The American Academy of Pediatrics has a conservative and cautious reputation, which is what you would expect from an organization dedicated to protecting children’s health. But this week the Academy took a dip with advice on the reopening of schools that seem to be in some way inconsistent with what administrators hear from some state and federal health officials.
The Centers for Disease Control and Prevention, for example, have reported that remote learning is the safest option. But the Academy̵
Dr. Sean O’Leary, an infectious disease specialist in pediatrics at the University of Colorado Anschutz medical campus, helped write the Academy’s guidelines. He is a father of two, 12 and 16 years old, and a Covid-19 survivor who is still experiencing symptoms after he and his wife contracted coronavirus in March.
“I take it absolutely seriously,” said Dr. O’Leary. “I’m still sick.” But he explained why the academy was emphasizing the need to bring students back to class.
This interview has been condensed and edited for clarity.
The Academy guidelines place a great emphasis on the importance of physical school compared to remote learning. Can you summarize why?
As pediatricians, many of us have already recognized the impact that having schools closed for even a couple of months has had on children. At the same time, many of us are parents. We have experienced our children by learning online. There wasn’t really much to learn. Now we are seeing studies documenting this. The children at home have led to an increase in behavioral health problems. Increases in abuse rates have been reported.
Of course, the reason they were home was to help control the pandemic. But we know much more now than we did then, when schools closed for the first time. We are still learning more every day.
This virus is different from most respiratory viruses that we treat every year. School-aged children clearly play a role in driving flu rates within communities. This does not seem to be the case with Covid-19. And it seems that in the countries where schools have reopened, it plays a much smaller role in driving the spread of the disease than we would expect.
In March, there was this idea of children as silent superscoverers who placed the elderly and other vulnerable people at immense risk. Has that photo changed?
What we have seen so far in the literature – and even anecdotally – it is that children really seem to be less likely to contract the infection and less likely to spread it. It seems to be even more true for younger children, under 10 or under 12 years old. And older children seem to play a minor role than adults.
Here in Colorado, I followed our state health department website very carefully. They update the data every day and include epidemics in the state they are investigating. As you can imagine, there are many long-term care facilities and specialized nursing homes, some in restaurants and grocery stores. There have been a total of four in childcare centers and we have many childcare centers open. In almost all of these cases, the transmission was between two adults. The children in the centers are not spreading Covid-19. I feel the same thing from other states too.
The Academy’s guidelines speak of balancing the need for physical distance with the educational and developmental needs of children, such as the need for practical play. They suggest that if older students are masked, three feet of distance between the desks may be sufficient, compared to the six feet recommended by the C.D.C. Why is your advice different?
I don’t know that we are different. The C.D.C. said six feet if “doable”. The point we are trying to clarify is that it is not really feasible. When considering the general health of children and in reality the community in general, adhering to a six-foot rule, which would mean having many children at home, may not be in the interest of general health. Something has to give.
From our point of view as pediatricians, the disadvantages of having children at home versus school are offset by the small incremental gain that you would get if you had children six feet apart rather than five, four or three. When adding other mitigation measures like wearing a mask, especially for older children and washing your hands often, you can reduce the risk.
I think it is a balance. I won’t go out here and say on June 30 that everything will be perfect in the next school year. There will be cases of Covid-19 in schools, even when they make their best efforts. But we have to balance it with the general health of children.
While I talk to school administrators, most are planning temperature checks. The Academy guidelines warn that this may not be practical and take the time of education away. Can you say more about why you are skeptical that this is the right strategy?
Do the damages outweigh the benefits? In this case, if it means that students are gathering, the risk of spreading may increase. And we don’t have much evidence that temperature screening is useful. This is for a couple of reasons. One, many children who have Covid-19, perhaps the majority, never have a fever. Use fever as a screen and assume it will be good enough? You will miss a child. And many fevers won’t be Covid-19. Children shouldn’t go to school with a fever, period.
As you were preparing these guidelines, the deadly potential emerged pediatric inflammatory syndrome linked to Covid-19 sways you at all?
We talked about it. It is in any case a rare condition. And therefore it is something we need to pay attention to and understand what the causes are and the best treatment. We must also emphasize that even those children who fell seriously ill, the vast majority of them recovered and did well.
The guidelines emphasize that teachers and school staff members should remain physically estranged to the maximum extent possible and conduct remote meetings. But I hear many teachers. Many frankly are afraid of going back to school before a vaccine is available. Some have told me that they believe their health is treated as expendable. What’s your message for them?
We are pediatricians. We are not educators. We don’t want to walk in the space where we don’t belong. But what I would say is that it depends on the level of risk for the individual person. Every district I talked to here in Colorado? They are making important considerations for their teachers, trying to understand how to protect them.
There are a couple of things we know now that we didn’t know when we closed schools in March. One is that the masks really seem to work. They are very effective. Two, physical distances also work. If they are taking all possible precautions, I think the risk is quite low.
Some of these are very personal decisions. But schools can do many things to make the environment as safe as possible.
What do you hope for next in terms of local schools planning to reopen?
The way this is implemented in August or September when schools reopen actually depends on what is going on with the virus at the time. If you are in a state that is doing well with very few cases, all the measures in the guide are much less important. But if you find yourself in a place where the virus rages, all of these things become much more important.
As a country, we need to access the same page. It is a tragedy for me that the virus has become a political problem. It costs tens of thousands, potentially hundreds of thousands of lives.
The reopening of schools is so important for children, but really for the whole community. Much of our world depends on whether children are in school and parents can work. Trying to work from home with the children’s home has a disproportionate impact on women. So it goes beyond the health of the child, which is obviously very important. As a country, we should do everything we can right now, for many reasons, to make sure we can safely reopen schools in the fall.