The situation regarding the reopening of schools and educational institutions is complicated!! The news changes almost weekly about schools opening, schools closing, campuses shutting down. We yearn for clear guidance. Perhaps there are too many variables at stake, and not enough clarity, regarding the role of our educational system within our communities and in our child’s growth. While we adults may find ways to be able to place our lives on this Covid driven pause, children’s development, by definition, marches on and is directly impacted by their everyday habits, routines, environments, and communities. As we deal with a pandemic, we must also deal with our children’s futures.
As pediatricians, developmental data tells us that it is critical to have children attend school for a multitude of reasons. In that light, the arguments for in-classroom schooling perhaps outweigh the fears of COVID-19 infection. However, it is important to remember that this would require that the risk-takers all assume the same level of risk, all behave responsibly, all wear masks. A fully committed shared responsibility. Below we will try to illuminate the basic pros and cons regarding school openings - as well as how to protect your child as best you can.
Our Children: Academics. Safety. Food. Mental Health. Development. Equity.
Schools and school-supported programs are fundamental to child and adolescent wellness: not only do they provide our children and adolescents with academic instruction, but they also support students’ safety, mental health and physical activity. Furthermore, school-based nutrition programs ensure that students have access to at least one if not two meals a day. And children and adolescents need to be with their peers for socio-emotional development. Schools also provide safe places for children to be while their parents work, and serve as a monitor of domestic neglect and abuse.
Importantly, schools also play a critical and essential role in addressing racial and social inequity. Without attendance in schools the COVID-19 pandemic has had a disproportionate impact on different racial and ethnic groups and vulnerable populations that cannot be ignored.
The AAP (American Academy of Pediatrics) has formally spoken out condemning “the persistent racial and social inequities that exist within the US educational system. The disparities in school funding, quality of school facilities, educational staffing, and resources for enriching curriculum between schools have been exacerbated by the pandemic. Families rely on schools to provide child care; a safe, stimulating space for children to learn; opportunities for socialization; and access to school-based mental, physical, and nutritional health services. Without adequate support for families to access these services, disparities will likely worsen, especially for children who are English language learners, children with disabilities, children living in poverty, and children of African American/Black, Latinx/Hispanic, and Native American/Alaska Native origin.”
And the disparities regarding access to Wifi and technology, the technological “homework gap,” as well as transport to and from school, disproportionately affects Black, Hispanic, and low-income families.
The Case for On-Campus Learning
Based on reports from the school closures of Spring 2020, evidence suggests that time away from school and associated interruption of supportive services has made it difficult to address important learning deficits. But even more alarming, making it harder to recognize and intervene in child and adolescent physical or sexual abuse, substance use, depression, and suicidal ideation. Suicide is the second leading cause of death among adolescents or youth 10 to 24 years of age in the United States, and many times the school is the place where risks get identified.
Finally, there has been a substantial and disproportionate impact on food security on Black, Latino, and Native American/Alaskan Native children and adolescents. According to the AAP report, in 2018, 11.8 million children and adolescents (1 in 7) in the United States lived in a food-insecure household. Because of the coronavirus pandemic, there has been a massive increase in unemployment and poverty increasing the number of families who will experience food insecurity. Last Spring, in the early months of the pandemic, schools were attempting to reach all families, often without success. The health risks associated with on campus education must be considered in light of the many students who experience food insecurity already (especially at-risk and low-income populations) and therefore will have limited access to food if schools remain closed.
However, this is a complicated issue, with many faces, and we must remember the reality of the pandemic that we still face. A pandemic that has already cost over 170,000 lives in the USA alone. So let us consider the risks of returning to school.
Parents and schools must consider the growing infection rates in the pediatric population, including the role they may play in transmission of the infection. The data seems to indicate that children and adolescents are less likely to be symptomatic and less likely to have severe disease resulting from Covid-19 infection. However, the AAP recently suggested that children older than 10 years may spread the virus as efficiently as adults, which would impact the policies and considerations taken in determining how to safely and effectively open schools.
It is important to acknowledge that no school-based policies are intended to eliminate Covid spread - only to mitigate. Suggestions below are offered as guidance, never to replace guidance from the CDC. Ultimately, the decision to re-open schools and to send your child to in-person learning should be based on the guidance of local and state public health authorities and school administrators.
1. Social Distancing:
This is simply the act of keeping people physically apart. To limit the spread of the virus. The primary mode of transmission is through respiratory droplets by persons in close proximity. Masks and physical barriers such as plexiglass are extremely helpful, as are face shields. Teachers and administrators should maintain social distance as well. This means keeping school employees accountable for making all the changes they can - ie: lunch outdoors or in classroom - not crowded cafeterias. No students in hallways - perhaps the teachers move classrooms, not the students. And parents should, in general, be discouraged from entering the school building. Bottom line: wear a mask!
2. Face Coverings:
Cloth face coverings protect others if the wearer is infected with Covid and doesn't know it. In other words, people who are not wearing masks are putting you and your child at risk. Children, even those with medical conditions, are able to safely and effectively wear face coverings if they are helped by adults who model the behavior and explain the importance. Demonstrate responsible behavior to your child. Bottom line: wear a mask.
3. Hygiene and Hand Washing:
Masks should be replaced appropriately after meals, and washed daily. Hand washing must be enforced at school, especially in children younger than 10 who may need to be reminded frequently. Try to help your child understand that hand washing is something important even when there is no Covid-19, but that now it is super important to help everyone stay healthy. Bottom Line: wash your hands
The main mode of COVID-19 spread is from person to person, primarily via droplet transmission. Infection via fomites (on surfaces) is less common, but it is possible to get infected after touching a virus-contaminated surface and then touching your mouth, eyes, or nose. Frequent hand washing is obviously critical. And Face shields also act as a barrier to touching your face so frequently, while still allowing you to see and be seen.
Remind your child that surfaces such as drinking fountains, door handles, sinks and faucet handles, etc, are often sources of potential transmission. Bathrooms, in particular, but also shared equipment including computer equipment, keyboards, art supplies, and play or gym equipment. It is important to explain this as calmly as possible, and if they do touch something, just tell them gently to wash their hands again. Don’t panic. Don’t panic them. Bottom Line: wash your hands
The CDC does not recommend universal testing of students and staff. First of all, virologic testing only shows whether a person is infected at that specific moment in time. (Meaning, within 2 minutes post-test, you or your child could be sneezed on, or touch a surface and then the test becomes irrelevant). And testing all students for acute infection prior to the start of school is not feasible in most settings at this time. Even in places where this is possible, it is not clear that such testing would reduce the likelihood of spread within schools. It is important to recognize that it is also possible that the nasal swab virologic test result can be negative during the early incubation period of the infection. In other words, a student who is negative for COVID-19 on the first day of school may not remain negative throughout the school year.
Another type of testing is serologic blood testing for antibodies to the Covid-19 virus, which reflects whether a person has actually been exposed to the virus and had a healthy immune response to that exposure by making antibodies. The CDC, at this time, clearly states that serologic testing should not be used for individual decision-making and has no place in considerations for entrance to or exclusion from school. The CDC states that serologic testing should not be used to determine immune status in individuals until the presence, durability, and duration of immunity is established. How the schools are implementing this, we don’t know.
Schools need to have a plan for what to do if a student or school staff member becomes sick with symptoms. Temperature checks and symptom screening are a frequent part of many reopening processes to prevent symptomatic people from entering. The list of symptoms of COVID-19 infection has grown since the start of the pandemic and the manifestations of COVID-19 infection in children are often not the same as that for adults. First and foremost, parents should be instructed to keep their child at home if they are ill, and staff members should stay home if they are ill. At this time, the CDC currently does not recommend universally screening students at school, because screening may fail to identify a student who has the infection (false negatives) and may over identify students with other common childhood illnesses such as a cold or the flu (false positives).
7. Mental Health Support:
Infection control is critical and complicated, as we know. But the emotional impact of the pandemic is equally as important: profound loss, financial insecurity, social isolation, anxiety and fear. And systemic racial inequity must be addressed, in a population that has now had even more limited access to critical school-based mental health services and the support and assistance of school professionals. If you or your child is experiencing symptoms of anxiety or depression, or hopelessness, it is important to reach out for experienced support.
Some more Resources Provided by the American Academy of Pediatrics
Information for Parents on HealthyChildren.org: Returning to School During COVID-19