Some schools are reopening this fall. COVID-19 is still going around, so parents have a lot of questions about what this means for their kids, their families, and their extended families. Here’s our take on the top questions we’re hearing. 

1. If my child returns to school, should I expect my child to contract COVID-19? If so, should I be scared about that?

Amy Anderson, RN, DNP: As a nurse and mother of four children, three of whom are school-aged and one in college, I understand the fear associated with reopening schools. It is possible that when our kids go back to school, some will contract COVID.

The good news is that children testing positive for COVID-19 are mostly asymptomatic or have mild illness compared to adults and almost all fully recover. Of course, as parents or guardians, it is our responsibility to assess our child’s own personal health risk and determine what is best for our family. If you are unsure about your child’s health risk, contact your medical provider. In my school district, parents can choose online school or in-person school.

Overall, I feel fairly comfortable with my kids going back to in-person school and participating in their normal school activities with reasonable safety measures.

Kevin Pham, M.D.: School-aged children are at low risk of both being infected and of infecting others. According to the Centers for Disease Control and Prevention, only 2% of confirmed cases are among those under 18 years of age.

Multiple studies from across the world have found consistently that children are at lower risk than adults of contracting the virus, and many nations that have not closed down their schools have found no evidence that children readily spread the virus to one another. Furthermore, school-aged children are at the lowest risk for developing severe disease, for hospitalization, and for mortality.

Children seem to be resistant to even being infected by the virus, but of children under 15 who do become infected, the mortality rate has been 0.3%. This 0.3% likely includes mostly children with underlying conditions that predispose them to severe disease, such as obesity, immunodeficiency syndromes, or heart or lung conditions, and interventions should focus on protecting these children.

The vast majority of students will be safe, especially if the schools implement at least basic precautions such as those outlined by the CDC.

2. Will my child have to wear a mask in school? How feasible is that all day for a 7-year-old? 

Anderson: Having worked as a school nurse, I can tell you that masks are going to be a challenge, especially in some age groups.

Masks are probably unwarranted in younger children. For those required to wear masks, it is important that we talk through how to manage their mask during the day and the importance of not touching the mask and using hand sanitizer or hand-washing if they do. Schools likely will provide some mask and hand-washing instruction this fall.

Parents also should discuss with teachers and principals when students can take a break from the mask during the day. When students are able to social distance or are outside away from other kids, they should be able to take some breaks. 

3. Should teachers wear masks?

Anderson: Masks should be worn by teachers when they are around other adults and when they are unable to maintain social distancing from their students.

Reports indicate teachers are more likely to catch the virus from other faculty and staff than from students, so enhanced instruction on when and how to wear masks and vigilance with mask-wearing and mask management should occur before school starts. This should help blunt the spread on campus.

4. Will COVID-19 vaccines be required to attend public schools once a vaccine is available? Should they be required?

Pham: Public schools already require a series of vaccinations to enroll, such as the measles, mumps, and rubella vaccine, or the pertussis vaccine. Schools can require vaccinations for attendance, and because COVID-19 has been the impetus for closing down parts of society, school districts likely will require a COVID-19 vaccine when one becomes available.

Anderson: Because of our lack of immunity to this novel virus and concern about widespread transmission to vulnerable groups, it’s likely states will require that students be vaccinated for school enrollment.

Because COVID-19 vaccinations will need to be prioritized during initial distribution and children seem to be at lower risk, certain age groups and those with no underlying health conditions may have to wait for the vaccine, and school requirements thus likely won’t take effect until all kids have access to the vaccine in their age group and location.

5. I have two children. If one contracts COVID-19, will the other child also have to stay home from school?

Pham: If someone in the household tests positive for COVID-19, the best practice would be to quarantine everyone for 14 days or until a diagnostic test returns negative. By the time people test positive, there is a good chance they already will have transmitted the virus to someone else, especially within the same household.

Anderson: Because close household contacts are the most likely way for children to contract the illness, students with a close family member with the virus will need to remain at home until cleared.

Parents should keep all their children home and contact the local district for direction if a close family member tests positive for COVID. Most schools have developed online or at-home options for classes and have a plan for how to handle the situation should the need arise.

6. Will there/should there be temperature checks every morning at school?

Pham: There may be, as a screening measure, but temperature checks may not always reveal an underlying case of COVID-19 and, especially with school-aged children, fever is not always a presenting symptom.

Temperature screens could be considered “better than nothing,” as they are generally cheap and easy to do, but they are unlikely to be helpful for purposes of COVID-19. Temperature checks may help find other illnesses, such as influenza or the cold.

Anderson: Some districts are using this as a screening measure, and student athletes may be asked to complete a screening questionnaire prior to participating in activities. This may not be a reliable or practical way to screen, given those who are pre-symptomatic or asymptomatic do not always have fever and not even all who test positive for COVID have a fever.

Parents or caregivers should monitor children daily for signs and symptoms of infection or a general feeling of unwellness and keep them home if there is any concern. School personnel will be watching for signs and symptoms of illness and immediately isolating and sending kids home if they suspect they are sick.

7. What school sanitation procedures do you recommend? 

Pham: COVID-19 is thought to spread primarily through respiratory droplets, which can contaminate surfaces. If another person comes in contact with the contaminated surface, that person may become infected. That being the case, desks, chairs, and common surfaces such as doorknobs should be sanitized as frequently as feasible.

Anderson: Hand soap and hand sanitizer should be readily available. If feasible, students or teachers should wipe down surfaces between classes, and districts should increase cleaning procedures.

If a student, teacher, or staff member does contract the virus or there is an outbreak in a classroom, the school should implement the highest protocol for cleaning and sanitizing the areas that were directly encountered.

School districts most likely will consult the public health department in these circumstances, and parents should feel comfortable that appropriate measures will be implemented before students return to school.

8. Should schools be batching students (co-quarantining them) in small groups?

Anderson: When feasible, districts should consider having teachers move between classrooms instead of having students move throughout the building to reduce contact points. Maintaining smaller groups would allow for easier contact tracing.

Pham: To the extent possible, yes. Although students are at low risk of being infected or infecting others, it is still possible. Keeping classes together with less intermingling of different grades and classrooms would work to contain any possible spread.

9. Do you recommend schools hold class outside?

Anderson: Given weather and safety concerns, this may not be practical in many schools.

Opening windows where appropriate and providing good ventilation for classrooms is important. Taking breaks and occasionally going outside for class, weather permitting, improves learning and mental health.

Kids need physical activity and activities such as marching band and athletics should be quite safe to do outdoors when safety measures are in place.

Our kids have been cooped up for almost six months. Reopening is essential to improve the social-emotional well-being, mental health, and long-term trajectory of our kids and will return vulnerable kids to a safer environment during the day.

10. My family has an elderly grandparent living with us and COVID-19 presents a high risk to them. Should I send my kid to school?  If so, how do I keep our elders safe?

Anderson: This is a difficult decision that many now have to make. Every family’s situation is different, and those who aren’t certain should consult with medical providers. Families should have the choice between in-person or remote learning for just this reason.

Our elderly are feeling more isolated and lonely during the pandemic as well. It has affected their quality of life, physical well-being, and mental health. There may be some creative ways to safely continue family interaction and keep the elder family member safe when kids return to school. There is just not a one-size-fits-all solution that will suit every family. 

Pham: The science shows repeatedly that children are at extremely low risk for transmitting the virus to adults. One worldwide study found that outbreaks or clusters of COVID-19 were traced back to adults in more than 90% of cases.

That said, the risk to elder Americans is great. Even though most of the recent cases are among those less than 65, most hospitalizations and deaths have been among those 65 and older.

This means that school-aged children and most teachers are at low risk for hospitalizations and deaths, but families that have elders in the household should consider further safety measures. It would be reasonable for these families to continue distance learning or otherwise keep children away from schools where maintaining distance and isolation is difficult or impossible.

In short, children pose little risk to others, and that risk only decreases if the school or school district implements good safety precautions. But the risk will never be zero, and families will have to look at what the schools are planning and decide for themselves how to proceed.

Policymakers should look to support those choices. As my colleague Lindsey Burke has written, families who want in-person instruction should be able to take their child’s share of education funding to learning options of choice. 

This article by Amy Anderson and Kevin Pham first appeared in The Daily Signal on August 11, 2020.

Image: Reuters.