Dr. Loades and Prof. Reynolds Reply

It is heartening to see that our rapid systematic review¹ is stimulating others to highlight the needs of particular subsets of vulnerable children and adolescents. We found evidence that loneliness in children and adolescents is associated with increased depression and anxiety symptoms both cross-sectionally and longitudinally. We agree with Dr. Morrissette² that children and adolescents with social phobia merit additional consideration in the 2019 novel coronavirus disease (COVID-19) pandemic. Speculatively, we suggest that many children and adolescents who did not have social phobia before the pandemic may begin to experience worries about social situations as schools reopen. Furthermore, we hypothesize that a range of mental health symptoms including social phobia are likely to become more obvious as many pupils return to school.