Returning to school in the Age of COVID

For more than 18 months now, the United States has been grappling with the COVID pandemic. This disease has had a significant impact on our lives, having resulted in almost 38 million cases and 628,984 deaths in the United States alone (Johns Hopkins Coronavirus Resource Center, Aug 10, 2021).

The disease has disproportionately affected Black, Indigenous, and People of Color (BIPOC) populations. Children had been relatively spared the worst of this disease, but this is changing as new, more infectious delta and lambda variants of this disease appear. In fact, there are recent reports of more children being admitted for treatment of COVID-19, including many with severe disease.

While there has been guarded optimism with the development of multiple vaccines to prevent the disease, as well as the development of treatment modalities to combat COVID-19 that have helped to stem the tide of the pandemic, there has also been great frustration and sadness. Too many have unnecessarily suffered or died from this disease.  

The ongoing politicization and outright dissemination of misinformation about the disease have led to the U.S. being the country with the highest number of COVID cases and deaths in the world and a recent surge of disease. An example of the challenges faced is the governor of Florida, Ron DeSantis, who despite a significant surge of COVID in his state that could potentially overwhelm Florida’s hospital systems, threatened to withhold funding from schools and school districts that enforce a mask mandate.

This is the height of folly and will, unfortunately, lead to unnecessary illness and death. Since the pandemic started in March last year, Florida has recorded 3,027,954 COVID cases, which includes 513,990 children and youth. Clearly, misguided political stances are not solving the problem.

To protect our children, it will be important to follow current, evidence-based guidelines. As we begin to gear up for the beginning of the school year, the American Academy of Pediatrics (AAP) has laid out guidelines to help ensure the safe return to school for children. This is especially important since many children are not yet eligible or will not have been able to receive the COVID vaccine.

The AAP stresses the importance of returning to in-person learning given the detrimental effects that remote learning has had on children, including significant inequities and the exacerbation of mental health concerns in children. The AAP highlights the importance of schools in education, the development of social and emotional skills, safety, reliable nutrition, mental health services and a variety of therapy services including speech, occupational and physical therapy treatments.

The AAP recommends that school districts work to ensure equitable access to education for children in under-resourced communities and employ a data and science-driven approach to COVID-19 planning for schools. Key among the AAP recommendations are:

1. All eligible children and adults to get the COVID-19 vaccine. Currently children 12 and older are eligible to receive the vaccine, and a new study, the KidCOVE Study, will be studying the safety and efficacy of the Moderna COVID vaccine in children six months to 12 years of age.
2. All students older than two and all school staff should wear masks at school regardless of vaccination status. The only exception would be those with medical or developmental conditions that prevent this. This will help protect those children who are not yet able to receive the vaccine. Mask wearing must not be politicized. After vaccines, it is one of the most effective ways to prevent the spread of this disease.
3. The AAP also discussed the importance of physical distancing—at least three feet in classrooms—and the use of outdoor and unused spaces for instruction and meals and activities like band when feasible.
4. The AAP recommends adjusting classroom routines including having students remain in a classroom while the teachers rotate between classes when possible, allowing children to eat at their desks or outdoors, leaving classroom doors open, and when weather permits having widows open during class to circulate air.
5. The AAP also stressed the importance of testing availability to screen for COVID-19, particularly for students and staff who have not been vaccinated, as well as diagnostic testing for symptomatic children and staff. The MN Department of Health also has additional guidelines with regards to reporting those with positive results to help with tracking numbers of infections and for contact tracing.
6. The AAP also recommended that schools follow CDC guidelines regarding the cleaning and disinfection of schools and classrooms and encourage proper hand hygiene for students and staff.
7. School buses are a difficult place to socially distance, so it is important for students to be masked and districts should consider assigned seating on buses.
8. The AAP also recommended that special accommodation be made for students at higher risk for COVID infection, including those with disabilities and those who are immunocompromised.
9. A significant area of concern is the mental health of students and staff. The pandemic and its resultant social isolation and deaths negatively impacted the mental health of many children. Schools will need to expand the mental health support mechanisms in place.
10. The AAP also encouraged schools to adopt a dynamic approach in adjusting their strategies and policies depending on the level of viral transmission and test positivity rate in the schools and surrounding community and as new information about the pandemic becomes available.
11. The AAP also stressed the importance of close communication and coordination between the school districts and state and/or local public health authorities and other medical experts.

This pandemic has resulted in many challenges for our nation’s children, and this includes the significant impact on their education. The remote learning necessitated by the pandemic revealed clearly the inequities present in our schools, particularly access to computers and internet access.

It left many children vulnerable to hunger and hampered their usual access to physical, occupational and speech therapy and to mental health expertise. Unfortunately, those most impacted negatively have been children in BIPOC communities. Therefore, a return to in-person learning is essential but needs to be done safely and in line with guidelines based on the latest science.                                                                                                                                  

Dr. Andrew Kiragu is an associate professor of pediatrics at the University of Minnesota and the co-medical director of the Pediatric Brain Injury Program at Hennepin Healthcare in Minneapolis. He is an associate of the Children’s Respiratory and Critical Care Specialist’s group and provides pediatric critical care at Children’s of Minnesota and Gillette Children’s. He is a fellow of the American College of Critical Care Medicine and the American Academy of Pediatrics. Dr. Kiragu is also engaged in injury prevention efforts nationally and statewide. He serves on the boards of Safe Kids Minnesota, the Midwest Injury Prevention Alliance, and the Injury Free Coalition for Kids. Dr. Kiragu is also a strong advocate on behalf of Minnesota’s children and is a past president of the Minnesota Chapter of the American Academy of Pediatrics. He is also a past president of the Minnesota Association of African American Physicians.