In writing about whether schools will open for in-person classes, check case counts in kids

Cheryl Clark

About Cheryl Clark

Cheryl Clark (@CherClarHealth) is AHCJ's core topic leader for patient safety, a MedPage Today contributor and inewsource.org investigative journalist. For most of 27 years, she covered medicine and science for the San Diego Union-Tribune. After taking a buyout in 2008, she became senior quality editor for HealthLeaders Media.

Photo: BES Photos via Flickr

As you write about the continuing back and forth over the how and when — and if — it will be safe to reopen schools for on-site classes next month, journalists might ask these questions:

  • What do case counts in children and teens look like in your area?
  • Are they growing every day?
  • If so, how fast?
  • Are the children symptomatic?
  • And are their teachers, administrators, family members and friends getting sick?

In California, for example, case counts among those 17 and younger have been climbing, from 1.3% of the state’s case counts on April 7 (222) to 3.4% on May 7 (2,181) to 8.3% as of Saturday (July 11), (26,652).

Since children and teens are not systematically tested, it may be that these young people are getting counted because they’ve exhibited symptoms, possibly sick enough to be treated in a hospital or other health care setting.

Children are the least tested population, White House Coronavirus Task Force Coordinator Dr. Deborah Birx acknowledged during a press briefing last week.

The American Academy of Pediatrics heated up the issue in late June with its advisory urging school districts to open this fall with “the goal of having students physically present in school,” surprising many parent-teacher organizations.

The AAP seemed at the time to downplay any suggestion that children and teens can transmit the virus, saying “the preponderance of evidence indicates that children and adolescents are less likely to be symptomatic and less likely to have severe disease resulting from SARS-CoV-2 infection.” It added that they “may be less likely to become infected and to spread infection.”

It did little, if anything, to address the impact on teachers, support staff, administrators, cafeteria workers, school nurses if an infected child was in their midst for any significant period of time.

That AAP guidance was bolstered by President Trump and Education Secretary Betsy DeVos, who said forcefully that children must go back to school this fall. There was a blunt threat that funding would be withheld from school districts that don’t reopen, despite there being very little authority to do so.

On Friday, the AAP seemed to backtrack on its bold guidance in June.  In a joint statement with the American Federation of Teachers, the National Education Association and the School Superintendents Association (AASA), the AAP said public health agencies should base their recommendations on “evidence not politics,” and that decisions on how and when to reopen schools should be made by local school leaders, local public health experts, teachers and parents.

Arguments to keep schools closed weigh the risks that children will fall behind in social skills, behavioral development and educational achievement if they are not able to experience education in person and that child abuse or problems at home will go undetected. They are balanced against the risk that too little is known about how this virus spreads, and whether asymptomatic or mildly symptomatic children and teens could infect each other and school personnel, or bring the virus home to their own families.

A July 10 study from the Kaiser Family Foundation looked at responses to the 2018 National Health Interview Survey and found that one in four teachers or other instructors, or about 1.47 million people, “have a condition that puts them at higher risk of serious illness from coronavirus,” such as diabetes, chronic obstructive pulmonary disease, heart disease, asthma, a body mass index greater than 40, or being 65 or older.

While the percentage is roughly the same as for workers overall, the KFF analysis found that for teachers, the risk may be more serious.   “The challenge for school systems and for teachers in particular is the sheer volume of traffic and tight quarters in many school environments, which may make social distancing a significant challenge in many settings.  For higher risk teachers, failure to achieve safe working conditions could have very serious results,” the KFF report said.

Every day seems to bring new information about how the virus is transmitted, from child to child, and in utero from mother to fetus.  (It reminds this former AIDS writer how we learned incrementally about the spread of HIV in the early 1980s, through breast milk, blood transfusions and heterosexual sex that previously were discounted or denied.)

Suggestions for sources to interview about this sure-to-be emotional topic include:

  • Talk with school nurses or licensed vocational nurses who must work in schools, checking on vaccination documentation and other issues, or school nurse associations representing your departments of education in your county or state (although it can be challenging to get a response on deadline.)
  • Interview leaders of area teaching organizations and teachers themselves, especially special education teachers, who may not be able to do distance learning or hold class online.
  • Ask teachers if they feel prepared to learn medical skills and act as de-facto classroom nurses identifying children who develop symptoms while on school grounds. Will there be protocols for a non-nursing trained teacher to guide a child or a teenager who starts to cough, and how they can distinguish what are sure to be pranks from the real thing?
  • How do support staff, from bus drivers to cafeteria workers to janitors, feel about going back to work in a school building? Will their job descriptions change? Will the district require that they be tested on a regular basis, or their temperatures checked every day? Will all of them now have health coverage if — perhaps as part-timers — they didn’t before? Will they have paid sick leave?
  • How will the schools screen parents, especially in areas of the state heavily impacted with COVID-19, so that exposed children are not inadvertently sent to school, bringing the virus with them?
  • Ask local providers and hospital officials what they think about opening schools. Will it increase their workload or tax a shortage of acute care or ICU beds or other resources? Local pediatricians and family doctors might be asked to take on more, perhaps writing notes or making more check-up calls to families where some members may have pre-existing conditions. How has their advice affected decision-making by the local school district board?

Here are a few recent stories on this topic:

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