No easy answers for the COVID back-to-school test

Dr. Beckmann shares his thoughts and expertise on the challenges of kids and teachers returning to the classroom in the middle of a pandemic.

As summer draws to a close, and schools are planning to reopen, we approach this school year with some trepidation because of the ongoing pandemic.

There’s been an ongoing debate about whether children should go back to school, and it can be difficult to arrive at an answer when emotions are high and lives are at stake.

The one truth among all of this, is that one size doesn’t fit all. We have to respect that parents and teachers are going to make decisions based on what they feel is the safest thing for the family. We need to listen and respect those choices.

Not every child is young and healthy. And not every teacher is young and healthy.

What we know based on statistics is that the chance of getting seriously ill from COVID-19 for people under 50 is very low, especially for kids under 18. 

Does that mean kids don’t get very sick or end up in the hospital, or even die? No. Those are tragic cases, and we wish that we could avoid those cases. But if you put that in perspective, one of the things that is so challenging about COVID 19 is that it affects people in different ways.

It is incredibly deadly for patients 70 years and older, and it is very deadly for people under 70 with underlying medical problems such as heart disease, diabetes, obesity, lung disease, and cancer. So it is a lot more deadly than the flu for older adults.

What’s unclear now is how significant this is for kids. If we look at stats in Illinois, there have been around 15,000 COVID cases under people under the age of 20, but there’s been only one death. If you look at other states, the hospital rate for people under 18 is around 1%. 

There are still a lot of statistics that we haven’t seen, and because we’re still early in the pandemic, it’s difficult to sort through all of the data.

So, it brings us back to school reopening. There are different age groups, and we should handle the age groups differently, as well. For example, colleges, high school students, and even some middle schoolers could probably do a fair amount of remote learning because they are generally more independent and are able to follow lesson plans.

The big challenge is with elementary school students … kindergarteners through sixth grade. These children really depend on the social interaction with their classmates. They really depend on in-person teaching to develop good listening skills, attention skills, multitasking skills, and the ability to work with others. These are critical years for the development of children, and remote learning has proved to be very challenging. 

So, when we look at the reopening of schools, we have to stratify the risk of COVID for these kids, but also look at the risk of not being in school and the long-term detriments.

Unfortunately, there are a lot of kids who don’t have access to technology and Zoom learning. Also, there are lots of children who don’t have parents who can help them the way teachers help them with homework or questions they have. And because of such variability in terms of schedules, access to technology, and in-person learning, it’s not hard to imagine a scenario in which kids who already start with disadvantages become even more disadvantaged if they don’t have in-person learning.

When you’re looking at these elementary school kids, we should do everything we can to get them back into the schools, but in a safe way, of course. Some important steps include reducing class sizes, staggering the days, staggering the times, reducing passing periods and the number of people in the hallways, trying to do outdoor instruction whenever that’s possible, having teachers and students wear masks as much as possible, and reducing the interactions of teachers with other teachers.

If there are teachers who are at higher risk of COVID, we should make accommodations for those teachers. We could potentially have those teachers broadcast their instructions and lessons from home, and have younger or lower-risk teachers’ aides in the classroom to go around and assist the students. That way, kids still get the expertise and experience of these important teachers, but the kids still get the in-person instruction that can help those who need it most.

Another big unknown is how often kids pass COVID-19 to adults. There have been studies in Iceland and Ireland that have traced cases of COVID, and results show that very few kids transmitted the virus to adults. Now these are still preliminary studies, and are not large-scale, so we still don’t know for sure. There are caveats, but it seems young kids passing the virus to adults is lower risk.

So when you take all of this information together, it can be overwhelming trying to decide what to do with your kids. Because there are so many variables, we have to listen and not shout-down or be aggressive toward parents who decide to keep their kids home or put their kids back in school.

If we take precautions and are vigilant, and we have options for high-risk students and teachers, we can make good decisions. Students who have underlying chronic lung disease or cerebral palsy or special needs, those who are at higher risk for complications or are unlikely to wear a mask, they should probably stay home for now. But students and teachers who are low-risk can go back with the proper safety measures. We need to think in terms of both the short-term risks and benefits and the long-term risks and benefits.

We have some kids who are in unstable or unhealthy home environments, and if they remain in those environments, it increases their likelihood of psychological and emotional problems. The isolation of kids at home, especially younger kids, can create all sorts of problems down the line. The education gap that we see already in students who are in disadvantaged areas will widen if they are not in school. 

There was a letter from the American Academy of Pediatrics recently with 65,000 physicians who agree that we should do all we can to get the schools open.

Right now, statistics show that children under 18 are at higher risk for complications from influenza than they are from COVID. Could this change? Yes. If we see a change or a shift, and we see more kids becoming very ill and hospitalized from COVID, then we will revisit our plans.

We also need to remember schools and businesses were shut down in the beginning to flatten the curve and the concern of overwhelming our healthcare system. Now that we know more about this virus and more about how to treat it and how quickly we need to get patients seen and treated, we’ve seen the overall death rate decrease and our hospital systems did not get overwhelmed the way we feared they would.

We need to make that distinction between flattening the curve and the increase in cases. We always knew lots of people would get infected, and we knew the number of cases of COVID would increase, especially as people go out more and businesses opened up more. That was inevitable. The question, then, is are we able to keep the vulnerable people isolated and safe? If we’re able to do that, then we’re probably able to keep that mortality rate low.

This is a unique time for all of us, so we need to understand all the factors and be compassionate toward each other as we try to make our way through this.

– David Beckmann, MD