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As Cases Surge, No Clear Answers on School Reopening

boy getting on school bus

July 10, 2020 -- With COVID-19 cases on the rise in more than 30 states, parents across the country are watching the calendar, wondering what the first day of school will look like in just a few weeks.

“As much as I want my son to be safe, I also understand that it’s going to take a toll on kids, just being home for 6 months,” says Ritu Malhotra, whose 6-year-old will be entering second grade at a charter school in Queens, NY. “He’s an only child, very social. He wants those interactions.”

Those mixed feelings are reflected in parent surveys from the education departments in major cities like New York and Philadelphia, where roughly half of parents say they’re willing to send their children back to in-person school with safety measures in place. A nationwide survey of parents done by the consulting firm Deloitte found that two-thirds are nervous about sending their children into schools.

In late June, the American Academy of Pediatrics issued a policy statement with guidance, urging localities to reopen bricks-and-mortar schools:

“The AAP strongly advocates that all policy considerations for the coming school year should start with a goal of having students physically present in school. The importance of in-person learning is well-documented, and there is already evidence of the negative impacts on children because of school closures in the spring of 2020.”

But in an interview with NPR, the president of the organization acknowledged that reopening may not be safe where community transmission remains widespread.

“We also recognize that COVID-19 remains a very real, active threat to community health. And we really believe that decisions on when and how to reopen need to consider a variety of factors, but a big one is the level of virus in the community,” said Sally Goza, MD.

Measuring the Risks

“It’s pretty clear the disease is far milder in children than in adults,” says Dan Cooper, MD, a professor of pediatrics at UC Irvine and the lead author of an article on reopening schools published in The Journal of Pediatrics. “So the good news is, bringing the kids back doesn’t mean you’re assigning large numbers of children to a terrible disease.”

Some research suggests that children are less likely to spread the virus to adults. “It’s all theoretical,” Cooper says. “We just don’t have the data.”

Other countries have already reopened schools. Most had strict safety measures in place such as reduced class sizes, social distancing, face masks, and staggered schedules. In places with low rates of community transmission, like Norway and Denmark, reopening didn’t lead to increased cases. But Israel, which lifted restrictions on class size soon after reopening, saw outbreaks 2 weeks later that included one school with 130 cases.

“I don’t consider anything safe,” says Josh Sharfstein, MD, vice dean for public health practice and community engagement at the Johns Hopkins Bloomberg School of Public Health. “The question is, is it possible to maximize the advantages [of school] to kids while minimizing the spread of coronavirus to a reasonable level?”

Remote learning, on the other hand, has several clear disadvantages.

“There is a cost of social isolation among children. They’re naturally gregarious and learn so much from interacting with other children,” says Cooper. “And there's the quality of distance learning, which is variable. Some kids love it. But in most cases, I think the data are pretty clear: Distance learning is not the same as learning in person.”

Research does show that students are falling behind thanks to the pandemic. One working paper out of Brown University estimates that students could begin the new school year as much as 50% behind, due to the spring closures. And an analysis by the consulting group McKinsey found that if students don’t return to fully in-school learning by January 2021, they may lose as much as a year’s worth of progress.

Other issues include the fact that millions of children rely on school meals for their basic nutrition, and staying home means they’re also moving less. For some children, the lack of in-person schooling can be dangerous -- 20% of child abuse reports come from schools.

Children with special needs may be especially hard-hit by remote learning. Some require the structure of the school day to thrive. Others need help because of physical disabilities.

“They respond to our smiles and words of encouragement, our gestures, facial expressions and body language,” Whitney Barber, a special education paraprofessional, told NEA Today, “But they can’t really see or hear well enough on Zoom or other video apps. They really need us to be right there beside them.”

Ashley Hernandez’s 8-year-old son has autism. “It was difficult, with services going remote,” she says. “There was a lot of regression, and I can’t work if he has to be homeschooled.”

There’s also the toll remote learning takes on parents. Those who work from home have to find time to monitor their children’s progress, and those who work elsewhere scramble to arrange child care or risk losing their jobs. The pressures mount further for single parents. As writer Deb Perelman put it in The New York Times, “In the COVID-19 economy, you can have a kid or a job,” but “you can’t have both.”

Social, Economic Factors

In addition to relying on school food, the most vulnerable children lack access to remote learning. Lysa De Thomas teaches second and third grades in Merced, CA, where the poverty level is 30%.

“A lot of our children don’t have computers at home, and even if they did, they might not have internet access,” she says. “For equity issues, we couldn’t teach remotely at first.”

Even after the school district distributed Chromebooks, access remained an issue. Only one was issued per family, so siblings had to share -- a real challenge for larger families. And many had to sit in their schools’ parking lots to use Wi-Fi.

For families in economically disadvantaged areas, going back to school presents a no-win situation. Remote learning means their children fall behind, and the parents must either risk losing their jobs by staying home or leave their children unattended. But attending school in-person when the district can’t afford adequate safety measures can be dangerous, too.

“I don’t blame my district. They did the best they could,” says De Thomas. But the lack of funding makes reopening harder. When school resumes in mid-August, she expects to be alone in her classroom with 24 students all day, including at lunch. Children will not be required to wear masks.

“We don’t have the resources to do proper social distancing,” she says. “It’ll easily be 108 degrees when we go back, so I can’t teach outside or open the windows.”

Crowded classrooms with fewer resources for sanitizing make it more likely that one infected child can spread it to others. Those children may live in homes that have more than one generation, sharing small spaces with older family members. And lower-income communities tend to have more other conditions like diabetes and obesity, which can make people more at risk from the coronavirus.

“If a kid from one of these neighborhoods gets infected and comes home, and that disease is transmitted to more susceptible people, that's a much worse situation than a kid in an upper middle-class neighborhood bringing it home,” says Cooper. And if a sick person can’t afford to stay home from work, that makes it more likely that the coronavirus will spread throughout the community.

What Schools Can Do

“I think it comes down to three general principles,” says Lawrence Kleinman, MD, a professor and vice chair of the pediatrics department at Rutgers Robert Wood Johnson Medical School. “First, exclude people who are symptomatic or recently exposed. Second, reduce the opportunity to contract the virus through social distancing, wearing masks, hand-washing, and sanitizing surfaces.”

Kleinman’s third principle calls for reorganizing the way schools work, to lessen the chance for the virus to spread. That includes measures like:

  • Putting children into smaller groups and keeping them away from other groups
  • Using larger spaces, like the gym and cafeteria, to provide room for those small groups to spread out
  • Staggering schedules so fewer people are moving around at any one time
  • Keeping children outdoors as much as possible
  • Making hallways one-way

Kleinman also recommends that all schools make arrangements for anyone who wishes to opt out of in-person learning.

The AAP’s policy statement also included suggestions for schools:

  • Be flexible and willing to make changes if specific policies aren’t working.
  • Focus on social distancing less with younger children and more with teens.
  • Discourage parents from entering the building.
  • Tell parents to keep children home if they’re sick.
  • Have a policy for symptom screening and what to do if someone becomes sick with COVID-19 symptoms.

Experts have also pointed out the challenges posed by school buses and bathrooms. Guidelines for schools issued by the Healthy Buildings Program at the Harvard T.H. Chan School of Public Health recommend:

  • Keeping windows open on the bus
  • Having fewer students per vehicle
  • Assigning seats, leaving alternate seats vacant
  • Keeping bathroom doors and windows closed
  • Running exhaust fans all the time
  • Staggering bathroom breaks by class

What Parents Should Consider

Many school systems are allowing parents to opt for all-remote learning or offering hybrid plans, in which groups of students alternate days or weeks of in-person and distance learning. Before deciding, experts recommend evaluating the options and risk factors.

When dealing with a deadly pandemic, communication matters, says Cooper. Ideally, parents should be told how the school district is making decisions: Are they working with policymakers, health care providers, or environmental health scientists? What measures are they taking to lessen risks? What’s the plan for dealing with a sick child?

“If you want to create anxiety in a parent, don’t communicate,” he says. “Even if they just say, ‘We’re working on it,’ that’s better.”

As a mom, Hernandez agrees. “It’s July, and we haven’t heard much, and it’s infuriating.”

Sharfstein suggests each family examine its own tolerance for risk. “If there’s community spread, someone in the school is going to get it. The goal isn’t to prevent anyone from getting it; it’s to prevent a substantial amount of spread.”

If a child or household member falls into a high-risk category for COVID-19, for example, he recommends opting for remote learning.

Part of the assessment should include looking at the family’s other risk factors.

“It makes sense to think about your overall risk. If you have to take certain risks, you may want to reduce others,” says Kleinman. “Think about the group of things you do that create risk and which ones you have control over, and exercise control where you can.”

A child’s age matters, too. Younger children are at a lower risk of having a serious case of COVID-19. They benefit the most from in-person learning, and keeping them home may require one parent to give up their job. A teenager, on the other hand, has higher odds of getting sick (though still relatively low, compared to older adults) and is likely more capable of handling remote learning with little supervision.

On July 8, the New York City school system -- the largest in the country -- announced that schools would be offering blended learning, with most students attending school in person 1 or 2 days a week.

Malhotra, whose son will be entering second grade, isn’t convinced it will be safe.

“I’m very, very torn. He’s an only child, he loves his friends and his teachers. As much as I want him there, for his safety I think I’m going to keep him home,” she says. “Every parent I’ve spoken to feels the same. Who knows where we’re going to be by the end of this year. A vaccine isn’t guaranteed, so we just have to wait and see.”

WebMD Health News Reviewed by Hansa D. Bhargava, MD on July 10, 2020

Sources

The New York Times: “Coronavirus in the U.S.: Latest Map and Case Count”

Ritu Malhotra, Queens, NY.

American Academy of Pediatrics: “COVID-19 Planning Considerations: Guidance for School Re-entry.”

NPR: “Top Pediatrician Says States Shouldn't Force Schools To Reopen If Virus Is Surging.”

Dan Cooper, MD, professor of pediatrics, University of California, Irvine.

Journal of Pediatrics: “Reopening Schools Safely: The Case for Collaboration, Constructive Disruption of Pre-Coronavirus 2019 (COVID-19) Expectations, and Creative Solutions.”

University of Washington School of Global Health: “Summary of School Re-Opening Models and Implementation Approaches During the COVID 19 Pandemic.”

Ed Working Papers: “Projecting the potential impacts of COVID-19 school closures on academic achievement.”

McKinsey & Company: “COVID-19 and student learning in the United States: The hurt could last a lifetime.”

Josh Sharfstein, MD, vice dean for public health practice and community engagement, Johns Hopkins Bloomberg School of Public Health.

NEA Today: “Special Education Paraeducators Navigate Distance Learning.”

Ashley Hernandez, Pen Argyl, PA.

Lysa De Thomas, Merced, CA.

Lawrence Kleinman, MD, professor, vice chair, department of pediatrics, Rutgers Robert Wood Johnson Medical School.

CDC: “Coronavirus Disease 2019 in Children -- United States, February 12-April 2, 2020.”

New York City Department of Education: “Message to Families, July 8, 2020: Return to School.”

 

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