Pediatricians group encourages schools to reopen if they can do so safely

July 07, 2020
Chairs stacked on desks
Schools are considering when and how to reopen for in-person classes during the coronavirus pandemic.

Elizabeth Mack, M.D., a pediatric critical care specialist at MUSC Children’s Health and a spokeswoman for the American Academy of Pediatrics, said the AAP is encouraging schools to try to reopen with in-person classes if they can do so safely. “The AAP strongly advocates that all policy considerations for the coming year should start with the goal of having students physically present at school.”

The South Carolina chapter of the AAP has written a letter to all school districts in the state making that position clear. While keeping kids home was seen as an essential part of flattening the coronavirus’ curve during the final months of the last school year, things have become less concrete, Mack said – at least from a pediatrician’s perspective. That’s because doctors and scientists have a lot more information about the virus and children than they did in the early days of the pandemic.

First, research suggests the virus’ effect on kids isn’t as bad as initially feared in most cases. For example, it doesn’t seem to be infecting kids in the widespread way the way the flu would. “We still don’t know exactly why kids are not as affected by SARS-CoV-2. But we know that it’s a fact around the world,” Mack said.

Dr. Elizabeth Mack 
Dr. Elizabeth Mack

Studies back that up. One, published June 16 in the journal Nature Medicine, estimated people under 20 were half as susceptible to being infected with the virus as people over 20. Another report in Pediatrics, the journal of the AAP, noted that children have not been “significant drivers of the COVID-19 pandemic.”

Mack’s own observations at MUSC Children’s Health back it up as well. “At this point, the numbers of children requiring hospitalization are much smaller than adults here in the Lowcountry. None of them has had the need for a ventilator that you think about with adults. In fact, most of the kids were here for other reasons and then found to have COVID. That part of their course wasn’t particularly serious. Obviously, it’s a scary diagnosis for people, but thankfully, our kids have done well.”

While there are concerns about multisystem inflammatory syndrome in children, or MIS-C, which has affected some children and is apparently linked to COVID-19, Mack said it’s rare. “We don’t fully understand how MIS-C is stimulated. But thankfully, most kids who get it do well.”

Second, while virtual learning filled a void caused by the pandemic, it hasn’t been ideal. In fact, it has had some serious downsides. “In the last few months, we have seen child abuse and neglect rise. We have seen more child hunger, since many kids normally get their meals during the school day at school. We have seen mental health effects in children. I’ve seen more victims of gun violence and suicide attempts in the pediatric intensive care unit than I’ve seen kids with COVID in the last few months,” Mack said. 

“Without the stimulation of other children, without the natural play, without the learning that kids are meant to do, we’ve seen increases in problems with ADHD, depression and anxiety. Kids have, in many cases, sort of reverted to electronic interaction. They may see no one outside of their house because we’ve asked them to isolate. It’s been really troubling for many kids.”

Third, it’s possible to reduce the risk of virus transmission in public places. Physical distancing, mask wearing, disinfecting frequently touched surfaces and doing things like keeping doors open can help.

The AAP gets into a lot of specifics in its reentry guidance for schools, but some of the takeaways include making sure there’s plenty of space between desks, reducing the need for students to move to different classrooms, requiring masks for everyone who can wear one safely and frequently disinfecting spaces touched by a lot of people.

The guidance varies by age – preschoolers aren’t likely to wear masks or practice social distancing, while older students are – but there are suggestions for every level of school.

Fourth, while testing is an important part of slowing the pandemic’s spread, it’s a nuanced area.

Mack said the value of testing every student for the virus that causes COVID-19 before the school year isn’t as clear-cut as it might seem. “They might be negative for that one moment in time. But it isn’t pleasant, and it doesn’t mean they won’t develop COVID later in the week or the year.”

She said antibody testing has also come up. “But there is concern about a class structure that might develop from the concept of assumed immunity. Also, we don’t think antibodies last as long as we initially did.”

The AAP doesn’t recommend temperature checks for every student, either, Mack said. “Many organizations have understandably let temperature checks go by the wayside. Checking every child would take a lot of time. Many people do not have fevers when they’re infected, and you can have a long course of COVID-19 with no fever, so it can be falsely reassuring.”

Mack said the AAP’s point of view is based on what it sees as best for families and children. She knows some parents will have a very different take, and so will some school employees. In fact, a USA Today poll back in May found that about a third of parents were “very likely” to focus on at-home learning in the fall, and 1 in 5 teachers were unlikely to return to classrooms then, either.

Mack said schools will have to strike a balance as they learn more about how the coronavirus affects children and the adults who take care of and teach them. “Ultimately, pediatricians believe the effects of in-person learning with proper precautions outweighs the alternative benefits, which are virtual learning and lack of social interaction.”

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