Re: Response to Letter to the Editor

Dear Editor,

I appreciate the opportunity to respond and am thankful for the author’s letter [1]. My co-authors were not part of this response. I would like to thank the Canadian Paediatric Society (CPS) for their efforts generally, and recognize my paediatric colleagues across Canada for the hard work they do.

In stating “the evidence base… has grown substantially,” the letter cites three articles, two are the subject of our original commentary and we responded to the other in our rejoinder. It is puzzling that the citations for the evidence base growing are the same citations used in our original commentary. Yet, evidence has grown, indeed. New data reflect the heterogeneity we referenced. A report from Greece shows most children maintained stable mood (63%) or had positive mood change (14%) during lockdown [2]. A multinational longitudinal study (with subjects from Peru, Netherlands, and the United States) of 1339 children 8–18 found depressive symptoms increased by 28% but anxiety symptoms remained unchanged during the pandemic [3].

Although learning loss was not a subject of our commentary, it is worth mentioning that there is a lack of Canadian evidence regarding this (for example, no evidence comparing learning loss between provinces, which would be welcome given variable school closure lengths). Data from the United States shows changes in National Assessment and Readiness scores (which are reported on a scale from 0–500) in Grade 4 and 8 mathematics and Grade 4 and 8 reading from 2019 to 2021 in a district with lengthy closures such as Los Angeles (−4, +1, +2, +9, compared to the 2019 baseline, respectively) are similar-to-superior compared with short-closure districts like Duval (−7, −5, −7, 0, respectively) and Hillsborough (−1, −7, +2, −2, respectively), counties in Florida [4–5]. A report highlights positive, negative, and neutral impacts of emergency online schooling in Italy [6]. Another highlights superior outcomes from an American cohort of students enrolled in an online school system that was well established prior to the pandemic, compared to traditional public schools or chartered schools [7].

Finally, being characterized for handling evidence in a way that amounts to misinformation is understandably challenging. Nevertheless, we were specific in defining what we meant by misinformation:

1. asymmetrical presentation of evidence and

2. proclamation of cause where causation evidence is lacking.

I stand by our assessment that the claim by the CPS that “online learning is harmful” did both.

Our commentary warns against jumping to conclusions based on early, incomplete, or potentially low-quality data. It is precisely my respect for the CPS and its 3782 members that I wish it to adhere to the highest standards and scrutiny of evidence interpretation, and I feel in this case they did not do so.

A comprehensive and nuanced understanding will better equip us to develop effective policies and strategies to support the mental health and education of children during the next pandemic or emergency.

Sincerely