious disease. For example, a 2013 study of a U.K. school intervention found that it succeeded in increasing handwashing among school children. To make the idea of invisible germs more accessible, teachers used glitter sprinkled on the kids’ hands and demonstrated how hand washing made the glitter “germs” disappear.

Previous studies help us to understand children’s concepts of illness, infection, germs, and contagion. We can track how children make meaning, through concepts known as “naïve biology,” and how, gradually, with development and formal schooling, these concepts more closely approximate accurate biological explanations.

However, understanding encompasses more than the biological facts. Children are processing what it means that school has to close, that parents’ workplaces are shuttered, and that friends can’t come to the house for a sleepover.

Children are faced with a shrunken world, with places like restaurants, movies, gyms, and even parks inaccessible or at best, negotiated with trepidation. Parents, caregivers, and public officials are constantly weighing ever-changing information to determine whether a place or activity is safe, or safe enough to risk.

Understanding the risk-benefit ratio in the context of incomplete and dynamically shifting information is mind-numbing for adults. What is it for teens and younger children? How are they thinking about what, who, and where is safe versus dangerous? What is happening to children’s feelings of exploration and adventure in a Covid restrained environment?

We also need more studies of how adults can support children’s emotional, and not just conceptual, understanding of all the aspects of Covid. What explanations are most effective in helping children understand and cope? What can teachers and school personnel do to make the Covid school a less stressful, more welcoming place? How can we build in intimacy, group togetherness, the need to be in an accepting ‘herd’, while we laboriously crawl our way to herd immunity (if we ever get there)?

As we wait for research to catch up to this rapidly changing and all-consuming Covid world, let us take a moment to appreciate children’s resilience and strength. In some future year, they will report to a changed world what growing up as Covid veterans was like, just as children of the Great Depression or the Second World War did. Let us hope they will grow into another Greatest Generation, tempered by the fire of pandemic, strengthened as they met its threat.