COVID19: Navigating back to school

This is my first blog post and I would be amiss to address anything other than what seems to be the main concern on parents’ minds right now: how to navigate back-to-school in the era of COVID19.

COVID19: Navigating back to school

The questions I’ve heard from parents include but are not limited to:

  1. Is it safe for my child to go back to school?

  2. What do I do if my child has a medical condition or if there are high-risk people in my household?

  3. What will the protocol be if my child or another child in their class develops symptoms?

  4. What are my options if I choose not to send my child to school?

  5. What if I don’t have the option of keeping my child home?

  6. I keep hearing about an inflammatory illness possibly linked to COVID-19 in children. Should I be concerned?

Let’s all take a deep breath together. Although it’s starting to sound like a buzzword that’s been thrown around far too often in the past few months, the situation we are all living right now is truly unprecedented. Therefore, the first piece of advice I have for parents is to abandon the search for certainty. Since the WHO declared COVID-19 a pandemic, we have been watching the scientific method play out in real time – experts are gathering information, testing hypotheses and making the best recommendations they can with the facts they have at the time. However, we are dealing with a novel virus and although we have learned a great deal about it in the past few months, it remains the case that there is still so much we don’t know. Therefore, nobody can be certain of how things will play out in the next few months, and I would be highly skeptical of anyone who claims otherwise. Right now, the best we have is the data and predictive models at our disposition which public health authorities can use to issue guidelines and recommendations. By the same token, I think all clinicians are struggling with the question “is it safe?” because we know we can never respond, “yes, it is 100% safe”. We can talk about relative safety and relative risk, and I think an extension of that is to reframe the question to “what level of risk do you consider acceptable?” Since we can never ensure a zero risk environment for ourselves or our children, on both a personal and public health level, or goal is usually to employ strategies that reduce or mitigate risk. Sending a child to daycare or school in normal circumstances is not a zero risk situation. The current situation significantly more anxiogenic because it’s hard to quantify the risk of the virus to our children’s health given all the uncertainty, particularly around potential long-term effects of infection. We can, however, look at the facts we do have to get a better idea of the level of risk:

  • The data to date suggest that the disease is much milder in babies and children, as compared to adults. In a recent study of COVID-19 in Chinese children, 90% of those who tested positive for the disease had mild symptoms, or none at all. (Dong et al, 2020)

  • Several studies have found that overall, people under age 18 are between one-third and one-half as likely as adults to contract the virus, and the risk appears lowest for the youngest children.

  • Serious illness in children with COVID-19 is still possible, and parents need to remain vigilant if their child is diagnosed with, or shows signs of, the disease.

It’s important to also consider the benefits of returning to school, or the risks associated with not returning. So far, 90% of the world’s school-age children have been affected by COVID-19 related school closures.

  • Many children benefit from school-based services and resources which are essential for their physical and mental well-being (breakfast or lunch programs, speech therapy, contact with a social worker, psychologist or special educator, just to name a few)

  • Continued lockdowns without return to school are expected to widen the existing inequalities in society, with socially and economically disadvantaged children paying the biggest price

  • There may be less opportunity for observation and reporting of suspected cases of child abuse and neglect

  • Distinctions between home and work life have been blurred for parents who must continue to work while also trying to supervise schoolwork or homeschool children, potentially contributing to psychological distress and parental burnout

Globally, it seems to be the case that the benefits of attending school outweigh the risks – at least in communities where infection rates are low and officials have a clear plan to identify and isolate cases and close contacts. There are two importance caveats to this statement. To keep risk to a minimum 1) social distancing and precautions such as mask-wearing and vigilant hand-washing must be enforced, particularly for older children and staff 2) The risk of transmission and infection does not seem to be the same across all age groups, and school boards may have to adjust protocols in real time as things evolve. It’s important to think about what is works for you and your family. With a massive return to classroom learning (even in small groups with decreased class sizes and social distancing), outbreaks are inevitable. Although we can strive to have “zero case” environments, it’s highly likely that cases will start to pop up in schools and daycares, just as they do with seasonal influenza and other viruses. Unfortunately, this will probably be our reality for a while.

My final message is this: if schools in your district are reopening, the decision of whether to send your child or not is a personal family decision that will depend on a multitude of factors: physical health status of family members, mental health considerations, parents’ work status and obligations, alternative options – there is no one-size-fits-all scenario and there is no right answer to this conundrum. The best decision is the one that is best for your family and can be adapted as the situation evolves and new information comes to light.

Here is a link to two of my favourite articles on the subject for those interested in reading more about it:

Look for the next few posts in this series where I’ll discuss a few specific scenarios such as guidelines for children with chronic health conditions, household contacts of at-risk individuals, and local protocols for testing and isolation.