Montefiore in the News

by Karen Gill, M.D. — Written by Molly Scanlan on July 28, 2020

If parents have the choice for in-person or remote learning this fall, there will be a lot of factors to consider before making a decision.

Making decisions as a parent can often be stressful and confusing. Are we doing the right thing? At the moment, you may be waiting to hear what your school district’s plans are for reopening or torn over whether to send your child back in the fall.

Unfortunately — as with so many parenting decisions — there is no definitive “right” answer, and there are many factors to consider.

You want to balance your kid’s health with their educational and social needs. You also want to consider how you are contributing to the rate of infection in your community and your ability to go to work.

The first thing to remember is that COVID-19 is a new virus. Scientists and doctors have only had a matter of months to begin to learn how it behaves.

There are few definitive facts. All we can do is try to make the decision that is best for our family and community, based on the information we have available so far.

Still, it’s important to remember the situation will likely change again throughout the year as the pandemic evolves. Whether or not returning to in-person school is a choice will likely depend on local infection rates and decisions made at a district, regional, or state level.

Risk of infection

A recent study in Geneva, Switzerland, tested 2,766 people to detect coronavirus antibodies in their blood. As antibodies are produced to fight off a disease, this indicates that the person has been previously infected. The study found that children under 10 had a significantly lower chance of having antibodies. In fact, only 1 child out of the 123Trusted Source children ages 5 to 9 tested had a positive result.

The suggestion that children are much less likely to contract the disease than adults is reflected in a report from the Centers for Disease Control and Prevention (CDC) in April. Of the 149,082 reported cases for which they knew the ages of the patients, less than 2 percentTrusted Source were children, although they make up 22 percent of the U.S. population.

Based on the information currently available, researchers believe children are less likely to become infected with coronavirus than adults. It’s worth remembering, though, that it’s possible that more children get infected than are detected. These studies also report that children are more likely to be asymptomatic than adults.

The evidence

If your child does become infected, the good news is that they are very unlikely to be in danger. A European studyTrusted Source of 582 kids with a median age of 5 concluded that COVID-19 is generally a mild disease in young children. A North American studyTrusted Source of admissions to pediatric intensive care units found that even these children had better hospital outcomes than adults.

Both studies noted that — as with adults — a risk factor for children experiencing the disease more severely is whether they have preexisting medical conditions. This is something to seriously consider if your child falls into this category and your school district is offering face-to-face instruction.

As with all the information we have about COVID-19, these are early findings, and ideas and data sets are developing all the time. Scientists and medical professionals are unsure why children seem to experience this virus in such a different way than adults. One theoryTrusted Source is that the lining of their blood vessels is in much better condition.

Still, it’s important to remember that we don’t yet know the long-term effects of COVID-19. So much of the disease is not yet understood. 

Risk of infecting others

In limited studies, young children appear to transmit the virus less than adults. Kids older than 10 transmit the virus at a rate close to adult transmission. Most transmission of COVID-19 seems to be from adult to adult, or adult to child.

As well as protecting your own child, it’s important to try and help slow the spread of infection to the rest of your family and the wider community. If children seem to get infected less often, can they still pass the virus on?

There have been a few studies examining pediatric transmission so far. Most were relatively small, focusing on a handful of confirmed cases.

However, one recent large study conducted in South Korea found that children under age 10 seem to transmit the virus much less than their older counterparts. Kids and teens aged 10 to 19 seem to transmit the virus at the same rate as adults.

For the previously published smaller studies, an important question might be whether these studies took place in areas where wearing masks was standard practice.

We cannot say for sure that their results reflect the general population, but these few case studies do suggest that young children may be less likely to infect others with the disease, even when in close contact.

In one case study, a 9-year-old boy who contracted COVID-19 and had the same viral load as an adult attended 3 different schools before symptoms appeared. After his test came back positive, contact tracing identified 172 people — mostly students and staff — who were exposed. All but one of the contacts tested negative for COVID-19.

An Australian study conducted in April 2020 looked at 15 schools — a mixture of primary (elementary) and high schools. Each school had one or two adults or children who tested positive COVID-19. Among those 18 people who tested positive, researchers identified 863 people they were in close contact with — among whom only two tested positive.

In Ireland, a study looked at six confirmed cases in schools: three children and three adults. In total these people had 1,155 contacts and there were no further cases found. A similar study in Singapore looked at three children with the virus who attended school and there were also no further people infected.

A larger sample size was used in a Dutch study that had 227 participants from 54 families. They found that the virus did spread, but mainly between adults and from parents to children.

This data is interesting to bear in mind when thinking about schools. It may be that it’s much more important for teachers to keep their distance from each other and their students than it is for children to maintain distance from each other — at least at elementary schools.

Considerations for parents

You may have already received information from your child’s school letting you know what the options are for the fall, or maybe your district is still in limbo. Either way, there is no simple solution to be found. Be prepared for your situation to change as the pandemic evolves.

As you weigh your options in order to make the best decision for your family, here are things to consider:

Location, location, location

The risks associated with sending kids back to school are higher in areas with a high rate of community transmission.

Dr William Hanage, associate professor of epidemiology at Harvard T. H. Chan School of Public Health, has this advice for areas with low case numbers: “I think that if you can keep community transmission low it’s reasonable to think that schools can reopen, and I think it’s reasonable to think that outbreaks within schools can be fairly rapidly controlled. Once community transmission gets high…then you’re in a different situation.”

Stay up-to-date with your local health department so you know what the situation is in your area. This will have a big impact on whether schools reopen and possibly on your own decision whether to send in your child.

Remote learning will be held to higher standards this fall

The switch to online learning in March was sudden. Teachers and principals had to figure out how to make it work as they went along.

Since then, they have had time to try out different apps, get feedback from students, and plan ahead for the 2020-2021 school year. This should mean that the remote learning experience is higher quality than it was at the end of March.

What prevention measures is your school taking?

If children are physically attending school, administrators should be putting safety measures in place to reduce the risk of infection.

The CDCTrusted Source has guidance for education settings. These include wearing face coverings, such as a mask, where possible, prompting regular handwashing and cleaning surfaces which are frequently touched.

In terms of distancing, the CDC recommends staying 6 feet apart “when feasible,” while the American Academy of Pediatrics (AAP) believes a minimum of 3 feet may be almost as effective if students are wearing face coverings and are asymptomatic.

Masks are key

Wearing a face covering like a mask is thought to be one of the most important measures to prevent the spread of COVID-19.

Dr. Rishi Desai, MPH, a pediatric infectious disease physician reinforces the message about masks, saying. “We need kids who can wear a mask (older than 3 years old) to wear a mask, and we need to get schools to do what they can to help implement social distancing.”

The AAP mask guidelines acknowledge that this recommendation may vary by age. Universal face coverings are recommended for middle and high schoolers. But for elementary school children, they recommend them “when harms (frequent face-touching, for example) do not outweigh benefits.”

Know the sick policy

You need to be clear on your child’s school’s policy on sickness. What will happen if a student or staff member has symptoms? Will the whole school close or will that particular class need to isolate? Perhaps case numbers in your area are low enough that just the infected person will be sent home and monitoring will take place.

Check with your child’s school or district to find out. This may have a bearing on how safe you feel the environment will be and also mean you are not caught by surprise if your child’s class is suddenly told to isolate.

What age children do you have?

Dr. Arnold Monto, professor of epidemiology at the University of Michigan’s School of Public Health, points to the examples of some countries in Scandinavia who began reopening schools by sending the younger children back first, followed by groups of older children.

As the youngest children seem to be the lowest risk for infection, Monto says this is a good approach to opening back up gradually. This means the case numbers in the school and the local community can be closely monitored at each stage in the process and plans can change if they need to.

Based on this, you may feel more comfortable with your kindergartener returning to their school before your teen.

Consider how safety measures will be funded

As well as a solid safety policy, schools will need the means to make it happen.

Dr. Margaret Aldrich, a pediatric specialist at the Children’s Hospital at Montefiore, says, “I would want to be sure that all schools have access to the resources needed to implement the safety recommendations in the time remaining until school is scheduled to open. It is not enough to have a good plan, we have to be sure that the plan can be implemented.”

Unfortunately, education funding is a worry for school staff at the best of times, and implementing the CDC guidelines comes with a cost. Again, your local district should make it clear to you what measures they can and will take.

Consider your family situation

Aldrich reminds us that “there is no zero risk situation when it comes to COVID-19, there is only risk mitigation.” Monto agrees, saying that parents “are taking a risk… they should continue to practice appropriate controls in the home and this has particular relevance if they’re in a multigenerational family.”

Furthermore, in homes where adults work outside the home and cannot do their jobs remotely, or if they don’t have access to the resources needed for remote work, families may feel they have to send their child to school.

Consider your child’s specific needs

So much of the decision will ultimately come down to what you feel is best for your child. Did your child thrive with remote learning last spring? Does your child receive services in school that they can’t receive at home? What are the social and emotional considerations for your unique child? Is your child at a high risk for academic regression if they are not in school?

Summary

Whatever you decide to do about school attendance, keep protecting your family and community by socially distancing as much as you can. Wear a face mask in public places and make sure you and your kids wash your hands thoroughly and frequently.

Whether your child can return to face-to-face learning will depend on local case numbers, school boards, and your own individual assessment of the risks. It’s not an easy decision, but know that you are not alone as thousands of families across the country are in the same boat, just trying to do their best.