The childhood obesity rate in the United States may increase by 2.4% if school closures continue into December, finds a new study from the Brown School at Washington University in St. Louis.
“Having schools closed nationwide, children in the U.S. have missed their opportunity to participate in physical education classes and other school-based physical activities, such as recess and after-school sports programs. They are also less likely to make up for it under the stay-at-home orders, as parks and outdoor recreation areas across the states are closed that limit physical activity opportunities outside,” said Ruopeng An, assistant professor and author of “Projecting the Impact of COVID-19 Pandemic on Childhood Obesity in the U.S.: A Microsimulation Model,” published May 23 in the Journal of Sport and Health Science.
Currently, all 50 states and Washington, D.C., have issued executive orders on school closures, and most states issued these orders March 13-23.
To date, no state has lifted school closure orders, and it is likely for the school closures in most places to continue for the rest of the 2019-2020 academic year, An said.
“It remains unclear whether and on what scale schools would reopen after the summer break, as such decisions are contingent upon how the COVID-19 pandemic evolves in the coming months,” he said.
In the U.S., childhood obesity prevalence increased by three-fold over the past few decades. In 2017-2018, 18.5% or 13.7 million children aged 2-19 years had obesity, An said.
“Lacking physical activity is one of the major behavioral risk factors for childhood obesity,” he said. “The Physical Activity Guidelines for Americans recommends 60 minutes or more of moderate-to-vigorous physical activity daily among children. Over three-quarters of children in the U.S. do not meet the guidelines’ recommended daily physical activity level. In the meantime, nearly half of U.S. children exceed two hours per day in sedentary behavior.”
In his study, An used a microsimulation model to project the change in U.S. children’s BMI (body mass index) and childhood obesity under the COVID-19-induced uncertainties.
The study simulated different future scenarios regarding the duration of school closure and change in social norms and their possible impact on children’s daily physical activity level.
“The model predicts that even a two-month school closure alone could result in an increase in the childhood obesity rate by 0.64%,” he said. “If school closures continue to the end of 2020 due to unsubdued community transmission of COVID-19, the childhood obesity rate in the U.S. might further increase by 2.4%. In such a case, by March 2021, about 1.27 million new childhood obesity cases will develop under the COVID-19 pandemic than otherwise.”
Compared with girls and non-Hispanic whites, the estimated impact of COVID-19 on childhood obesity could be modestly larger among boys and non-Hispanic blacks and Hispanics, respectively.
“We need to address the increasing health disparities caused by the COVID-19 pandemic,” An said. “Customized policy interventions are warranted to prevent further deterioration of weight-related health outcomes among these two socioeconomically disadvantaged racial/ethnic minority groups.
“The harsh reality is, for the coming months or longer, the majority of children in the U.S. may not fully resume their daily physical activity routines due to the nationwide closure of schools, gyms, recreation centers and parks and cancellation of sports activities,” An said. “Public health interventions are urgently called on to promote an active lifestyle and engagement in physical activity among children to mitigate the adverse impact of COVID-19 on unhealthy weight gains and childhood obesity.”
We asked a few students from China to explain what it has been like to live through this global pandemic while so far from home, and so worried about their own family and home country.
Reflections from Zizi Xu, MSW
Since the COVID-19 broke out in China, I have followed the associated news closely as I have seen many people in my country were suffering. This massive outbreak has now happened in other places, and more countries, communities, and those people are adversely struck by this virus as well.
I have felt deeply concerned about this pandemic, because of its fast contagion and many uncertainties, and I felt powerless because I cannot go back home and help due to the travel restrictions. In late January, as one of the co-chairs of the International Student Association (ISA) at Brown School, I helped run a workshop to try to raise awareness of this new virus. We realized the importance of sanitation to prevent the spread of COVID-19, and we provided the masks and sanitizers for the participants, but it was hard to get those products at that time almost everywhere.
As an increasing number of COVID-19 cases have been confirmed in the U.S., I feel obligated to do my best to serve the local community because I feel heartbroken to see more people and their families are suffering from this disease, even losing their lives.
When the COVID-19 outbreak was contained in March in China, many essential medical resources were available. I noticed that many families or friends mailed essential Personal Protective Equipment (PPE), such as masks, to Chinese communities in other countries. Along with my experiences working for International Alumni Development Programs and running ISA, I thought it would a good idea to connect these essential resources to people in need. I tried to connect my family and friends in China who could provide masks with some of my friends working or serving in hospitals, schools and churches. Because of the customs, lack of funding and different standards for imported medical supplies, etc., it was difficult to make it happen, but I didn’t want to quit. I reached out to Linyun Fu, manager of the Global Program at Brown School, and Assistant Professor Ruopeng An, and we worked together to develop the ongoing Brown School Community Mask Program. (Read the full story about this program.)
My Jefferson City practicum was ended, and I started working on a COVID-19 response project. From a legislative perspective, we have done the research to try to build a tracking system for how each state has responded to the crisis according to various factors, such as the majority party of the House and Senate, governors’ genders, COVID-19 associated bills, etc. We have also built a tracking system to see the associations between those factors and COVID-19 health outcomes, such as confirmed cases, testing cases, fatality rate, and so on. We hope this project would bring some insights and perhaps influence future decisions of administrators and legislators.
From this pandemic, I have learned to be more socially responsible and ethical as a member of our global community. Additionally, I realize how significant and essential it is to strengthen our solidarity and cooperation to overcome this global challenge together, regardless of different ideologies, nationalities. There are many uncertainties out of my control, and possibly, there are misconceptions, hatred and even discrimination due to this unprecedented pandemic, but there are always positive things that we can do to make positive change as individuals and to benefit communities in profound ways.
I have never expected that my last year at the Brown School would be ending this way, but I cherish this incredible journey that allows me to learn not just from class, but also from the realities of life.
Reflections from Grace Ruqing Cao, MSW/MPH
Back in January, when the COVID-19 pandemic broke out in China, I was really anxious about my family back in China because many of them are in the high-risk population. I tried to send some face masks back because it was really hard to get masks in China back then. I contacted them everyday and become hypervigilant of my phone notifications. Even during class, I would open the notifications as soon as possible, because I was so afraid that there would be some bad news.
Now it is my parents’ turn to worry about me because the situation in the U.S. is worse. For a while, I was not able to get any masks in St. Louis, and they sent me back some masks they had left. The masks my mom sent me were far more than what I expected. She said she wanted to share these masks with my classmates who were in need. So I donated them to the Brown School Community Mask Program. (Read the full story about this program.) Not only does my family worry about the virus itself, but they are also frightened by all the news of hate crimes and racism towards Asian people. I check in with them everyday to let them know I am still safe and healthy.
Reflecting back to the past four months, as a Chinese international student, I feel I am continuously living in fear and anxiety about the well-being of my family, friends, peers and myself. At the same time, I am still very lucky because I am able to share resources with my loved ones both here in St. Louis and across the sea. I am also able to receive love and care from both communities.
If there were only one thing I learned from this pandemic, it would be that hatred, division, and blaming each other will never save people’s lives. Instead, they only put underprivileged people under risk. As social workers, it is our responsibility to fight for social equity, which is already threatened by broken systems that are exacerbated under the current situation. To make it through this hard time, we need to hold each other accountable, diminish our distance while social distancing, and help each other as much as possible when we can.
The Navajo Nation now has the highest rates of coronavirus infection per capita in the U.S. The people need assistance, says Wynette Whitegoat, assistant director of the Kathryn M. Buder Center for American Indian Studies at Washington University’s Brown School and a member of the Navajo Nation.
“There are many factors that have led to the Navajo Nation’s current struggle and fight for well-being, including colonialism, federal government relations, poverty and lack of resources,” she said.
According to the Navajo Department of Health, as of May 16 there have been 3,912 cases of COVID-19 and 140 confirmed deaths — among roughly 175,000 people. That’s an incidence rate almost three times higher than the total of U.S. deaths, or the equivalent of nearly 239,000 fatalities across America, when there were nearly 84,000.
The Navajo Nation is an American Indian territory covering about 17,544,500 acres occupying portions of northeastern Arizona, southeastern Utah and northwestern New Mexico. This is the largest land area retained by an indigenous tribe in the United States. The Nation’s median household income is around $20,000 per year.
Despite the underlying factors that make the Navajo Nation and other tribal communities most vulnerable to this pandemic, Whitegoat said, measures have been put into place by the Navajo Nation leaders, including 57-hour-long curfews reservation-wide, increased screening locations, and a surge in grassroots efforts operated by tribal members.
“While the Navajo people continue to be resilient and strong as their ancestors have done when faced with adversity, support is still needed to ensure high-risk individuals, especially elders, are protected,” she said.
“I hope people will consider donating to the Navajo Nation by visiting Go Fund Me or the Navajo Nation Relief Fund,” Whitegoat said.
Every year since 1990, Brown School at Washington University in St. Louis students and the Kathryn M. Buder Center for American Indian Studies have hosted an annual Pow Wow—a gathering that brings together people from all across the country to celebrate Native culture. The 30th annual event was to occur on April 11, 2020 with the theme of “Steps to Sovereignty: Decolonize, Indigenize, Revitalize.”
With the coronavirus crises, this year’s Pow Wow was canceled. But, explains Buder Center Director Kellie Thompson, “We wanted to keep our commitment to our Pow Wow Head Staff — individuals who run the event, in their respective roles. We did this through the ways we have been taught by our elders: by creating relationships, learning through listening and elevating stories.”
The 20 students on the Pow Wow Committee each interviewed one Head Staff member as well as event vendor in mid-April about how the current pandemic was affecting their lives, their tribes and their traditions.
The result was a digital book, the Pow Wow Committee COVID-19 Report and Resource Guide, created by the 20 students on the Pow Wow committee. The book contains information about how Native people are dealing with issues of online education, keeping up tribal language revitalization while social distancing, leadership during a time of crises, and of course, the crushing health and economic impact the virus is having on reservations across the country.
“Interviewees were generous with their time, stories and knowledge, and each student created a unique document,” said Thompson. “Our goal was for people to find solidarity in these stories, resources that would be helpful for their communities and hope for our future generations.”
High levels of social distancing would lower the COVID-19 infection, hospitalization and death rates over the next six months across all counties in Missouri, finds a new study from Washington University in St. Louis.
Although death rates will be lower than in urban areas due to lower population density, rural areas will see significant numbers of hospitalizations and deaths from COVID-19. In all regions, projections are impacted by the local levels of social distancing, the study’s authors wrote in a recently released paper.
“Our analysis illustrates that greater levels of social distancing will lead to lower rates of COVID-19 infection, hospitalization and death over the next six months throughout Missouri,” said Abigail Barker, research assistant professor at the Brown School and faculty lead for data and methods at the university’s Center for Health Economics and Policy at the Institute for Public Health (CHEP). She is lead author of the CHEP policy brief “High Levels of Social Distancing Lower the Projected Impact of COVID-19 in Missouri.”
“For example, with low social distancing, St. Louis County, with a population of 998,684 people, is projected to have 901,386 infections over the next six months, a 90.2% infection rate,” Barker wrote. “However, that number is reduced dramatically to 8,481 infections with high social distancing, or a 0.8% infection rate.”
The model that Barker and her colleagues built predicts that the overall rates of COVID-19 infection, hospitalization and death will be lower for rural areas than for urban areas over the next six months.
“However, we expect to see higher rates of hospitalization and death in rural areas among those infected, based on the age distribution and health of rural Missouri residents,” she said.
“Regardless of population size, all counties will see significant drops in the number of infections, hospitalizations and deaths when social distancing is high,” Barker wrote. “Net changes in numbers will be larger for urban areas due to higher population counts, but rural areas may see higher relative decreases. Further, unlike urban areas, rural areas’ projections suggest cases could drop to zero with robust social distancing measures, due to the lower baseline spread of disease in the setting of lower population density.”
While the findings support social distancing to limit the spread and impact of COVID-19 in the state, higher levels of social distancing may lead to economic and social costs and it is unclear the amount of time a high level of social distancing will be needed to protect the health of Missourians.
“Areas with greater proportions of older individuals and people with chronic conditions face greater risks due to COVID-19 — and benefit more from social distancing — than other areas,” Barker said. “High levels of social distancing will lower the projected number of infections and hospitalizations, preventing hospitals from exceeding their maximum capacity, which would affect their ability to care for patients.”
In particular, she said, this could help reduce the burden in rural areas, which have fewer hospital beds and other resources, and would therefore be disproportionately burdened by an uncontrolled COVID-19 caseload.
The brief is accompanied by an interactive data visualization that is updated weekly with the latest data. Contributing authors to the policy brief were Kristine Huang, Leah Kemper, Linda Li, Timothy McBride and Karen Joynt Maddox, all affiliated with the Center for Health Economics and Policy. Second author Huang will be at the Washington University School of Medicine in St. Louis this fall.
Spurred by a desire to help their Brown School community during the COVID-19 pandemic, Chinese students, faculty and staff community have collected nearly 1,500 masks for free distribution to those who need them. The single-use masks are available through pickup or delivery to any members of the Brown School community.
As the coronavirus spread slows in China, where mask production is at full tilt, families there have sent masks to relatives in the Brown School community, said Linyun Fu, manager of global programs for the Brown School, who helped organize the initiative. She realized many had a surplus because of this, and masks were hard to find in St. Louis. Fu, along with Assistant Professor Ruopeng An and Zizi Xu, a second-year MSW student, began soliciting donations of masks from the Brown School Chinese community and distributing them to those who requested them. Additional masks were also ordered directly from China.
“This is a difficult time for all of us,” said Fu. “We know need to all work together for everyone’s benefit.”
An puts masks in a large cardboard box outside his home for pickup, while Fu, Xu and two other Brown students, Grace Cao, MSW/MPH, and Danyi Li, MSP/MPH, deliver masks. Because the masks are single-use, they are given away in quantities of 5-10, with more available for people with special needs. As of May 1, masks have been given to 131 people who requested them.
Fu noted that as the outbreak unfolded and mask-wearing was not common, some Chinese students faced discrimination and taunts when they shopped for food, making them fearful of going to grocery stores wearing masks. The Brown School created a grocery-shopping program in which volunteers shopped for students. “Chinese students feel grateful,” she said, “and they wanted to do something for our larger community.”
Xu said she was moved to act when she saw the crisis in China but was unable to return. “I felt a bit powerless because I could not go back home and help. I feel obligated to do my best to serve our communities here because I feel heartbroken to see more people and families are suffering,” she said. “There are many uncertainties and impossibilities out of my control, but there always things that we can do to make small changes as individuals and benefit our larger communities.”
Cao, the co-chair of the International Student Association at the Brown School, said she received a great number of masks from her family in China, and her mother suggested she share them with classmates. She heard about the mask-donation program and decided to volunteer.
“If there was only one thing I have learned from this pandemic, it would be that hatred, division, and blaming towards each other would never save people’s lives,” Cao said. “Instead, they put underprivileged people under risk. To make it through this hard time, we need to hold each other accountable, diminish our distance while social distancing, and help each other as much as possible when needed.”
“Brown School is my community. Professors, teachers, and my peers helped me a lot and they play an important role as my social support system,” said Li. “I also want to be supportive as a member of the Brown School family. Stay together, stay strong.”