In Person School for Young Children in the Era of COVID-19

I just read two articles that I thought that many of you who are parents of young children might find interesting. They are about in-person school safely in the era of COVID-19, something that I have gotten a LOT of questions about!

The actual articles themselves are pretty dense and “medical”, one is an editorial in JAMA Pediatrics by an infectious disease specialist, and the other is in the CDC’s publication, the Morbidity and Mortality Weekly Report. But I think that they make a good point, and if you want to dive into the actual data, look at the articles themselves and the links to the references.

To simplify - these are my two main takeaways from these articles:

1) There are major benefits to in-person school that will never be replicated by remote learning, and we should have that as a primary goal.

2) While we won’t be going back to “normal” right away, mitigation efforts can keep school from being a source for spread of infection. Remember, the main worry isn’t so much about kids getting sick (scary, but rare), but about increasing viral transmission in the whole community, which absolutely means increased numbers of hospitalizations, deaths and long term disability.

So what are mitigation efforts? All the stuff that we have been talking about for a year. Personal stuff like mask use and hand hygiene. Engineering stuff like better ventilation. Policy stuff like staff sick leave. Curriculum stuff like maximizing outdoor time and avoiding unnecessary mixing of smaller school groups during the day. Public health stuff like screening for illness and testing. And political stuff like getting the money to pay for all of this.

While every decision in medicine involves balancing risks and benefits, in-person learning can and should be done safely. As some of you know, my wife is the director of a lower school, and I have seen up close the tremendous amount of work done behind the scenes to do this right.

From the editorial:

“Throughout this pandemic, many of us in the field of pediatric infectious diseases have been asked some version of the question, ‘Can children spread COVID-19?’ As if somehow anything in medicine is binary. When a question begins with “can,” the answer is almost always yes. Unfortunately, in too many parts of the world, the decisions to open or not open schools and childcare facilities have stopped there, ignoring the nuance necessary to understand the question. We know far more now about both transmission dynamics and mitigation measures than we did in March 2020 when most schools shut down. … [therefore] we ought to be asking what we should do with the knowledge we have accumulated since the pandemic began.”

I know that all of this is scary. Trust in institutions and experts is never a given, and even less so now. But read with an open mind, learn from each other, and listen in good faith.

Vaccines are coming. Spring is coming. We can do this.