Throughout the COVID-19 pandemic, health experts and educators have struggled to balance competing needs. One priority: Keeping kids, teachers and their families safe. Just as important: Opening schools to give kids the healthy interactions crucial to their development and mental health.
Now, medical experts, including UC Davis Health pediatricians and infectious disease specialists, say the science shows that it’s both important to open schools and possible to do it safely.
“From all the studies we’ve seen, I think schools should make every effort to open up,” said Dean Blumberg, chief of pediatric infectious diseases at UC Davis Children’s Hospital. “We’ve seen it can be done safely and we know how important that social interaction is for kids.”
But Blumberg said reopening must be done right – when community infection rates are not soaring and by following critical safety protocols including wearing masks, social distancing, testing and contact tracing.
“All of those steps have been proven to help prevent transmission and to mitigate the spread of the coronavirus,” he said. “Just as importantly, we have to respect teachers’ circumstances. They might be at high risk or have underlying conditions or have multi-generational families at home. We need to be sure teachers or students will be able to opt out if they want and continue with remote learning.”
Studies show kids need social connections
UC Davis pediatrician Lena van der List said more and more data show the emotional hardships on children and teens who have lost their normal interactions with other kids.
“The mental health impact can be serious,” van der List said on the podcast Kids Considered™ about kids and health she records with Blumberg. “Data show an increase in mental health-related emergency room visits, suicide attempts and depression among really young kids and kids 12-17 years old.”
For example, UCSF Benioff Children’s Hospital reported a 66% increase in the number of suicidal children who came to their emergency room and a 75% increase in kids who required hospitalization for mental health services.
— Lena van der List
And the Centers for Disease Control and Prevention (CDC) reported an increase of mental health-related emergency department visits in 2020 of 24% for children age 5-11 and 31% for kids age 12-17.
“This is so alarming and significant,” van der List said. “It’s been almost a year that many kids have been out of school. We need to be having these important conversations about when they can go back.”
But health experts aren’t saying rush to open schools no matter what. And, although younger kids are less likely to catch or transmit COVID-19, that doesn’t mean they are immune.
“I have seen kids who were scary sick,” Blumberg said. “We’ve had kids in intensive care with pneumonia on ventilators, very sick children who we weren’t sure were going to make it.”
In addition, although they are less likely to be infectious, children still can transmit COVID-19 to adults. Plus, teenagers are more like young adults in terms of COVID-19 infections, meaning they may not get as sick, but they can infect older people who would get seriously ill.
“We know COVID-19 is more dangerous to teachers, staff and administrators,” Blumberg said. “That’s why health protocols are so important. What’s encouraging is that studies are showing that kids infecting educators and staff is rare when safety measures are followed, and that kids can follow those safety rules.”
Safety measures are crucial – and the keys are masking and social distancing
Blumberg said the top priorities should be masking and distancing. “Those are the most crucial,” he said. “And we now know kids will wear masks if we tell them to. Kids are adaptable. They can adjust to new rules.”
— Dean Blumberg
The CDC studied a rural Wisconsin school district where masking was required and reported that students complied 92% to 97% of the time. During 13 weeks of in-person instruction, there were only seven COVID-19 cases among 4,876 students that were transmitted at school, and no cases among 654 teachers.
Other safety measures for schools include dividing students into smaller classes to help maintain the social distancing, and “cohorting” – keeping kids in small groups and away from other groups of kids with shortened days or staggered schedules for classes, recess and lunch.
“Rigorous testing and contact tracing are also vital,” Blumberg said. “If an infection does occur, that’s how we contain it.”
The American Academy of Pediatrics reported a study of 11 school districts in North Carolina with more than 90,000 students where safety protocols and contact tracing were used. Over nine weeks, researchers found that the infection rate among students was four out of 100,000 per week – for comparison, Sacramento County’s rate at the end of February was 13 cases per 100,000 people per week for the general population. And there were no cases when a child transmitted COVID-19 to an adult.
“When schools have been opened,” Blumberg said, “almost all the cases that did occur resulted from adults infecting other adults who were not following masking and distancing guidelines.”
There is still a balancing act to be handled.
Some students have thrived in distancing learning. Teachers may be asked to greatly increase their workloads if they have both in-person and distance learning students working on the same lessons. Plus, the time remaining in the school year is relatively short, so much of the value for students may be social and emotional.
“Teachers are doing such wonderful work shifting to distance learning and keeping kids engaged,” Blumberg said. “They have been among the heroes of the pandemic. But the distance learning doesn’t work for everyone and the isolation can be hard. Kids need to be with other kids.”
Blumberg and van der List say they understand the complicated emotions and contrasting needs involved with reopening schools, but they point to studies and argue the science has recast the outlook.
“We know children are suffering. We know how to keep them, their teachers and their families safe,” Blumberg said. “If all the safety measures are in place and adhered to, and if there are options to opt out, I believe the bottom line is that we should try to reopen schools if at all possible.”