With social distancing, schools should be safe to reopen this fall, experts say
(HealthDay)—Kids should be able to safely return to reopened schools this fall, resuming their studies with little risk that they will contribute to the COVID-19 pandemic, some infectious disease experts argue.
The scientific evidence so far indicates that children do not tend to spread the novel coronavirus between themselves, nor do they appear to regularly infect adults, a new editorial in the journal Pediatrics claims.
"Generally, the younger you are, then the less likely you are to transmit to other children or adults," said editorial co-author Dr. William Raszka Jr. He's a pediatric infectious disease specialist with the University of Vermont's Larner College of Medicine, in Burlington.
"With precautions, schools should reopen," Raszka said.
The upcoming school year became a political football this week, with President Donald Trump threatening to cut federal funding for schools that do not fully reopen in the fall.
But the drive to reopen schools is supported by mounting epidemiological evidence that kids don't appear to play a major role in the spread of COVID-19, said Dr. Amesh Adalja, a senior scholar with the Johns Hopkins Center for Health Security, in Baltimore.
"We have seen schools open in places like Denmark and Finland without a problem, and day care centers have been open for essential workers throughout the pandemic," Adalja said. "It will be important for schools to develop a plan for dealing with cases and allowing for social distancing, but we are causing harm to a whole generation of students who are not able to be educated adequately."
Not all medical experts share this view, however.
States that have COVID-19 infection rates under control might be able to reopen schools, but other places in the midst of a coronavirus infection surge should think twice, said Dr. Matthew Heinz, a hospital physician and internist in Tucson, Ariz.
"Certainly not for my state, if the numbers continue the way they are," Heinz said of reopening schools in Arizona. "We are in a fulminating virus-on-the-rampage situation. I can't see where this would be safe. I would caution the leadership in the states that are hardest hit to take appropriate steps to delay reopening."
Early studies show young kids not infecting others
Raszka's editorial in the July 10 issue of Pediatrics accompanied a new study of families in Switzerland that found that adults most often transmit the coronavirus to children.
Only about 8% of the time did children appear to pass COVID-19 to older family members, the researchers found. Most of the time, adults infected kids.
"This contributes to the bulk of evidence that children are infected by adults, but not the other way around," said senior researcher Dr. Arnaud L'Huillier, a pediatric infectious disease specialist with Geneva University Hospitals in Switzerland. "Reopening schools does not seem to be a public health issue when compared to reopening restaurants, bars and shops."
Raszka, an associate editor of Pediatrics, also cited other pediatric evidence that's surfaced during the pandemic:
- A Chinese study found that nearly all children diagnosed with COVID-19 had contracted the coronavirus from an infected adult.
- A French boy with COVID-19 exposed more than 80 classmates at three schools to the disease, but none became infected.
- In New South Wales, nine students and nine staff exposed a total of 735 students and 128 staff across 15 different schools. Only two infections resulted, and one was an adult who transmitted the coronavirus to a child.
"What we've seen so far in examinations of household contacts and the experience across the world in schools is that young children very infrequently transmit the virus to other children and to adults, which really supports the idea that particularly young children can re-enter the school system," Raszka said.
"I keep thinking, let me get this straight—we allow adults into bars to drink without a mask and congregate together for hours on end, but we don't send kids to school," Raszka added. "It's just mind-boggling to me."
No one knows why children don't seem to spread COVID-19, he said, particularly given their active role in spreading influenza and other germs.
"With influenza, children are well-known spreaders of the disease," Raszka said. "That's been one of the major surprises, that children do not spread or transmit coronavirus as efficiently. It's sort of mysterious why younger children seem to be much less frequently infected and generally speaking have much less severe disease, and why they don't transmit as often."
Schools should still use social distancing if they reopen
It might be that kids with COVID-19 don't cough as much because they don't become as sick as adults, or that they don't have the same sort of extended conversations with each other as adults do, Raszka said.
Despite the evidence, Raszka said schools should still take steps to reduce transmission risk by encouraging social distancing, requiring that students wear masks, and eliminating activities that require large groups of children to congregate in enclosed spaces.
Schools should space desks out as far as they can, have students all face the same direction, and even require classes to eat lunch in the room where they're taught, he suggested.
"Having 150 kids together having lunch in one small room would potentially encourage transmission," Raszka said. "Even though we think it's pretty unlikely, that's just something we can do to minimize the risk of transmission."
Trump has criticized school reopening guidelines released by the U.S. Centers for Disease Control and Prevention that call for these sorts of protective measures, but CDC officials have said they will not revise their guidelines and instead will craft additional guidance documents for school officials.
Heinz said he's concerned that U.S. school districts simply won't be able to afford to enact the measures urged by the CDC and experts like Raszka.
"Historically, we do not fund our schools adequately by any stretch of the imagination. Where is the budget for the various protections and protocols?" Heinz said. "There's not money there for anything, in some cases basic supplies for the students, much less a viral pandemic management budget."
The American Academy of Pediatrics has gone on record supporting reopening, urging school districts in a recent report to do everything they can to bring students back to classrooms.
"Children get much more than an education at school," AAP president Dr. Sally Goza said during a meeting at the White House on Tuesday, the Washington Post reported. "Being away from peers, teachers and school services has lasting effects for children. Although this will not be easy, pediatricians strongly advocate that we start with the goal of having students physically present at school this fall."
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