Coronavirus in Context: Should You Send Your Children Back to School?

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You're watching Coronavirus in Context. I'm Dr. John Whyte, Chief Medical Officer at WebMD. Should you send your children back to school? What's the latest data in terms of COVID and children? Can they catch it? Do they make other people infected?

To answer these questions, I've asked Dr. Nathaniel Beers, a pediatrician at Children's National Hospital, to join me. Dr. Beers, thanks for coming on today.

Thanks for having me.

Let's start off with, what's the latest data between the relationship between COVID-19 and children?

So there's more and more data every day. What we know today is that there are good data at this point that suggests that children continue to be less likely to get coronavirus, less likely to get side effects and severe complications from coronavirus, less likely to have long-term sequelae from coronavirus, and less likely to spread that coronavirus to other people, including adults in their family or outside their family.

Would you call it rare? Because when you turn on the TV-- let's be honest-- you often do see cases of a child who has died somewhere, and that's making a lot of people concerned. So when we say they're less likely, is it very low? Is it rare? How would you define it to help give parents and viewers context?

Sure. I think it certainly falls into the rare category when you look at even the most severe complications, such as this multi-inflammatory systems disease that we are seeing. That is occurring very rarely in children. Certainly we saw an uptick in numbers when we were having larger numbers of kids show up with coronavirus in places like New York City, which had large populations of people who are experiencing infection all at once. But as the number of children has come down, you have seen those cases also come down and not seeing those continue despite the fact that there is ongoing infection in many of those communities.

Now, children is a large age range. So does it matter by age in terms of when we think about infection risk? So my children are on the younger side, less than 10. Is that the same in terms of how we manage that as those that might be teenagers, 15 through 18, or are the 17, 18-year-olds just younger adults? Help us think through that.

It definitely varies by age. And so certainly, we see many fewer kids under the age of 10 or 12 who experience complications from coronavirus. They also are less likely to spread because of their lung capacity. So the spread of coronavirus is still dependent on being able to produce respiratory or air droplet particles. And because their lung volume is less, they are less likely to be able to expel enough air to create as much a spread of disease. And so we see greater spread amongst adolescents with each other than we do between other children and greater spread between adolescents and adults than we do with younger kids and adults.

That's an important distinction about lung volume. We have not heard that much on this program. Now, I apologize in advance. I'm going to give you a hard time.

You are on the American Academy of Pediatrics Re-Opening Task Force. And I think there has been some confusion in the media in terms of what's the position of the academy as it relates to reopening. First, as you know, there was a statement about full reopening of schools with some caveats. And then a week later, it seems as if there was a bit of a walk-back. Help clarify the academy's position in terms of reopening of schools that can help parents make decisions about whether or not to send their children back to school.

Sure. Within the context of the statement, the American Academy of Pediatrics decided that the conversation about reopening schools was solely focused on what the spread of COVID was and not taking into account the impact of all the other issues that are created for children when schools are closed. And so two weeks ago, the American Academy of Pediatrics released a statement saying that as many children as possible, as frequently as possible, should receive in-person instruction as long as it was safe.

The issue is that many people feel like there was a rollback because people didn't listen to the last piece, which is as long as it is safe. And so it recognized within the body of the guidance that it was important to ensure that there was individual, local decision-making around what is the disease spread in our community, what is the state of our workforce in our schools. Is it an older workforce? Do they have more underlying conditions that put them at risk for coronavirus?

Do we have adequate supplies to be able to ensure the safety of our staff and teachers and students? Are we going to be able to effectively clean our schools, and is the environment of the school safe for us to be able to reopen that space? And all of those are factors that were highlighted in the guidance and got missed as we sort of focused on a more simple approach of all kids should be in school.

Some parents have jokingly said it's all moot because as soon as a child catches COVID in the school, the entire school is going to shut down. Is that the right approach when we have a case in school, whether it's a teacher, a parent of a child, a child, a staff member? How do school districts think about that?

It's a really important piece because we could be back where we were in March with every school district being shut down if we don't think about how we're going to respond to positive COVID tests. There will be kids or adults who are COVID-positive who are in schools if we reopen the schools, whether that's two days a week, five days a week, or virtually, and there are still staff and school buildings.

And so how do we manage that? And part of that is understanding what that exposure is. And so what we might do at the elementary school level may look very different than what we do at the secondary school level because at the elementary school level, you can probably contain kids to one classroom. And so there's less movement of staff, less movement of kids across the various classrooms.

That means that you can contain the infected zone of a school to a smaller space, which means you should be able to shut that down for a shorter period of time, that space, create cleaning around that space, and keep the rest of the school open during that period as well as reopen that space more rapidly. Now, if you have multiple kids or multiple teachers in a school building, it may require shutting down the whole building for cleaning. But the recommendations are typically that that space sits unused for 24 hours, at which point it's available for cleaning. And then typically, you should be able to do the cleaning within another 24 to 48 hours and reopen that space within 72 hours.

Now, at the high school level or middle school level where kids may be changing classrooms, may be moving through the hallways, maybe be in a lot more spaces, you have a lot more areas that may have been impacted by the individual student or individual teacher. And so that has to be taken into account when you think about how much of the building needs to be shut down and for what period of time you need that shutdown in order to be able to effectively ensure that you've cleaned the spaces effectively, and really, most importantly, allowed the air to clear itself. So we can wipe down all the surfaces and do all those pieces, but part of it is time for the air to circulate enough to have a chance to move on any particles that might be in the air.

You've been quoted at times saying that parents should weigh their risk appetite. And you're an expert in behavioral and development pediatrics. How do they weigh the risk, especially for younger kids, where we know the importance of social interaction for development against the risk of catching a disease that can be serious, or perhaps bringing it back and impacting other family members? So how do they weigh that risk appetite? I like that phrase.

Yeah. I mean, I think that there are several different factors that people have to consider. First, we all have to acknowledge the bias that we have, which is we are way less tolerant of risk. And so things that we think are completely normal for adults and risk levels that we accept for an adult are completely unacceptable for kids. And so we just need to acknowledge that bias that we all have inherently as we think about caring for our own kids and thinking about the broader population of kids.

With that in mind, families need to think about a couple things. First, they need to think about what is the health of their own family. Do they have people in their family, their child or adults in the family who have underlying conditions that might put them at higher risk for complications from COVID or might put them at higher risk to catch COVID? Those are important variables that are going to help people weigh their risks.

In addition, they need to think about, beyond just the immediate household, are there other people that they are in contact with? Are they dependent on a grandparent or an aunt or an uncle who's older and has their own conditions that might put them at risk? And so it is more than just that immediate household.

It also matters what the household does. So what kind of risks are other people in the household bringing in? What is the job of the family? Do they have a health care provider, someone who's a frontline worker who's out in the community getting exposed on a regular basis? Part of the inequity that this COVID virus creates is that both with frontline workers, but also with people making childcare or schooling decisions, the reality is that some people are afforded the opportunity to weigh these risks. Some people can't afford to weigh these risks because they have no option but to go back to work.

And so how do we as a society ensure that in that case, their kids are as safe as possible? And how do we make sure that schools implement the elements that they need to do in order to ensure that safety for those kids, particularly for those families who don't have a choice about returning to school?

Dr. Beers, I want to thank you for that framework and providing insight and all you're doing to help make sure we keep our kids safe during this pandemic, and at the same time, ensuring their appropriate development.

Thank you for having me. It's a pleasure being with you today.

And thank you for watching Coronavirus in Context.