I recently came across an excellent article by an infectious disease epidemiologist Dr. Benjamin Linas, who addresses the question on every parent’s mind, “will there be school for my children this year?” I strongly recommend you read his analysis which addresses five questions everyone is asking about reopening schools:
- Are Kids Going to be Safe?
- Are our teachers going to be safe?
- Will kids bring Covid -19 home to their family?
- Will opening schools lead to a second wave and lock down?
- What are the risks of not reopening?
In today’s pedcast, we are going to breakdown what Dr. Linas says and take a look at what a “safe” reopening of schools might look like.
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Question 1: If School Reopens, Will They Be Safe?
If school reopens, will your children be safe? Dr. Linas argues that the answer to this question is “probably yes”. He notes that current information indicates that not only are children less likely to become infected but their disease is generally much milder than Covid-19 in older individuals. Yes, it is definitely possible for children to get sick with Covid-19, even sick enough to end up in the hospital or ICU, but the chances of that happening are about 3 times less likely than someone over age 18 years. This has been true not only in the US experience, but also the same effect has been seen in China, Italy, and Spain. Will there be cases of Covid-19 among children in the U.S. if school reopens? Definitely. Will some children get seriously ill? Unfortunately, yes. But today’s experience says that this will not happen very often.
Question 2: Will Teachers Be Safe Going Back to School?
The next question people are wondering is will teachers be safe going back to school? Here, Dr. Linas says there is not much data except from France. In this French study, the investigators did not find one case of child to teacher transmission among 46 teachers and 541 students. So, Dr. Linas’s answer to the question, will teachers be safe is again “probably yes”.
Question 3: Will Children Bring Covid-19 Home and Make Their Families Sick?
Next let’s consider if children will bring Covid-19 home and make their families sick? To answer this one, you need to know what an index case is. When a clustering of cases of a sickness occurs, sometimes that cluster begins with one person who makes the others sick. That first case is known as the index case. So, if children were to be bringing the sickness home and infect others, they would be the index case in their family’s outbreak. Dr. Linas’ analysis of available evidence leads him to the conclusion that children are rarely the index case in a family’s Covid-19 outbreak. He bases this on 700 scientific publications that not only were children sick with Covid-19, but they were rarely the first case in the family. So, the answer Dr. Linas gives to the question, “Will children bring Covid-19 home to their families sick? It can happen but not very often.
Question 4: Will opening schools lead to a second wave and lock down?
At the time of writing this, it looks like parts of the U.S. are already having a second wave of illness so the real question is whether children will throw gas on that fire and greatly increase the spread of Covid-19 like they do with most respiratory infections. As I used to tell parents when I practiced pediatrics when explaining how infections move around a community, “parents, you wipe your kids noses, not the other way around”. That was my way of saying that children usually get sick first and make adults around them ill, not the other way around. But Covid-19 seems to break that rule, I think because children are just harder to infect with SARS-CoV-2 than adults. They are not as fertile a ground for this germ. Here is Dr. Linas’ conclusion from his reading of the available data: “Modeling studies demonstrate no clear role of in-school transmission explaining current Covid-19 epidemiology”. That is doctor talk for he is not sure but he is hoping that children will not fuel a larger outbreak.
Question 5: What are the Risks of Not Reopening Schools?
Here is Dr. Linas’ final question he addresses, what are the risks of not reopening schools? Here is where having a smart epidemiologist analyzing a problem really stands out in my mind. We can harp on the risks of opening schools and always find reasons not to open them, but we need to consider the negative health effects of not opening as well. Dr. Linas sees many negative effects on the health and well-being of children by continuing to teach children remotely. Here is a partial list. Not opening school will deprive children, especially at-risk children, of a considerable amount of educational time in the classroom with teachers. Dr. Linas call this the “Covid-19 Slide”, the loss of reading and math skills that come from not being in a classroom – a problem for some children but devastating for others. Dr. Linas also notes that 20 percent of child abuse reports are made by schoolteachers and counselors. Without children being physically present in school, these possible abuse situations will not be investigated, with potentially devastating consequences for a child. Additionally, children who are not in school will miss out on the meals that they eat there, the structure and security of school, and the social interaction with their peers. As you can see, not being in school can add up to a big negative for many children. The American Association of Pediatrics has also released a statement emphasizing the importance of children returning to school if at all possible, siting many of the same reasons.
What would a Safe School Reopening Look Like?
When asking what safe reopening would look like, the U.S. should take school openings in other countries into consideration. Schools in Asia and Europe have opened with success, but it’s important to note that countries in both places which have successfully brought schools back into session have had on-demand testing, vigorous contact tracing, and declining rates of COVID-19. By comparison, the U.S. is seeing a clear surge in cases and is unable to offer on-demand testing and is struggling with contact tracing. In many locations around the country, our situation is just different right now than the rest of the world. If we are to reopen, we are going to have to address many many questions to ensure the safety of children, teachers, families, and the community at large.
Are we up to it? I hope so. Others have done so successfully and unsuccessfully. What have we learned? The following is what I have learned reading about this subject and these measures would be on my vision of a “safe” school reopening:
- Class sizes would be limited to a teacher to student ratios that is safe.
- Children would be socially distances to a minimum of 3 feet and optimally 6 feet and that includes socially distancing teachers as well. Outdoor instruction would be offered whenever possible.
- Children would be, always kept together, attending school with the same classroom children.
- Some type of symptom and fever screening would be done at the beginning of each school day.
- If a child was found to be sick, they would be isolated and tested for SARS-CoV-2. If the test is positive, school contacts would be promptly and appropriate isolation of contacts would be directed by the health department.6.
- Hallway traffic would be unidirectional and travel kept to a minimum.
- All children and staff would be masked except when eating
- Each classroom would be sanitized every few hours and at the end of the school day. Ventilation systems would also be cleaned and maintained with special filters.
- All the children and staff’s hands would be sanitized every few hours
- Food would be pre-boxed, served and eaten in the classroom.
- Every child found to be ill would be isolated from school, tested rapidly for Covid-19 if appropriate, and that information would be shared with the school quickly community.
- Schools with a few or more cases would be closed for two weeks and remote learning instituted.
- Schools would need to have the resources to rapidly test children and staff for Covid-19 on demand.
- The health department would have the resource for contact tracing necessary to determine the extent of outbreaks.
- Schools will have adequate resources to implement all of the above.
Can we do everything necessary to reopen the schools safely? Frankly, I have my doubts, but I hope so for the sake of all children. Balancing the needs of the students, the teachers, the parents, and our economy will take enormous cooperation and skill. Everyone will need to sacrifice for the greater good- something Americans used to do very well but seemed to have lost the ability to do of recent. Achieving my vision of a safe school opening would be a herculean task for any school system to institute, especially during a recession, when resources are scarce. It’s time to see how creative, bold, and imaginative school boards, parents, teachers, and administrators can be. Let’s all hope they are up to the task.
I know I have made quite a few pedcasts on the topic of Covid-19 and children and I hope you are not tiring this subject but things are changing so fast that I feel an obligation to keep my listeners up to date. Hopefully, someday soon we will be looking at Covid-19 in the rear-view mirror and we can talk about other child health subjects. This is Dr. Paul Smolen, hoping you can keep your cool, about Covid-19 and school. Until next time.