Repercussions of the COVID-19 pandemic from the childrens’ perspective

Objective: To understand the repercussions of Coronavirus Disease 19 (COVID-19) from the perspective of schoolchildren. Materials and method: A qualitative study, of the participant action type, based on Paulo Freire’s theoretical and methodological precepts. The participants were 10 children living in the coastal area of Santa Catarina, Brazil, from a virtual culture circle held in July 2020. An analogy was made with the colored pencil to go through the stages of the research itinerary. Results: Two generative themes emerged for discussion: the good things of the COVID-19 pandemic and the “ cannots ” of the pandemic. In the first theme, they highlighted more time with the family and strengthening family ties, proximity to pets, and self-care. In the second, they pointed out the impossibility of playing with friends, celebrating birthdays and hugging people. Conclusions: The children identified positive and negative points experienced during the pandemic and unveiled the challenges of transforming moments of social isolation into spaces of family proximity, although restricted to their homes.


Introduction
The Coronavirus Disease 2019 (COVID-19) is considered a public health emergency, according to the World Health Organization, and imposes changes in people's daily life (1). Since its outbreak, children began to live intensely with their families, in a scenario permeated by rearrangements concerning the needs of social isolation, as a possibility to minimize the spread of the new virus. The social isolation caused by the COVID-19 pandemic brought uncertainties, fears and approximations in the daily lives of children and families as a whole (2).
Although children are below the infection rates indicated by the epidemiological scenario, in relation to adults and older adults, it is urgent to insert them in the context of care by their families and by health professionals, considering the other limitations that a pandemic imposes on child health (3). Thus, in general, during the COVID-19 pandemic, children experienced distancing from their routine, started taking remote classes, using technologies more intensively, creating coping strategies and, many times, were exposed to mental health problems.
Added to this are the questions surrounding the losses caused by the disease, which can cause dubious feelings and are difficult to manage. Examples of these feelings can be anger, anxiety about the loss of bond with people around them -due to social isolation, illness or even the death of a loved one -, which impairs the children's reflexive function (4).
Relationships between children, family and friends end up suffering impairments due to dismay and increased concerns. In view of this, it is relevant to pay attention to the reactions of the children presented in this period, being important to support them, motivating them to experience the moments of crisis and providing opportunities to face the adversities (5). With so many uncertainties and challenges, it is important to guarantee children moments of listening and dialog that pay attention to their desires, in order to subsidize strategies to improve and strengthen their resilience mechanisms.
From this recent context, research studies that address the repercussions of the pandemic on child health become important, in view of the manifestations that demand attention and care from all those involved with this population. Therefore, the following research question emerged: What are the repercussions of COVID-19 from the perspective of schoolchildren? In view of that, the aim of the study was to understand the repercussions of COVID-19 from the perspective of schoolchildren.

Materials and method
A qualitative study, of the participant action research type (6), based on Paulo Freire's theoretical and methodological precepts. The Freirean research itinerary was used, which comprises three interdependent stages, namely: (a) thematic investigation: it is the initial dialog to identify the generating themes, which are extracted according to the reality of the research participants; (b) coding and decoding: it is the phase in which the generating themes are reflexive, representing the existential situations in a critical manner about the lived reality; (c) critical unveiling: it is the critical awareness of the existential situation, in which the limits and possibilities of reality are evidenced (7).
The research itinerary takes place in a space, called by Paulo Freire as a "culture circle", which promotes the sharing of feelings and experiences combined with the construction of knowledge. It is a group of individuals who discuss common themes by means of horizontal and participatory dialog, fostering collective knowledge in search of the transformation of reality (8).
Faced with the pandemic situation, the virtual culture circle (VCC) has become a necessary and innovative practice. To conduct it, the Zoom® application was used, through the cameras of electronic devices, in order to provide interaction and dialog among the study participants.
The research participants were 10 children living in the coastal area of Santa Catarina, southern Brazil, with only one VCC being carried out which, being a participatory action technique, allowed exploring data saturation during the dynamics. Two children and their guardians, from the researchers' social network, were contacted and invited via telephone to join the research. Then, using the snowball sampling method (9), these children and families invited the other participants to join the VCC. It is noteworthy that the snowball method favors the selection of participants with close ties, since they tend to indicate people close to them.
The inclusion criteria were as follows: schoolchildren, between 7 and 9 years, 11 months and 29 days old. The exclusion criteria considered were not having access to the Internet and electronic devices to participate in the VCC.
In the week before the VCC, a message was sent via What-sApp to the guardians of the children participating in the study, in order to explain the objective of the research and the need to sign and explain the Free and Informed Consent Form (FICF) and the Free and Informed Assent Form (FIAF). The FICF and FIAF were sent via e-mail to those responsible, who signed them and forwarded them to the researchers, and to the children. At that time, the children were also asked to provide blank sheets of paper and colored pencils for participation in the VCC.
The VCC took place in July 2020, lasting approximately two hours, and being recorded on an electronic device. The children's parents helped them to virtually enter the application, and the mediator (lead researcher) supported them in explaining how to use audio and video. After that first moment, the parents withdrew, and the children participated in the activity in the company of the VCC mediator, in order to provide greater freedom of expression for the study participants.
In order to go through the stages of Paulo Freire's research itinerary in an interactive, critical, creative and playful way for the children, an analogy was made with colored pencils, which is something concrete in childhood experience ( Figure 1). To start the VCC and go through the first phase of the Freirean itinerary, which is thematic investigation, the mediator shared her taste for painting drawings and, from there, with a colored pencil in her hands, she urged the participants to investigate the parts of a pencil. After some discussions, she invited the children to use their colored pencils to symbolize their life during the COVID-19 pandemic, by means of drawings or colorful words. Then, each child presented their productions to the group, while the mediator wrote down their testimonies, using keywords, on a cardboard.
The mediator read all the keywords for the children and encouraged them to organize these testimonies, according to the subject matters covered by the group. Thus, two generating themes emerged for discussion in the VCC: (a) the good things about the COVID-19 pandemic; (b) the "cannots" of the COVID-19 pandemic.
For coding and decoding, the second stage of the research itinerary, the mediator pointed to the children the graphite with the color mine that is inside the pencil wood, which allows them to have several tone options to make the drawings. In addition, she explained that colors, in the illustrations they presented, also had many meanings, which needed better understanding. Subsequently, she posed the following questions: What are the good things that CO-VID-19 brought to your life? What are the "cannots" of the COVID-19 pandemic? The children discussed intensely about these questions in a welcoming space to share their perceptions, experiences and knowledge. Then, the meanings of their perceptions were recorded by means of phrases, which were coded and decoded ( Figure 2).
To validate these records, all the phrases were re-read to the children in order to motivate them to continue reflecting on the proposed themes, with a view to validating the action-reflection-action process, encouraging them to understand their ability to cope with the challenges raised and share proposals that would make it possible to transform their reality (7). The VCC dialogs were transcribed and organized, according to the two generating themes.
For critical unveiling, it was addressed that the colored pencil made it possible to draw many meanings, such as those that occurred during the VCC, inviting children to reflect on everything they said and heard, in order to unveil the real possibilities of living healthily and overcoming the challenges of COVID-19 in childhood, seeking to transform negative situations, in a process of awareness and resilience, strengthening them between each other. Finally, the children were asked about the meaning of having participated in the VCC. The process of unveiling the themes occurred concurrently with thematic investigation, according to the assumptions of Paulo Freire's research itinerary, which provides for the analytical process (7). This moment, called "data analysis" in the Freirean research itinerary, occurs continuously and with the participation of everyone involved in the culture circle. After the VCC, the transcriptions of the speeches were carried out. Their coding was done by choosing the name of a color preferred by the children, in order to maintain their privacy and anonymity.
The study was started after being approved by the Committee of Ethics in Research with Human Beings of a public university in Southern Brazil, with opinion number 4,111,692 and Certificate of Presentation for Ethical Appreciation number 33736920.3.0000.5564.

Results
The children participating in the study attended elementary school between the second and fifth grades; four of them studied in public schools and six in private schools. The participants were subjected to social distancing, with remote classes and/or online activities, due to the pandemic situation. Six boys and four girls participated, living in the company of their parents, in different municipalities on the Santa Catarina coastal area, Brazil. The effective presence of the family members in the home made the children realize that, due to the quarantine, their parents started to have more time to assist them in carrying out school tasks and developing joint activities, such as riding a bicycle, painting screens and cooking: Learned the important of washing their hands Family has lunch together every day Father and mother work at home Mother has time to play Mother teaching how to cook Classes through the computer Family became more united Family adopted a puppy Painted on canvas with the mother Father helps in school tasks Gather has time to ride a bicycle They speak more with grandparents and relatives Some participants raised the situation that, for some time, they wanted a dog, but their parents said that they did not have time to care for the animal. However, with the quarantine situation, the family finally decided to have a dog, which brought joy to the house: I've been asking for a dog for a long time, since I was a little boy. But my parents never gave it to me. And now, I won a beautiful one. I'll get it for you to see... Thor is cheering our house up, he's a lot of fun and everyone likes him, look how beautiful! (Red) I also finally got a dog. She is called Pipoca and everyone here at home likes her, especially me. (Pink) The children discussed that they learned some lessons from the pandemic, such as the importance of washing their hands and maintaining hygienic care for individual and collective well-being: With the pandemic, we learned more about the importance of always washing our hands and having hygiene. (Orange) I learned that we have to respect people, that we have to take care of ourselves, in order to take care of others around us too. So, everyone has to do their part, mom always says that to me, for this pandemic to go away... (Green) Despite the need for social distancing, imposed by COVID-19, the children revealed that they are talking more with their family members today, especially with their grandparents, through electronic devices: Now I talk a lot more with my grandparents than before the pandemic, because every day mom calls them and I talk to them, so they don't feel homesick. (Pink) Here at home my mom and dad also call the whole family every day to talk to my two grandpas and my two grandmas. So, I think we talk a lot, even in this pandemic. (Purple) The children also stated that they appreciated the idea of online classes, due to the impossibility of attending school, and praised the activities of the teachers: I think online classes are really cool because we don't even have to leave the house to take classes. I'm really enjoying it! My teachers are very nice and do some fun activities on the computer. (Red) I also like computer classes and my teachers also make some really cool classes. And the cool thing is that we can attend the class even in pajamas, with a blanket, right? At school it couldn't be like that. (Green) However, the children also felt some challenges in coping with COVID-19. When discussing the second generating theme, they pointed out the impossibilities, the "cannots" in the experience of the pandemic, as they called it, such as not being able to play with friends, not having pajamas parties at home and not celebrating birthdays: Now I can no longer go to play to my friends' house and they don't even come here to play with me. With COVID-19, some weekly activities were canceled, such as school, soccer and ballet classes. In addition, the children reported not being able to go to the pizzeria and cinema with the family, feeling homesick for strolling in the shopping center: The children said that they will not be able to travel on vacation this year and stated that several other schedules have been canceled, such as the school's June party. As a consequence of preventive actions, they also revealed that they cannot leave the house without a mask or hug people who do not live in their house: Every year my school has a very big June party and this year it didn't happen and I was sad. (Black) This year we won't have July vacations. We travel and now, it won't work because of COVID. (Orange) We can't hug people who don't live with us. My mom always tells me that even though I know a lot and like other people, if we meet them somewhere, I can't hug them, I like to hug people and now, I can't. (Pink) We can't leave the house without a mask. But wearing a mask is really bad because it keeps dropping all the time and doesn't let us breathe properly. (Brown) As for participation in the VCC, the children shared that they found it a fun moment and that they learned together, revealing it to be a special moment: I thought it was really cool for us to meet on the computer, because now we have to meet anyway. Tomorrow I will tell my teacher. (White) It was really fun, there was only one thing missing for us to eat together, right, guys? (Purple) I thought it was cool because I learned a lot about the pandemic from everyone. (Black) It was really cool that we participated and also very special because everything we talked about here is very important for the world. (Green) I liked it very much because I hadn't talked to anyone about these pandemic things and it was good to have talked here today. (Yellow)

Discussion
The pandemic caused by COVID-19 has transformed the life and routine of all population segments. With regard to the child population, it is known that the infection rarely develops and, when this happens, the manifestations of symptoms are generally mild (10)(11)(12).
However, despite the fact that the child population is less affected than the adult population and presents, in most cases, the asymptomatic form, they are considered transmission vehicles (13). In this scenario, the need for social isolation is present and has conditioned families to a new reality. The development of work activities at home, added to the child's inability to attend school spaces in person, has had an impact on the narrowing of family life.
From the children's perspective, this reality was positive, as it enabled parents to be more present in daily activities, be them educational or recreational, a reality that was not possible in a normal routine. In this sense, social isolation can become an opportunity to improve the interaction between parents and children, with the involvement of children in family activities and with the improvement of their self-management skills (14). Difficult times such as what society is currently experiencing can allow for creative opportunities, as well as build stronger relationships (15).
With the inability to attend school, the parents are asked to assist school learning in a way not previously seen. Transporting learning from the classroom to the home, on a large scale and with such speed, can present human and technical challenges, and it is up to the families to circumvent them (16,17).
Parental engagement in the children's educational process is an indicator for children's good school performance, while parents and teachers play different roles in the educational process, not to mention the increased workload on both and the structural and objective conditions of each family (18). In this sense, it is believed that creating schedules of tasks and activities with texts and interactive figures, as well as including the child in the organization of these schedules, helps in structuring the necessary transitions between daily tasks (17).
With the changed routine and accumulated work demands, in view of the activities inherent to home and family life, parents end up giving in to some requests previously denied to their children, such as adopting a pet. Family pets can act as enhancers to strengthen bonds in family life, reframe attention under the current context, and help children overcome challenging situations (17,19).
Another positive point listed by the children in the study was the lessons learned from the advent of the pandemic. Understanding the importance of hygiene measures and respiratory eti-quette, not only for their own health, but for the maintenance of collective well-being, are significant premises in the daily lives of these children. In this situation, it is essential to establish communication compatible with their level of understanding, with reflection on the current pandemic context, so that, they are thus able to contribute, in their own way, to overcome this moment (20). It is also essential to listen to what the children believe about the transmission of COVID-19 and to provide an accurate and meaningful explanation because, from that and from what they have access to in the media, they will be able to formulate their own conclusions (20,21).
The perception about the negative points that the pandemic brought to the children's lives was referred to as the "cannots" that are present in their daily lives. The impossibility of going to school, meeting with friends, and practicing outdoor activities are some examples of the experiences during the pandemic. The pandemic situation caused by COVID-19 is changing the organization and the lives of families. The United Nations Educational, Scientific and Cultural Organization estimates that 1.3 billion children are out of school or daycare, without access to group activities, team sports or playgrounds (15).
Even if school activities are maintained remotely by the educational institutions, it is imperative to look beyond the learning issues, noting the absence of social interactions that this scenario represents. In a similar study carried out with children who had the same experience, they stated that they miss school because, in addition to studying, the environment allows them to play with their colleagues and perform physical activities. The school institution has both an educational function and is essential for children to be in contact with their peers, developing their potential (20).
Isolation in the family environment can cause loss of external references, represented by the school and by the interactions with other family members: uncles, cousins and grandparents. This adaptive need requires increased surveillance of the family's internal organization, both in terms of structuring the domestic environment and in strengthening personal resources and the family network (4).
The routine changes, the limitations of social contact with friends and family, even though they are accepted by the children, may not be well understood, deserving special attention from the Nursing professionals who work in the pediatric area. Although attention focused on reducing the transmission of the new coronavirus is essential, attention to children is necessary because, in view of various information and abrupt changes in their social and leisure routine (21), they are exposed to developing high levels of stress and anxiety. This will demand from Nursing professionals a careful and sensitive view of the situation in order to offer care that meets these needs.
The future of children requires a holistic strategy in view of all the uncertainties they are facing, and this will be the new challenge for the families and the Nursing professionals who work in the care of this group. In addition to monitoring the child's performance and behavior, the parents also need to respect their identity and needs, seeking to help them develop self-discipline skills (14). Health outcomes, both for children and adults, depend on coping resources, as the COVID-19 pandemic requires the individual to adapt strategies to cope with stress (coping) in an adaptive manner (4).
To make up for the absence of family and social interactions, children and adults began to use technologies and social media more frequently to establish contact and create interactive communication channels. Such technological resources have become the only alternative to minimally guarantee what would be a fundamental right for family and social interaction and coexistence (22).
In this context, it is evidenced that the use of technologies has shown an important rise in the daily lives of children and families during the pandemic. New ways of learning, communicating and interacting needed to be rethought and reformulated in order to maintain educational, personal and social needs, which are crucial for the child's full development, even in conditions of social distancing. This scenario leads us to a possibility that can be inserted in Nursing care, that is, using technologies and/or social media to approach this population, creating bonds, and aiming at therapeutic care relationships.
As a limitation of the study, the challenge of mediating the VCC with the children is mentioned, as they are active and easily dispersed; therefore, the mediator needed to resume data production frequently. However, the children were already participating in remote classes, which helped to minimize dispersions and allowed them to participate in the progress of all phases of the research itinerary in a reflective and dialogical manner. Another limitation was to find Brazilian studies that addressed childhood in the fight against COVID-19, which highlights the relevance of this research proposal in giving visibility to the children's view of the pandemic moment. Although it may seem like a limitation, the small group of children participating in the study is consistent with the method chosen, which provides for a small number, in order to promote dialog and interaction between those involved.

Conclusions
In this study, through dialog and reflection, the positive and negative points experienced and highlighted by the children during the pandemic moment were identified. In addition, they unveiled the challenges of transforming moments of social isolation, as spaces of family proximity, although restricted to their homes.
The Freirean research itinerary used made it possible to achieve the proposed objective. In turn, the development of the culture circle in a virtual manner revealed its potential for the performance of Nursing in health-promoting actions in the field of childhood, as well as for individuals and collectives of different age groups. Thus, it is recommended to carry out participatory research studies in order to integrate the participants into research, allowing a space for the exchange of knowledge in a conscious and critical action on the theme of the study. In addition, it is suggested to continue studies to analyze the impacts of COVID-19 on child health, since the conclusions are limited, for presenting a new and challenging situation in the lives of children and their families.
Conflict of interests: none declared.