Time is approaching quickly when American families will have to make a very tough decision – Whether they should send their children back to school this fall or not?
American Academy of Pediatrics (AAP) strongly advocates reopening of school in the fall based on the evidence that children and adolescents are less likely to have symptoms or severe disease from infection and are also less likely to become infected or spread the virus. But, it is worth noting that the scientific evidence supporting this notion is at best limited. It is a fact that children represent less than 2% of confirmed COVID-19 cases in world, but researchers are still divided on whether children are less likely than adults to spread the virus. High-quality population studies to settle this debate are lacking as of now.
1) Rate of community transmission of Coronavirus in your area:
If the rate of community transmission of coronavirus in the adult population is high in your community, reopening of schools will likely facilitate transmission, as respiratory viruses are known to circulate in schools and day cares. If community transmission is consistently reducing, likelihood of your child getting exposed to coronavirus in school also reduces. Please pay attention to number of new cases, number of ICU bed occupied by COVID patients, number of deaths due to COVID-19, and COVID-19 test positivity rate in your community which will help you understand if coronavirus is becoming more or less prevalent on your area.
2. Is your child at a greater risk for severe disease?
Children with certain underlying conditions are at greater risk for severe disease. These conditions include but not limited to immune compromise; chronic cardiac, pulmonary or kidney disease, sickle cell disease, type 2 diabetes.
3. Do you have a family member who will be in close contact (defined by CDC as contact of greater than 15 minutes with distance of 6 feet or less) of your child and is at a risk of serious symptoms?
The risk of developing dangerous symptoms increases with age, with those who are age 85 and older at the highest risk of serious symptoms. In the U.S., about 80% of deaths from the disease have been in people age 65 and older. Risks are even higher for older people when they have underlying health conditions like chronic lung and heart disease, weakened immune system, diabetes, chronic liver or kidney disease, sickle cell disease, Type 2 Diabetes.
4) Are you satisfied with your child’s school’s reopening plans?
Review your child’s school’s reopening guidelines. Pay special attention to the following and ask appropriate questions:
- Has the school established clear reopening guidelines?
- Are these guidelines based on the guidance from Center of disease control (CDC), American Academy of Pediatrics (AAP), state education and public health boards and at the same time factor in special needs and unique situation of your local community?
- What steps is school taking to make sure that these guidelines will be followed by students and their families?
5) What will the policy regarding use of face coverings?
Both CDC and AAP have stated that there is a mounting evidence that universal face coverings is very effective in interrupting the spread of COVID-19 and they highly encourage that everyone in the country should face masks. They also state that there can be some exceptions. Per AAP, children under 2 years and anyone who has trouble breathing or is unconscious, incapacitated, or otherwise unable to remove a face covering without assistance should not wear cloth face coverings. AAP also states that students and families should be taught how to properly wear (cover nose and mouth) a face covering, to maintain hand hygiene when removing face coverings for meals and physical activity, and for replacing and maintaining (washing regularly) a cloth face covering.
6) How will school ensure social distancing between kids at all times including in the classroom, during lunch break, in cafeteria and in the school bus, etc.
Classroom: CDC recommends that schools “space seating/desks at least 6 feet apart when feasible.” AAP recommends the same but also acknowledges that in many school settings, 6 feet between students will not be feasible without limiting the number of students. AAP states that evidence suggests that spacing as close as 3 feet may approach the benefits of 6 feet of space, particularly if students are wearing face coverings and are asymptomatic. Schools should weigh the benefits of strict adherence to a 6-feet spacing rule between students with the potential downside if remote learning is the only alternative.
Hallways: AAP suggests the following:
- Consider creating one-way hallways to reduce close contact.
- Place physical guides, such as tape, on floors or sidewalks to create one-way routes.
- Where feasible, keep students in the classroom and rotate teachers instead.
- Stagger class periods by cohorts for movement between classrooms if students must move between classrooms to limit the number of students in the hallway when changing classrooms.
- Assign lockers by cohort or eliminate lockers altogether.
Playgrounds: AAP acknowledges that enforcing physical distancing in an outside playground is difficult and may not be the most effective method of risk reduction. Emphasis should be placed on co-horting students and limiting the size of groups participating in playground time. Outdoor transmission of virus is known to be much lower than indoor transmission.
Meals/ Cafeteria: Per AAP recommendations:
- Consider having students cohorted, potentially in their classrooms, especially if students remain in their classroom throughout the day.
- Create separate lunch periods to minimize the number of students in the cafeteria at one time.
- Utilize additional spaces for lunch/break times.
- Utilize outdoor spaces when possible.
- Wash hands or use hand sanitizer before and after eating.
7) What protocols will be followed for hand washing, cleaning and disinfection?
8) What other important measures will school take to help reduce the spread of coronavirus?
9) How will school screen for students who might be infected and are likely to spread the virus?
Please remember that period of greatest infectiousness is earlier stages of infection and duration of infectiousness lasts up to 10 days after onset of symptoms. Per AAP, temperature checks and symptom screening should be completed daily on every student and staff member and any other person entering the school building. Parents should be instructed to keep their child at home if they are ill. Any student or staff member with a fever of 100.4 degrees or greater or symptoms of possible COVID-19 virus infection should not be present in school. Schools should develop plans for rapid response to a student or staff member with fever who is in the school regardless of the implementation of temperature checks or symptom screening prior to entering the school building.
10) What are the guidelines in the event your child is possibly exposed to coronavirus? Which close contacts will have to quarantine and for how long? What criteria need to be satisfied to return back to school?
As per CDC guidelines, any person with symptoms suggestive of coronavirus infection should self-quarantine. All family members who live in the same house and everyone who came in close contact of the individual with coronavirus symptoms (within 6 feet of distance for more than 15 minutes) should also self-quarantine. CDC/WHO recommends use of either symptom-based strategy or test based strategy to decide when it is safe to discontinue home isolation in COVID-19 patients. Guidelines are little different based on the if the individual has clinical symptoms of COVID-19 or not.
Individuals with clinical symptoms:
Symptom-based strategy (preferred): Home isolation can be ended when the following criteria are met: At least 10 days have passed since symptoms first appeared AND at least three days (72 hours) have passed since recovery (defined as resolution of fever without the use of fever-reducing medications AND reduction (per CDC) / resolution (per WHO) of respiratory symptoms (eg, cough, shortness of breath)
Test-based strategy: Patients may discontinue home isolation when there is: Resolution of fever without the use of fever-reducing medications AND improvement (per CDC) / resolution (per WHO) of respiratory symptoms (eg, cough, shortness of breath) AND at least 2 negative COVID-19 tests greater that 24 hours apart from each other.
Asymptomatic patients:
Time-based strategy – If a time-based strategy is used, home isolation can be discontinued when at least 10 days have passed since the date of their first positive COVID-19 test, as long as there was no evidence of subsequent illness. If symptoms developed, the symptom-based strategy should be used.
Test-based strategy – If a test-based strategy is used, home isolation can be discontinued when patients have 2 negative COVID-19 tests greater than 24 hours apart from each other.
AAP has established that for most kids in-person learning is more effective then remote learning. However, this coming school year teachers and schools will most likely be equipped to handle online classes more effectively. You need to understand the following:
- Is school district offering online classes as an alternative?
- What tools your child’s school is going to use to make sure that online learning is successful?
- Did your child fall behind in learning last semester?
- Do you believe that your child will fall behind further if in-person learning is not resumed
- Does your child has an IEP (individualized education plan) in school which is hard to follow with on-line remote learning
- Does your child receive other services in school like speech therapy, OT, social skills training which can’t be provided with online format?
12) What are the emotional needs of your child?
AAP states that in addition to academics, children learn social and emotional skills, get exercise and access to mental health support that cannot be provided with online learning. Kids tend to have more behavioral and emotional problems if they are isolated at home.
Think about the following:
- Does your child have a mental health disorder like ADHD or a learning disability that affected your child ‘s learning on the online format after the school was closed down last school year?
- Did your child had more emotional and behavioral problems at home last school year after school was shut down?
- Does your child have a mental health disorders that might make her difficult to return back to school after such a long break?
Kids with social anxiety disorder, separation anxiety disorder, autism spectrum disorder and certain other mental health disorders might have difficulty returning back to school after a long time away from it. Please contact your child’s mental health provider to understand what extra steps you will have to take to make transition to school year smooth and find out if school is will be able to cooperate it with the process.
Unfortunately, our country is currently divided on the issue of mask wearing. Children learn things by modeling behavior. If they will see adult around them not wearing mask in public and not following social distancing guidelines, they are less likely to do it which will eventually increase the risk of coronavirus transmission in school. It is important to understand that no single action or set of actions can completely eliminate the risk of coronavirus transmission, but implementation of several coordinated interventions can greatly reduce that risk. Each and every student, their families and staff members need to follow the guidelines closely to make reopening a success.