Editor’s Note: Pediatrician Dr. Tanya Altmann is a spokesperson for the American Academy of Pediatrics, an assistant clinical professor of pediatrics at UCLA Mattel Children’s Hospital and adjunct clinical assistant professor of pediatrics at Children’s Hospital Los Angeles. The views expressed here are her own.
As school districts across the country ricochet between fully in-person, hybrid and fully online education, depending on the Covid-19 infection rates, we’ve learned something important about education: We can protect our society from coronavirus and prioritize schools to yield more effective overall public health.
First, schools are not superspreaders. We know much more now than we did when the pandemic started, how the virus spreads and how to decrease transmission. Emerging evidence in Europe shows schools have not been major centers of transmission of the virus, especially for young children. And public health officials have acknowledged that schools have been among the most prepared institutions.
All schools — public and private — can safely operate in some form or fashion because as child-centered institutions, schools care about safety, know how to follow rules and can implement guidance. And so in the United States — with masking, distancing, cohorting, testing, tracing and all the other measures schools have put in place — we aren’t seeing much transmission in schools.
Opening schools can also help teachers and staff. Just as you can’t drive a car without wheels, you can’t run a school without teachers.
“The vast majority of our staff did feel it was important for us to get up and running,” said Tom Leonard, superintendent of the Eanes Independent School District in Austin, Texas. “Our teachers want to be in the room with kids; they really do. Even with masks, Plexiglas, distancing and tight protocols they want to be with the kids.”
Leonard admitted that it isn’t easy for all schools to implement the technology and equipment changes, especially since schools need to offer both safe in-person and virtual school options – 40% of students in his district opted to stay remote for medical or personal reasons and are able to attend class virtually. He said his district plan also allows opportunities for teachers who need or want to be remote.
Support for teachers
Many schools across the country are working with teachers to make sure that they feel supported, safe and have needed supplies. Yet, I think we can all acknowledge that teachers didn’t sign up to be frontline workers who have to sanitize their classrooms to pandemic standards, anymore than they signed up to protect our children from school shootings.
Educators are making huge sacrifices to stay safe and teach students in person, and they need the families they teach to support them and follow safety protocols themselves.
Some teachers have said it’s unrealistic expectations from parents in many communities that seem to cause them the most stress. “We choose this profession because we care about educating students,” said Kris Eisenacher, a high school English teacher in Southern California.
Just as many schools finally got into an online rhythm with hotspots and computers for students, teachers are being asked to start over again and switch to in-person or hybrid instruction.
“The hours spent re-creating all of my lessons to make them accessible for my students, responding to e-mails from students and parents, learning new apps — it’s not enough, apparently,” she said, responding to those in favor of reopening schools.
“I have to risk my health and perhaps my life to do exactly what I’ve been doing from home.”
Open schools for kids’ well-being
Yet, I think it’s well known that in-person education improves health, which means that school closures are hurting physical and mental health.
A recent JAMA Network Open study by Dr. Dimitri Christakis, director of the Center for Child Health, Behavior and Development at Seattle Children’s Hospital, calculated that “the decision to close US public primary schools in the early months of 2020 will be associated with a decrease in life expectancy for US children.”
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, agreed that schools should take priority over bars.
“Close the bars and keep the schools open,” Fauci told ABC’s Martha Raddatz on Sunday.
In order to keep schools open, Fauci said Americans must continue to stop the spread of the virus within the community.
“Let’s try to get the kids back, and let’s try to mitigate the things that maintain and just push the kind of community spread that we’re trying to avoid,” Fauci said. “And those are the things that you know well – the bars, the restaurants where you have capacity seating indoors without masks.”
“Those are the things that drive the community spread – not the schools,” he said.
Without the routine of school, mental health issues are on the rise. Some 27% of parents reported worsening mental health for themselves, and 14% reported worsening behavioral health for their children, according to a national survey.
Visits by children and adolescents to the emergency department for mental health problems increased more than 24% during the pandemic, according to the US Centers for Disease Control and Prevention.
“We know from research on the impact of natural disasters on the mental health of children that prolonged exposure to this kind of toxic stress is damaging,” said Dr. Sally Goza, president of the American Academy of Pediatrics.
“Most natural disasters have an end, but this pandemic has gone on for more than eight months and is likely to continue to disrupt our lives for many more. We’re very concerned about how this will impact all children.”
Stopping community spread
Some may argue that closing bars, malls, theaters and other public-facing businesses will decimate our economy and ultimately, hurt students as parents struggle to survive. But in these environments, people are in close quarters and, in relaxed social settings, likely to break rules.
We’re aware of far more transmission linked to indoor gatherings such as wedding receptions, bars, restaurants, malls and other non-school-related gatherings. It’s not during school that Covid-19 is being transmitted. It’s on the days kids aren’t in school that they tend to gather without masks.
Luckily Covid testing options are expanding through the country. This will play a key role in not only helping teachers and parents feel safer but also will help detect cases before they can spread. Several schools currently doing regular surveillance testing of teachers and students have reported that early detection in a student or teacher has helped to identify and isolate infected individuals before any transmission could occur on campus.
Schools are experienced in setting up structured environments and regulating behavior. We know how to keep kids safe at school, and similarly, we know how to protect against Covid-19 with symptom screening, masks, distancing, disinfecting, handwashing and testing. Multiple studies have shown over 80% virus transmission reduction with masks and, when combined with at least 1-meter/3-feet distancing, there is greater than 90% reduction of transmission indoors.
Rules and routines help young students thrive, and despite popular belief, kids do follow the rules. Their innate honesty often informs teachers when they report illness symptoms in their home or family travel. In addition, schools have proven to be the perfect setting for contact tracing, as we know where each child sits, their fixed cohort or class and who they play with.
Although surveillance testing and in-house contact tracing could be improved upon with more funding in many areas across our country, the schools who are doing it have it down to a system. A system based in science.
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If there was any time for a national, strategic, public health effort to curb the spread of Covid-19 and save lives, the time is now. Our children are struggling from missed education, social isolation, lack of mental health services, school breakfast and lunch, and more. We can’t afford to wait any longer.
The United States must establish universal recommendations such as masking, distancing and testing, restricting events and exposures, and bringing case numbers down without sacrificing our children’s education, mental health and future. Perhaps if everyone followed school guidelines, we could flatten the curve.
CNN’s Leanna Faulk contributed reporting to this story.