It is with a mix of frustration and hope that I am writing a second back-to-school blog about COVID-19. At this same time last year, there were so many unknowns about the pandemic and how to handle returning to school. The uncertainty led to fear, which in turn fueled a respect for the virus, which unfortunately is lacking in the current decision-making to ban mask mandates. The irony is we have so much more science and data than we did at this time last year that we could and should be smarter about our policies. Nonetheless, with some children vaccinated, and more to become eligible soon, this next school year should be better than the last.
Make no mistake, COVID-19 is alive and kicking and stronger than ever, buttressed by the Delta variant - especially among those who are unvaccinated, which sadly includes all children less than 12 years of age.
If the vaccine were already available to all school-age children, it would make our decisions much easier to navigate – especially for those who want to immunize their children and mitigate COVID-19 risk.
For those who do not plan to vaccinate their kids, the status quo isn’t any different from a “choice” standpoint, but even these students would benefit from their peers being vaccinated as each shot administered brings the entire student body one step closer to herd immunity.
Unfortunately, we begin this school year with a large portion of our students ineligible for the vaccine, which is why masking is so very important, especially to protect those children with underlying health issues.
If the pandemic has done nothing else, it has exposed how differently each family approaches risk. As a pediatrician, we see this everyday in our office, as we navigate choosing car seats, SIDS concerns, medications, tests, and different therapies. Each choice has a tradeoff and every family has their own approach, which is why medicine is truly as much an art as it is a science.
Accommodating the varying risk appetites of several hundred families as schools reopen, especially in this polarized political climate, is a herculean task with no easy answer. No matter the policy, there will be naysayers much like the parable of the old man, son, and the donkey. But at the end of the day, decisions have to be made and unlike figuring out who sits on the donkey, science and data can and should help guide our thought process. Importantly, let’s appreciate our teachers, caregivers, and administrators no matter how things play out.
In writing my advice for returning to daycare and school, I have come up with some parameters to assist in decision-making. I recognize there are many caveats to each family’s situation as they come up with the best solution for their own children. One important thing to bear in mind is that our decisions not only affect our children, they affect your neighbor's and friend's children too (and vice versa).
Daycare
1. Until the current delta variant surge lessens, when possible I think it is preferable to forego daycare. This may only be for a short time until things improve. I don’t have a clear mathematical answer as to when to return, but a reasonably safe criteria would be when the ICU/hospital capacity is no longer critically full at the children’s hospitals in Houston as it is now.
2. For those who are unable to pull their children from daycare, if the facility is following best practices for COVID-19 and the majority of employees are vaccinated and all the adults are masking, I think it is reasonably safe to continue attending daycare. Don’t be afraid to ask the staff about masking policies and overall staff vaccine status – it is important to advocate for your child! Importantly, it would behoove the parents to both get vaccinated as there is a real risk in their infant bringing COVID-19 home to them.
3. For all children 2 years and older, who don’t have a medical reason not to wear a mask, I would highly encourage mask wearing, even if it is not mandated and others are not complying. Be sure to use a high quality mask.
Elementary School/Middle School
1. How safe school is without mandatory masking remains to be seen. Ideally, masks would be mandated other than for those medically unable to wear them. But even without mandatory masking, I think it is reasonable to send children to school, but would highly recommend they wear a high quality mask, regardless of whether other children do or not.
2. The COVID-19 vaccine should drop down to 5 years of age hopefully by this fall/winter, and when it does I would encourage everyone to get their children protected as soon as possible. Same as daycare, it would behoove the parents to become vaccinated ASAP.
3. Until the delta variant surge lessens, it may be wise to limit indoor group activities with other children outside of school hours. The more indoor time your child spends with other unvaccinated children, the greater the risk of catching COVID-19, and while the test positivity rate remains high during the surge, aside from school which I deem essential, it is best to reduce exposure otherwise. As things improve, such as the ICU capacity no longer being critically full, it would be reasonable to consider returning back to certain indoor activities. Group outdoor activities (ideally masked) for the most part should be safe, even now.
High School
1. The key is to get vaccinated. Every pediatrician I know has vaccinated their teenager(s). Even with the real risk of transient myocarditis (inflammation of the heart), we all recognize the risk/benefit ratio heavily favors immunizing our teenagers. If your teen is vaccinated, I think they can participate in all school activities safely.
2. Even if your child is vaccinated, I would still encourage them to wear a mask, more for the sake of others, as they themselves will be fine, but they could potentially spread the virus to others who are vulnerable and/or immunocompromised. For those who are unvaccinated, they absolutely should wear a mask.
3. Despite the delta variant surge, those who are vaccinated should be quite safe, but they can become vectors for spreading the virus. Help them to be aware of this and should they become exposed and/or symptomatic, test for COVID appropriately and should they test positive, have them properly isolate to help mitigate spread of the virus. The better we are all proactive about the pandemic, the sooner things will improve.
The bottom line is that school for the most part is reasonably safe for all children, but best practices such as masking and getting vaccinated when eligible are paramount to reducing real risk. Daycare is reasonable, even now, but when possible, waiting out the current surge would be preferable.
Risk appetite is different for every family, but keeping our children safe is a common goal that everyone can rally behind. As much as the pandemic has already stolen from the precious childhoods of our families, it is crucial that we band together as a community to protect this upcoming school year.
