As the start of school draws near and parents are faced with the difficult decision of in-person or virtual school, we struggle to know what to do. As a pediatrician, this is a question I am faced with every day. As a mom, this is something I’ve been pondering since March 12, 2020, the last official day of in-person school. While each family’s decision is unique, I am hoping to provide a little information to make your decision a little less stressful. As a parent, I understand.
Over the past four months I’ve done a lot of reading and learning about COVID19, as have all physicians, because we knew nothing of it prior to late January. Initially, it was thought that children could be asymptomatic (meaning they have no symptoms of the illness but are infectious) carriers and could infect adults without being sick themselves. As more time goes on and more of the illness is learned, it is possible that children, especially those younger than 12, may be “dead ends” to the virus, meaning they can get COVID but can’t transmit to anyone else. This would make COVID very different from any other respiratory illness that we know where children tend to be the source and spread to everyone. A researcher in California, Dr. George Rutherford, studied data and could not find a single child under 12 who transmitted the virus to someone else. Some other interesting statistics are that “children appeared to be at least 10 times more likely to die of influenza than COVID and are more likely to be struck by lightning than to die of COVID.” According to the CDC there have been three deaths in children under 18 from COVID and 185 deaths due to influenza in the 2019-20 season. This is in no way comparing the flu to COVID because they are not the same. This is just comparing death from COVID to death from the flu in children.
In looking at countries that reopened elementary schools, there was not an increase in cases, which is consistent with children not being a major vector for the illness. Denmark and Norway were able to reopen elementary schools without any mask wearing in children or adults. IF there is mask wearing in the U.S. by either children, adults, or both, that would potentially make both transmission even less likely and possibly the severity of the disease less if it does occur-although the use of masks has clearly been a place of contention and disagreement.
I am not saying children do not get the virus, they do. However, for the most part, healthy children who are infected with COVID tend to have a much milder illness than their adult counterparts. In this way, COVID is very different from influenza or even the common cold.
There are a number of scientific theories as to why children do not get as sick, one being that the amount of virus in them (the viral load) is just lower. This is thought to be due to the robust immune system and immune response children have. Their bodies are so used to seeing new viruses that they mount a much greater response than adults or immunocompromised individuals do. This information is great news for teachers and children, because not only are children less likely to transmit COVID, but if they do, the dose of virus is a lot lower and it is thought that the lower the dose of virus you get, the less severe your illness will be if you even get symptoms at all. A way to think about this is those working in the Emergency Departments or the COVID units at the hospital are much more exposed than those working out in the community. Therefore healthcare providers in the hospital are more likely to get sick than their community counterparts.
Enough about the science, let’s consider the non-educational aspects of school and the part that is really concerning when considering in-person vs. virtual school. We all know that the internet infrastructure in Monroe County is severely lacking, even with the new Wi-Fi buses. Most homes in the county don’t have internet access. Virtual learning relies on the internet. If we don’t go back to in-person schooling, these could be some of the consequences:
• A further entrenching of socioeconomic disparities, job loss for parents who can’t afford childcare therefore worsening poverty and neglect (and no, I am not implying that school is childcare);
• More abuse of children going unrecognized as our teachers serve as an extra set of eyes to identify child abuse;
• A lack of support for children with special needs, missed therapies for children whether it be speech, occupational, or physical therapy further setting these children back in their gains;
• Worsening anxiety and depression in our children-something I have seen first hand in my own practice since the quarantine started.
Children are social by nature. Isolating them or limiting their human contacts can have long term affects on their psyche and development. The long-term risks of children not being in school - loss of learning, inability to report abuse and neglect, hunger, social interaction, exercise, IEPs for children with special needs - are great.
Children are our future and figuring out how to re-open schools safely is infinitely more important that figuring out how to reopen amusement parks and malls. As you know, some daycares never closed and I am not aware of any huge outbreaks in our area from daycares.
This article is meant to give parents information to help them make the best decision for their family. Every family situation is different. I hope this article offers reassurance to teachers and school staff who are worried they will get sick by going back to school. I am not only a pediatrician but a mom to a second grader, preschooler and toddler. My children will be returning to in-person schooling should that remain an option.We feel this option best fits our children’s educational and social needs.
Dr. Holly Hoenes of Forsyth is a pediatrician with Northside Pediatrics. She and her husband Kevin have three children, one in Monroe County schools. Email her at Drhollynorthsidepeds@gmail.com