July 27, 2020
Local, state and federal officials are considering a re-opening of K-12 schools, leaving parents understandably concerned about the safety of their children at school.
Dr. Brian Gannon, a pediatrician at University Medical Center, said it is important to consider the benefits and risks of both in-person and virtual learning. Gannon is also assistant professor of pediatrics at The University of Alabama College of Community Health Sciences, which operates UMC.
He said the best available evidence indicates that children without underlying health conditions are less likely to suffer severe symptoms from Covid-19 and that death rates among these school-age children are lower than among adults. At the same time, the risks to children from closed schools – academic, social and economic – can be significant, Gannon said.
In addition, the lack of in-person schooling disproportionately impacts low-income and minority children and those with disabilities. These students are less likely to have access to private instruction and more likely to rely on school-supported resources like food programs and special education services.
Gannon and Dr. Richard Friend, dean of the College of Community Health Sciences, sat down recently to discuss re-opening schools during Covid-19.
Friend: I think as parents, we all have some questions and concerns about sending our children back to school. If schools re-open, how can they do that safely, and what steps should schools take to keep their students and teachers safe?
Gannon: It is so important for children to have the opportunity for in-person schooling because there are so many children that really do better with that setting. And we do know that children are not spreading the virus amongst themselves very much. There are lots of studies out there showing this. We don’t have a huge amount of evidence because there haven’t been a lot of cases in children in general. But it really seems like the risk of spread is not huge.
We have guidance from the CDC (U.S. Centers for Disease Control and Prevention), the American Academy of Pediatrics and the Alabama Department of Public Health that are all saying there are definitely a lot of things we can do to make things safer (at school). The most important thing is for parents to remember that it starts at home. They should not send their children to school if they have fever or if they’ve had exposure to a known virus case. That’s really important. If a child who may have the virus gets on the bus and then arrives at school, that child is then exposing lots of other people and that is really the most unsafe situation.
Once they do arrive at school, many of the schools will be screening the children. It’s not completely clear how that’s going to work. I think a lot of the schools are still figuring that out. But they are going to be screening children so they can catch those who might be sick and send them home, preventing them from spreading the virus throughout and to the adults who are in charge of them. There are other ways schools can look at their physical layout and the way they organize the school day so that children are not mixing between groups. One of the words you’ll see in the expert guidance is cohorting. What that means is keeping the same group of children together all day (maybe in one room) and have the adults move from one group of children to another. It’s not clear what the options will be for eating lunch in the cafeteria and going to PE (physical education). Those things are probably going to be limited for right now.
Cohorting is a little more challenging for older students because in high school, you might have 20 students who all have different schedules; they aren’t taking the same courses. One way to achieve limited mixing for the older students is to limit the amount of time they spend at their lockers, so that they bring their books with them and keep them with them the whole day. Schools can have one-way hallways so that you don’t have students going back and forth. And schools can also try to stagger times that students are changing classes. Maybe 9th graders change classes 10 minutes before 10th graders.
The challenge for schools is that they have to think about all of this and have a plan before school ever starts. I think that’s been one of the big barriers to many schools feeling ready to implement in-person schooling by August.
Friend: Tell us about the risks of Covid-19 to children and what sort of issues they may face. I know from the data I’ve seen, children have less disease burden, and less serious consequences than older adults and high-risk categories of people. But particularly for those students who may have underlying health conditions, or vulnerable family members at home, what sort of risks might they expect?
Gannon: Children who have been identified with Covid-19 have had mild illness, they’ve not been that sick. And of the deaths from Covid-19, only 1 of 1,000 of those deaths has been a child, and almost all of those children have had other underlying medical conditions. The challenge with underlying medical conditions is we’re not completely clear which ones make children more vulnerable because the numbers are so small. We don’t know about asthma, which is, of course, a very common problem. The data is not really clear on that for Covid-19. Most of the children who’ve died (from Covid-19) have had serious and complex medical conditions rather than just asthma.
The other question is about the adult population (teachers, staff), and I think that’s where a lot of the school decisions become complicated. You may have 20 students in a classroom, one of them gets sick and may spread it to a few of the other children, and none of them get very sick. But what if a teacher gets sick? And what if the teacher might be more vulnerable medically. I think that’s where a lot of the worry comes in.
We do have evidence from several studies that children really don’t spread it (Covid-19) amongst themselves. There was a (contact tracing) case report in France that showed one child visited three schools, there were 86 contacts and none of them got (the virus). A large study in Korea showed that most of the kids (with Covid-19) got it from the adults in their family. Very few of the cases were spread from one child to another.
Friend: What should schools do, in your opinion, if there is a positive case or an outbreak, and when should they consider shutting down?
Gannon: I think what most schools are looking at is ADPH (Alabama Department of Public Health) guidance. So, if there are a lot of cases – the number I’ve seen is 20% of the school appears to be infected – then they’re going to be shutting down. Part of that comes to how do you define a close contact. I think schools are looking at that differently. Some schools are saying anyone in a classroom is a close contact, others are taking it on a case-by-case basis. Clearly, if 20% of students and teachers have been sent home because of an exposure, it will be really difficult to conduct classes at that (school).
Friend: I think schools will depend on testing. But what about communities? What risks can the community expect by re-opening schools?
Gannon: That’s a lot harder to predict. If children are not spreading (Covid-19) amongst themselves, other than maybe the older kids, it’s going to be very important for parents to keep children at home who are exposed, and that quarantining is going to be really important. I think schools are looking at transitioning groups of children to virtual learning during a quarantine period. That should help so that as we identify cases, we’re able to trace those cases, quarantine that group of people, including the teachers, and then if they’re at home they won’t be spreading it.
Friend: It sounds like the pediatric population is going to remain (fairly) healthy throughout this. Can you talk about what kinds of symptoms you’ve seen in Covid-19 positive patients that you’ve treated at UMC or at the hospital?
Gannon: I don’t think we’ve had any (pediatric hospital) admissions here, actually. The patients that we’ve seen (at UMC) have been identified because there was an adult contact, and we have tested the child because of the adult. We’ve had a few with mild, cold-like symptoms – cough, maybe fever for a day. But, even in those cases, often by the time we have the test back, the child is already back to normal without fever.
Friend: What are the effects this global pandemic will have on school-age children as they get older? And what kind of risks are they facing by going to an online curriculum? School children haven’t had a lot of social contact since mid-March. What do you foresee as the risks for these kids?
Gannon: There are really two big risks. Academically, the CDC guidance that just came out shows that children, even during a normal summer, may lose 30% of the knowledge they gained in the previous school year. With this extended period, there’s a lot of concern that children across the country will lose a lot of what they learned up until March of 2020. That will have a disproportionate effect on vulnerable communities, where up to two-thirds of school districts did not insist that the children continue to do school the last part of spring 2020. That had to do with a lack of resources or lack of parent availability. Many parents had to continue working and it wasn’t possible for them to school (their children) for those last few months. If this continues for the entire fall semester, then we may lose an entire academic year for a lot of children.
Obviously, there are better virtual learning platforms than we used to have. Many school districts are being pro-active and expecting that kids may move back and forth between groups, so that even if they are in-person initially, they also become familiar with that online platform and can move seamlessly between. But there are many kids (children with disabilities) who will not be able to benefit from that. It’s really hard to do speech therapy or special education services remotely. Many education experts worry that that group of children will simply lose a lot of progress.
The other issue is mental health. I think many parents are concerned that we will raise a generation of children who are a little bit OCD and worried about germs, and who have been overly isolated and without access to their peer group. It’s certainly a concern, and there are resources available. Healthychildren.org is a website of the American Academy of Pediatrics with resources about talking to young children about Covid-19. It is child friendly in terms of advice and gives parents a better sense of how they can talk to their children and help them with anxieties about the world we live in right now.
Friend: It sounds like we’re at risk for K-12 students getting behind, but it sounds like we’re more at risk for children with special needs getting further behind. What kind of adaptations or technologies are out there for these students?
Gannon: I don’t know a lot about the technologies, but I do know that some children seem to engage better if they have earphones or earbuds in rather than just looking at the screen because it feels like the teacher is with them. I think that sort of thing can help. I think preparation helps, if children have worked with a (online) platform previously with a teacher or parent. If parents are available to sit with their child, it’s an opportunity for parents to see what teachers are experiencing and to see how their child learns. When you have a child that already has an IEP (Individual Education Plan), the parent can work through those with advice from the special education teacher and parents can be even more engaged in their children’s educational progress.
Friend: It sounds like parents are going to need to continue to be involved with their children throughout the school year in a different way than they have before. It’s a challenge, but I think that parents will do a great job. As a pediatrician and parent, what advice can you give to parents struggling with the decision of whether or not to send their children to school this year, if schools do re-open? And what advice can you give them if schools remain closed?
Gannon: As far as re-opening, my personal opinion is that it’s safe to go back, for most children. There certainly may be children with serious (health) problems where parents need to make that decision, and particularly if you live in a household with vulnerable adults. I think that’s really the group I would be the most concerned about, in terms of the child going to school, getting sick and bringing it (Covid-19) back into the house. But I think for most families where everyone is healthy, being at school is a good option, and the negative impact of losing out on that in-person teaching and all the other benefits probably outweighs the risk.