A pediatric infectious diseases expert weighs in on mask-wearing, when to keep sick kids home and measures to keep schools open this school year as the COVID pandemic continues.
The highly contagious delta variant has thrown a wrench into back-to-school plans across the country.
In Florida, thousands of students are already out of school and quarantined because of COVID-19 exposures. In Georgia, numerous schools have been forced back into virtual learning just weeks into the new school year.
Similar stories are being reported in states like Mississippi, Louisiana, North Carolina, and South Carolina where COVID-19 outbreaks and exposures continue to disrupt schools' reopening plans.
Such news can be nerve-wracking for families sending their kids to school and who may have questions about how to manage yet another pandemic-era school season. Among them: mask wearing in schools that don't require them, what symptoms warrant keeping kids home and how younger unvaccinated kids can safely socialize with peers.
"Children and teens suffered a lot last year and missed out on many aspects of regular kid life, including months or even a year without in-person school," said Alison Tribble, M.D., a pediatric infectious diseases specialist at University of Michigan Health C.S. Mott Children's Hospital.
"We owe it to them to get this pandemic under control and do everything we can to keep schools open. We can use the knowledge we've gained over the last year and half to help kids safely participate in activities that are important to their emotional, social and physical growth and health, including school."
Children need to be in school, and we should be doing all we can to prevent COVID in schools.Alison Tribble, MD
8 Back to school tips from a pediatric infectious diseases specialist:
Expert advice is the same whether your kids are vaccinated or unvaccinated: They should all wear masks inside a school building.
"We've already seen cases across the country suggesting that the delta variant could more easily spread in schools without proper mitigation measures and examples of how COVID can continue to prevent kids from having a normal school year," Tribble said.
"Masks are one of the best measures we have to protect kids too young to get vaccinated against COVID. And the more successful we are in reducing COVID transmission in schools, the more successful we will be in keeping them open."
While the risk of severe sickness in vaccinated students and staff is low, data now shows that that some vaccinated people may still be able to transmit the delta variant to others.
"Everyone should wear a mask in the interest of protecting vulnerable people and those who aren't vaccinated yet," she said.
Help kids prepare for unstructured school times
School districts may have various plans for activities that aren't as amenable to certain mitigation measures, such as masks and social distancing. Top of the list: lunchtime. At some schools, kids will eat at desks in classrooms while others may be in a traditional cafeteria setting.
Tribble advises parents to talk to kids about keeping masks on as long as possible even during times when they're allowed to take them off. For example, they should first unwrap their sandwich, set up their food and even put the straw in the milk carton before taking their mask off to eat.
"Hopefully schools will all be doing what they can to maintain distancing and prevent large groups from congregating but there may still be less structured times that are harder to supervise," Tribble said. "We don't want kids to feel anxious about eating lunch or talking to friends, but the highest risks of exposure happen when they're sitting in a room with a bunch of kids without masks. Limiting this time to under 15 minutes will greatly reduce exposure risks."
Parents should also continue reminding children of other safety measures like avoiding sharing food or drinks, washing hands or using hand sanitizer regularly through the day and maintaining a 3 to 6 foot distance with peers as much as possible.
Role play to help kids manage social pressures
In schools that don't mandate masks, parents may worry about kids feeling like they stand out if they're among a minority wearing them voluntarily.
Parents may equip them with simple phrases they can use if a peer makes comments, like "My parents have asked me to wear it" or "I'm wearing it to protect my family," Tribble said.
"Mask wearing in schools isn't anything new and most kids have gotten pretty used to seeing classmates wear them," Tribble said. "But it may be helpful for parents to talk to their kids about how to handle potential conversations with peers in schools without mandates."
Parents may also advise kids to tell a teacher or other adult if they're being bullied for wearing a mask.
New Symptoms? Keep your child home from school and consider a COVID-19 test
Unsure if that sniffle or slight cough is cause for worry? Families should check with their school districts and health departments for local guidance on when kids should stay home from school.
But it's usually best to err on the side of caution, Tribble said.
"It may be difficult to know for sure whether it's just allergies or a cold versus COVID," Tribble said. "In general, we all need to be pretty suspicious of potential COVID symptoms. If your child has a new runny nose, cough, sore throat or fever and there's no good explanation, they should stay home."
"We all need to do our part to keep sick kids out of school. A couple of days out of school is better than a school shutdown due to COVID cases and quarantines."
If symptoms don't fade within a day or two, or multiple or concerning symptoms develop, such as a persistent cough, difficulty breathing or loss of taste or smell, families should seek a COVID-19 test. A polymerase chain reaction (PCR) test is most reliable, but results may take a few days while rapid antigen tests through a pharmacy, doctor's office or home testing kit can produce results within 24 hours.
Bring back pandemic pods, stay outdoors
Last year, many families started cohorts or bubbles that allowed kids to socialize with a limited number of other kids during virtual learning or playdates. Parents of younger children unable to get vaccinated may consider repeating some of those steps this year when it comes to after school activities – especially if they're planning anything indoors.
Families should be transparent with each other about their vaccination status and activities or interactions with other groups that may increase exposure risks.
"The fewer contacts kids have, the less likely they are to take COVID into schools," Tribble said.
Tribble also recommends families pursue outdoor group activities for as long as their children can tolerate the cold.
As more extracurricular activities like winter sports move indoors during colder weather, risks of exposure are likely to increase, particularly among unvaccinated people, Tribble said.
Families should consider having their unvaccinated children avoid densely packed indoor settings, such as restaurants or indoor concerts where the vaccination status of other people are unknown, especially if masks aren't required.
Vaccinate kids who are eligible
Kids 12 and older have qualified for the Pfizer vaccine for months, but vaccination rates among adolescents and teens continue to lag, with millions of students starting school unvaccinated this year.
Schools with higher vaccination rates among students and teachers will have the lowest risks of COVID-19 spread that could prompt disruptive quarantines, Tribble said.
"The risk of getting COVID for vaccinated children and staff is low," said Tribble, whose own 12-year-old son got the COVID-19 vaccine last spring. "The vaccine is the best protection we have against COVID and best weapon to keep our families, communities and schools as safe as possible during this surge."
According to guidance from the CDC, vaccinated teens and adults also don't need to stay home after close contact with a person who has a confirmed or suspected COVID-19 infection. They are advised to wear a mask when they're outside their home and get tested three to five days after the exposure.
Meanwhile, both Pfizer and Moderna have trials underway to determine the best dose of their vaccines for kids younger than 12. Scientists are developing an appropriate dose of the vaccine that's still effective against the virus but minimizes side effects.
"We're approaching a year of COVID vaccine distribution, with a tremendous amount of global data proving the vaccine is safe and effective," Tribble said. "We're going to have plenty of sufficient follow-up data to show these vaccines are safe in younger kids. Everyone is taking this process extremely seriously.
"Getting kids vaccinated not only offers personal protection to them but also allows them be part of the solution to ending this pandemic," she said.
If your child or family member has underlying conditions, seek expert advice
Families with immunocompromised children or family members at home may be considering whether to keep their kids in a remote learning environment.
Children who have a history of medical complexity, including neurodevelopmental disorders, congenital heart disease, obesity, chronic lung disease or immunosuppression, may be at an increased risk for severe illness from COVID-19, according to the Centers for Disease Control and Prevention. But further research is needed to better understand these risks among pediatric populations, Tribble said.
"There need to be individual considerations for each child based on multiple factors, such as their health history, whether they're vaccinated, their community's transmission and vaccination rates and their school's policy on mask mandates and other mitigation measures," Tribble said.
"We know in-person school offers significant benefits to a child's health and development, and families should weigh these benefits against exposure risks. Parents who are concerned should discuss options with their child's health providers."
Same goes for families who have an immunocompromised family member at home and are worried about their risks of exposure to unvaccinated children attending school.
Understand COVID-19 risks to kids
With a more transmissible variant now driving the new COVID surge just as schools are back in session and states have reopened with fewer restrictions, kids are more vulnerable to COVID-19 exposure – especially those who aren't vaccinated or are too young to get a vaccine.
Severe COVID-19 is still rare among children, but pediatric COVID-19 hospitalizations are up across the country. States also continue to report cases of a rare but very serious complication in kids called multi-system inflammatory syndrome, or MIS-C, which causes severe inflammation in vital organs and tissues.
"Already national pediatric hospitalization rates are the highest they've been since the beginning of the pandemic. And as we see more COVID infections and kids are more exposed, especially in communities with a high prevalence of cases, these numbers are expected to go up," Tribble said.
"Even though most kids won't end up hospitalized, a small percentage of them do experience severe illness or die from this virus. And the more children who get COVID, the more hospitalizations and deaths we will see."
A growing number of kids and teens are also experiencing long haul COVID-19, with symptoms persisting for months after even mild cases – impacting kids' abilities to play sports and participate in other usual activities.
"Given the new variant, we need to be cautious about relying on data from earlier in the pandemic on how COVID affects kids," Tribble said. "And we can't predict which kids may be at risk of getting very sick or having longer lasting symptoms."
"The good news is we've experienced this for nearly 18 months and now know what we need to do to prevent spread and school closures: staying diligent in using masks, social distancing, encouraging regular hand hygiene and other mitigation measures while increasing vaccination rates. In order to get this virus under control and improve the likelihood of a normal school experience for our kids, we can't let our guard down.
"Children need to be in school, and we should be doing all we can to prevent COVID in schools."
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