With school quickly approaching, Shoreview Pediatrics continues to understand the questions and worries weighing on families in their decisions to return to in-person education vs virtual learning. Our stance remains the same: there is no universal recommendation and each decision is multifactorial and family-dependent. Below we will summarize some of the newest research, which is ever-changing, alongside recommendations that pertain to coronavirus disease in the pediatric population, and we hope this can help in your decision making in the weeks ahead.
Each family is going to have a different make-up of risk-levels if they were to acquire the virus from the person potentially attending school. Ie: Is there frequent, close contact with a grandparent? Is someone at home on an immune suppressive or higher risk for getting sicker with SARSCOV2?
So far, SARSCOV2 has proved to cause a less serious initial illness in children. What we’re still learning is how it affects children (and adults) long-term. MISC (the multisystem inflammatory disorder) that follows a typically mild-moderate case of COVID is still rare. However, if it occurs, it can be very serious and long-term effects are still unknown and remain a rapidly evolving topic of research.
Some information about spread:
- There has been an increase in disease amongst ages 15-24 years (an increase of 3-fold in 5 months, from making up 4.5% of total cases to 15%). This is important when counseling teens about their social habits now and moving forward as they may become predominate spreaders. Both within households, where rates of spread are most significant, and beyond the household. A recent contact tracing study out of South Korea showed that household transmission of SARS-CoV-2 was high if the index patient was 10–19 years of age.
- Previous studies have shown that predominate modes of transmission are adult-to-adult and adult-to-child, with child-to-child spread less significant (https://pubmed.ncbi.nlm.nih.gov/32430964/). But their contributions are not insignificant. A recent study published by the CDC at the end of July demonstrates that children may still play an important role in transmission, especially if proper mitigating interventions are not adhered to. However, if proper infection prevent control measures are in place, as shown in a study out of Australia published in August, there are low levels of virus transmission. In this same study they re-demonstrated that transmission was more predominate staff-to-child and staff-to-staff, and less likely to occur child-to-staff and least likely child-to-child in daycare and school settings.
- https://www.cdc.gov/mmwr/volumes/69/wr/mm6931e1.htm
- https://www.upi.com/Health_News/2020/08/03/Australian-study-suggests-children-less-likely-to-spread-COVID-19-than-adults/2051596489369/
- This speaks highly to the importance of mitigating efforts like masks, social distancing, etc. for children as well.
- In a large study out of South Korea (ref above in bullet 2), the highest COVID19 rate was for household contacts of school-age children (over adults). They also noted a significant decline in household transmission rates in the middle of school closure. Even if children are not predominant spreaders, they still are contributing to virus transmission, especially within households. This speaks to the importance of infection control measures within the home as well.
- Recent studies suggest children <5yo do harbor a higher viral load than older children and adults, which is important to note when looking at transmission rates of SARSCOV2 as children may be important drivers of disease spread in the general population, similar to other viruses.
- Asymptomatic/pre-symptomatic spread remains a challenge in undetected transmission. Masks work. They have been and will continue to be our most effective tool to slow disease spread, especially between children and adults in indoor spaces.
- https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-guidance.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fprevent-getting-sick%2Fcloth-face-cover.html
- https://www.who.int/publications/i/item/advice-on-the-use-of-masks-in-the-community-during-home-care-and-in-healthcare-settings-in-the-context-of-the-novel-coronavirus-(2019-ncov)-outbreak
- Infection control measures are extremely helpful. The ideal situation would include: Masks for children >2yo, masks for caregivers/teachers, social distancing (6+ft from others, so in classrooms, hallways/lockers, lunch), sanitizing items between use, no sharing food/equipment, proper ventilation.
- There have been lots of ongoing updates re: school sports. Some sports are riskier than others in potentiating spread of SARSCOV2 (ie those that require more sustained, close contact like wrestling, basketball, football, lacrosse vs those that allow for more distancing and less equipment sharing, like golf, swimming, running).
Other factors to consider:
- Parents need to be productive in their workplace, which for many has become their home. Unless employers are willing to change expectations, working full time while also providing childcare for 1+ children at home, or helping with online virtual learning, is nearly impossible to keep up with for a prolonged period of time without causing significant burn out, stress, mental health burden, and strain on the family dynamic.
- Some children need to be social and have had significant behavioral/emotional struggles with the pandemic and isolation. For them, school/daycares are a necessity, not an option.
- Many children rely on schools for therapies, physical activity, and food. For these children and their families, in person school is also a necessity.
- Some children really struggle with virtual learning or do not have the resources they need to be successful with it and therefore will require in-person learning.
- SARSCOV2 can infect nannies, daycare workers, and teachers alike. In general, the less contacts for each individual, the less likely the chance of acquiring the virus and continuing transmission.
Adopting an overarching sense of community and social responsibility will be paramount for all of Milwaukee’s children and their families to maintain a physically and mentally healthy Fall/Winter season. We’re in it together! We fight it together! We get back to normal together!
