COVID-19 Update: Returning to School

Times have changed.

When we first realized we were in a pandemic, we were terrified about the potential effects of COVID-19. But as the weeks and months have passed, we have learned some very valuable lessons. Perhaps most importantly: Children are the lucky ones.

The Pediatric Landscape

The overwhelming majority of children infected with COVID-19 do just fine. What we have seen in the office is they get sick for a few days with fever, sore throat, and maybe some upper respiratory or GI symptoms. However, they get over it very quickly.

I was on a conference call with some pediatricians recently. Amongst the group we had 50,000 patients across our respective practices. Most interesting was the fact that not a single one of us had a patient that had been hospitalized because of coronavirus. The pediatric hospital volumes are still very low, and hospitalizations and ICU admissions are down in the pediatric landscape.

The Negative Impacts of Lockdown

There are outliers, of course. There have been isolated incidents where kids have died from coronavirus, most of which had separate, pre-existing medical conditions (to date there have been about 30 pediatric deaths).

The fact that there are ANY pediatric deaths is terrible. In the first half of 2019 there were approximately 2,500 teen suicides. We don’t yet know those numbers for 2020, but adolescence is a difficult stage. Not to diminish the importance of any pediatric death whatsoever, my point is that I think we are causing harm to our children by continuing this lockdown, based on what I’ve seen

What I See in My Practice

It has become more and more clear that children (particularly under age 10) are not the vector. They are not bringing coronavirus home. If an adult gets coronavirus, 95% of the time it is from another adult.

Do you know what else I am seeing? BEHAVIORAL problems amongst all age groups. This pandemic has been very hard on our children and teens. Kids are acting out, and rates of anxiety and depression are way up. Kids are feeling isolated and alone.

What Can You Do?

I encourage you to allow your kids to see friends in an APPROPRIATE manner. And by “appropriate” I mean:

  • Outdoor play dates
  • Masks (as much as they will wear them)
  • Frequent hand washing
  • Physical distancing (not social distancing)

I believe the lack of social interaction is having a negative impact on the development of our children. So, it’s important to facilitate this while doing everything possible to minimize the risk of infection.

What About School?

The question I am getting the most right now is, “Should my child go back to school?” My answer is a resounding “YES.”

I think the spring of 2020 was a disaster from an educational standpoint. Some schools did a better job than others, but it was still suboptimal in terms of quality of education.

If your school is offering in-person education, I would encourage you to participate. If your child is of daycare age, I am now fine with daycare, as well. I have definitely changed my opinion about daycare as more information has become available.

Summary

My belief is that children are fortunate and COVID-19 is not that serious for them, for the most part. This is based on what I’ve seen both in my practice and in the pediatric community at large. Children are not the vectors who bring the virus home to the family. However, children ARE having severe behavioral and mental health issues from the isolation. Therefore, kids should go back to school and daycare.

Note that all of the above goes with the understanding that the proper precautions are taken.

Wear a mask. Wash your hands. Do your part.

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26 thoughts on “COVID-19 Update: Returning to School”

  1. Thanks Dr. Pip – I always look forward to your posts and opinions on COVID. I know lots of research and thought are put into it, we appreciate it.

    Reply
  2. Thank you for this post! We have decided to send both Aariyan and Eyan back to school but have been met with some resistance from grandparents and others who obviously love them and want them to be safe and healthy. This helps put our minds at ease and know that we are doing the right thing.

    Reply
  3. This is beyond helpful, Dr. Pip! Do you have any perspective on adding a newborn to the mix? We are due any day now and have an almost 5 year old who we want to be able to enjoy Pre-K. Thanks for any insight you can provide.

    Reply
    • Hi Julie

      Newborns are at a higher risk than older kids, but still less than adults. So I think I would just give the kids a bath the second they come home prior to contaminating the baby. Still would have them go to school – they are losing their minds I suspect.

      Thanks for reading and reaching out – I appreciate it.

      Reply
      • Pip, Ted Brand here-while I appreciate your experience and that of so many other pediatricians around the country with regard to COVID in your patients, it remains to be determined, at least to my understanding, whether or not kids can be vectors. Your experience and that of others is primarily from a post-lockdown perspective. Kids have been at home and socially distanced since March, thus not really in a position to be the primary vector in a household.
        Once kids return to school, and COVID will spread amongst them, well then be able to really see if they bring it home(if we can test and trace, that is)
        Thoughts??

        Reply
        • Hi Ted – how are you?
          The interesting thing is that in the contact tracing studies in countries that didn’t close the schools is where we are getting the information that the kids aren’t the vectors. France, Ireland, and Australia. I’ve attached a screenshot from the cdc. I’m really hopeful that kids start to go back to school and do well!

          CDC Screenshot

          Reply
  4. My daughter forwarded me this tip, and I enjoyed reading it. I am certainly in agreement with your opinion that the present coronavirus quarantine is bad for kids, and, for the kids, going back to school in the safest manner possible is essential.
    However adults, both in the family and teachers at school, should be aware that there may be consequences for them. You see, I am a practicing internist in the Orlando area (where COVID-19 is presently very active). Many of my adult patients are chronically ill, very compromised and subject to great risk from coronavirus infection. Many are also parents (or grandparents enlisted as caregivers for kids). I agree that many studies show it’s unlikely that adults are infected by younger children (although a recent report from the Lurie Children’s Hospital that young children infected with Covid-19 may have 10-100 times the viral load of older kids or adults is concerning). And teens, who transmit the virus like adults, may be more difficult to get on board with masks & distancing.
    The original guideline for re-opening schools & workplaces was positive virus tests less than 5% in the community, But limited testing capacity and faultering political will intervened, so parents & schools are proceeding with little assurances.
    So adults really need to tighten up on CDC recommendations that they maybe aren’t used to doing with family. And even then, we medical folks don’t really know how this is going to play out. But that’s nothing new for this pandemic.

    Reply
    • Hi John – thank you for responding – I agree with you 100% that we need to protect the vulnerable population, those at high risk from COVID, the elderly, etc. I think the teachers in school can wear a mask and wash their hands. I have been seeing sick patients in the office since March 13th and haven’t gotten COVID (thank god) but I have been wearing a mask, asking our patients and parents to wear a mask and washing my hands very frequently. I do not like that JAMA study about the viral load in kids at all. They were looking at tests from March and April – we were not testing kids at that time. I am willing to bet they were testing mildly symptomatic adults to severely symptomatic kids. I think the results are probably overstated. Additionally, some have hypothesized that kids are not generating a forceful enough cough to aerosolize the virus particles. Time will tell. I just think that a lot of the result is coming out too fast and is not peer reviewed and leading to some very erroneous conclusions.

      I have 2 yo kids in my practice wearing a mask, I am hopeful the teenagers will comply. I think my own kids are willing to wear a mask if it means they can go to school and see their friends. Do you know what I mean? They have suffered and realize that mask wearing is the key to getting them back into a social environment.

      Thank you for everything you are doing with your patients as well. I do wish people would wear their masks correctly as well – not touch and readjust them so much. Maybe I need to make a video about that as well!!

      Stay safe and thanks for responding.

      Reply
  5. Great article with great information! I whole-heartedly agree that the isolation and “quarantine” is having more of a negative effect on our children than COVID ever could (barring any medical issues). From just the few times my kids have been in social seatings, it has drastically improved their mood, attitude, and even dinner table conversations!

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  6. We wish Dr.Pip could write us a doctors orders note to send our kids back to school (were in public school). Thanks for always being a voice of reason!

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  7. This is interesting, and worth thinking about. However, there are some pretty big gaps in your logic here Dr. Spandorfer.

    You write, “…children (particularly under age 10) are not the vector. They are not bringing coronavirus home. If an adult gets coronavirus, 95% of the time it is from another adult.”

    Bringing coronavirus home from where?

    Most (but admittedly not all) schools in the U.S. have been closed since sometime in March, so most kids have not been going to school. Kids (particularly, as you say, under age 10) don’t have jobs, so they haven’t been going to work. They don’t go out and do the grocery shopping. Is it surprising, then, that they aren’t “bringing coronavirus home”?

    Furthermore, consider the specific assertion that if “an adult gets coronavirus, 95% of the time it is from another adult.” According to the Johns Hopkins University Center for Systems Science and Engineering, as of August 2 there have been 4,620,502 confirmed cases of Covid-19 in the U.S. If only 5% of them have come from children, that’s still over 230,000 cases–and that from a segment of our population that, as I’ve already pointed out, hasn’t been going to school, work, or the grocery store.

    Also, most schools have a sizable adult faculty and staff population. Even if the 1,000 or so kids who go to the school are not particularly threatened by their own physical presence in the school buildings, the 150 teachers, administrators, custodians, and other support staff at the school are. Nationwide, that’s several million educators/support staff to consider.

    Are you really confident that the encouraging numbers you cite would still be true if kids were going to school? I’m not, and many other parents, as well as educators and medical experts, aren’t either.

    Reply
    • Thank you for reading and commenting.

      I want to say that schools can have kids return if they approach it from the standpoint of let’s do this safely and smartly. I am a fan of facemasks and hand washing/sanitizer.

      I am pointing out that there is a lot of harm to our kids for not going back to school and socializations and that should be a part of the conversation.

      The 95% statistic is from all the European contact tracing from countries that had kids still going to school. It is not the kids.

      Doctors and nurses have been working with sick patients since the doomsday of March 13th. I have gone to work everyday. How do I stay safe? I wear a mask and wash my hands. I am seeing sick patients. Teachers will be with healthy children.

      I apologize for upsetting you.

      Thanks

      Reply
  8. No mention of the parents, teachers, driver’s, custodial staff or administration. Kids aren’t the only ones in the buildings/busses

    Reply
    • Hi James

      Thank you for reading and commenting.

      With respect to the adults taking care of the kids, I think they should not be nervous. They can wear a facemask and wash their hands/use hand sanitizer. I have been seeing sick patients every day since March 13. How have I stayed healthy? Wearing a facemask and washing my hands. School personnel will be working with healthy children, not sick children. This can be done safely. Every doctor and nurse goes to work every day and takes care of patients. We protect ourselves.

      Thanks

      Reply
  9. Thank you so much for your article Dr. Pip. I have read so many studies that show wearing masks, cloth masks in particular, do more harm than good. I’ve seen many videos that show the CO2 level being way above safety guidelines, they are a breeding ground for bacteria, and they simply do not prevent viral transmission bc the virus is smaller than the fabric holes. I understand if someone were to sneeze right on you that it would stop some droplets, but rarely do people (children above kindergarten age) sneeze or cough directly on others. They are taught from preschool to cough in their elbows. I simply can’t get over the recommendation for children to wear masks. Let alone actual mandates. It’s so obviously a psychological operation since the science does not support this…and at best the data is conflicting. When would these mask recommendations perceivable come to an end? The virus is going to keep spreading right?

    Reply
    • Thanks for reading and commenting.

      Masks are a contentious topic for sure! If worn properly and the right kind of mask, you can help decrease the spread of the aerosolized virus particles. But you can’t keep touching your mask, rubbing your nose etc. Anytime you touch your mask/nose, you need to sanitize your hands. The masks still don’t contain the particles when someone sneezes or coughs, but they do help just with the little spit that comes out when we are talking normally. My recommendation – wear it correctly when you can’t spatially distance 6 feet apart. Just as important, if not more so, wash your hands and use hand sanitizer. When you wear a mask, you are decreasing your chance of giving coronavirus to someone else. It is a sign of respect for them. I do wear a mask – but I am around newborn infants and sick patients – so I am doing whatever I can to avoid getting my patients and their families sick.

      You are correct about the science behind the masks. One of my partners checked his oxygen level after wearing the mask and it was 90% instead of the normal 100%.

      Thanks again.

      Reply
  10. Thank you for this article and your medical viewpoint! I’m curious if you have any concerns about any long term affects/damage in children who have had covid? It doesn’t seem many studies are being done on this, and a few very small ones indicated there was damage especially to heart and lungs in patients with mild or asymptomatic cases. Any medical insight you might have on this would be greatly appreciated.

    Reply
    • Hi Isabele

      I appreciate your reading the blog and commenting, I don’t know of any good studies showing that there is long term damage. I am operating under the assumption that COVID 19 will behave like all the other coronaviruses in children and there will be very minimal long term issues.

      Reply
  11. This is very helpful! Any guidance to parents about how to handle kids getting sick, especially once we are in the middle of cold and flu season? Should we keep them home as we usually would if they have a fever, but let them go to school with a runny nose? My kids are in daycare so are often sick with colds, but I’m unsure about how to handle this during the pandemic.

    Reply
  12. Thank you for sharing your thoughts with us. My children have just completed their 4th day of school. After Day 1, when I asked my 6 year old son how his day was, he said great, but I wish I didn’t have to wear a mask. I asked, “Would you rather do school at home without a mask or go to school with your friends and wear the mask?” His response was “Oh wear the mask at school, mom, definitely, school, it’s not that bad really” My 4 year old daughter didn’t complain at all that first day and neither one of them have complained since. They are so happy to be back at school in person and I feel confident we are making the right choice due to the help of your guidance.

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  13. Dr. Pip, Thank you. We sent Meyer back to a different school (another story), and I’ve been so worried. I know there’s no “right choice” here. But, I have tears of relief. You are this Mom’s continual anxiety reducer. I can’t tell you how much I appreciate you.

    Reply

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