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What is the biggest health risk in the coronavirus era: children at school or at home?

Syracuse, NY – Should schoolchildren return to classrooms this fall, even in the middle of a pandemic that may be rolling for a year or more?

Yes, says pediatricians and teachers. New research suggests that children do not appear to be at high risk of spreading the new coronavirus, they say, and it may be more detrimental for children to keep them at home than to bring them back to school.

“I think we should open schools for children for the benefits they get: It̵

7;s social, it’s emotional, it’s meals, it’s a safety net,” Dr. Jana Shaw, a pediatrician for communicable diseases at Upstate Medical University. “There are a number of benefits that students receive in school, and they are important regardless of race and income.”

Shaw said new research suggests that children are less likely to get Covid-19, less likely to get sick and less likely to transmit it than adults are. She cites a flood of new studies showing that children are not driving the epidemic.

However, the data are suggestive and most have been implemented in other countries. The virus originated in Asia in December, and many US schools closed in March, so there have been no studies of transfer in schools here.

Not all doctors embrace the idea that children are less likely to pass the virus.

Dr. Ted Triana, a family physician who is also the medical director of the Syracuse City School District, says science has not been settled. He says some of the studies have serious deficiencies and that we know that children can get the disease without symptoms.

“If you put four scientists in a room, you will have four different answers,” Triana said. “I think (kids) can be quiet transmitters.”

The calculation to decide to reopen schools is similar to reopening the economy: Are the effects of a continued school closure worse than the potential spread of the virus?

The largest group of pediatricians in the country thinks so. The American Academy of Pediatrics encourages states to open schools again in the fall as students learn better and form important social bonds in classrooms than online.

“Many children struggle with trying to learn from home,” said Dr. Ed Lewis, a pediatrician in Rochester who chairs the academy’s Upstate New York chapter. “The home is not school. There are children who need their routines. There are children who really need the structure. “

Children can’t see their friends and live a normal life now, Lewis said, and that has long-lasting consequences. Many low-income students are dependent on schools for breakfast and lunch, and for the care and advice of school nurses and psychologists. Online learning is aggravating society’s inequalities; For example, low-income and rural families often lack the necessary Internet connections.

Teachers who suspect their students have mental health problems or are abused at home may seek help.

“We have received medical permits in the school environment that would otherwise have gone through,” says Triana, whose staff in the school district has 48 nurses and 22 health assistants.

The personal school teaches more than just academics, and students stuck at home do not learn how to interact with others, said Jeremy Belfiel, superintendent of the rural 800 student LaFayette Central School District.

“In a small family dynamic, there is not much opportunity for children to learn to make friends, build relationships, build rapport, learn to resolve disputes,” Belfiel said. “I think it’s a very critical skill.”

Dr. Geoffrey Hopkins, a psychiatrist at St. Joseph’s Health Hospital, said he has already seen an increased anxiety in his pediatric patients caused by school closures in March. It could be worse if they are kept at home during the fall, he said.

“For children who have underlying mental health conditions, Covid-19 and social isolation have amplified their symptoms,” said Hopkins, medical director of the hospital’s extensive psychiatric emergency program. “When I ask them what do you think about going to school in the fall, they say, ‘I miss my friends so much.’ The social and emotional protection and support provided by schools cannot be overestimated. “

The school also serves as daycare for working parents; If the children are stuck at home, parents cannot go to work, which hinders the family’s ability to make money and the economy’s ability to recover.

The federal Centers for Disease Control and Prevention have issued guidelines for schools to reopen, including encouraging masking and disinfecting classrooms. Mr Andrew Cuomo says he will issue guidance today and approve final plans in early August.

Schools in New York and around the country were suddenly closed in March after the first confirmed cases of coronavirus, called SARS-CoV-2. The governors saw classrooms as being threatened by the transmission of coronavirus: dozens of children close together, breathing on each other and not washing their hands frequently.

This is true of the seasonal flu affecting children and which they easily transmit to others. It was also true in 2009, when the H1N1 virus, also called swine flu, broke out in the United States. Children were most severely affected because they had no immunity, while the elderly had some immunity because they had been exposed to an older form of H1N1.

“We assumed SARS-CoV-2 would do the same and we wanted to be careful and close schools,” Shaw said.

However, new science suggests that children are not as effective at spreading the new corona virus.

“We know that children are rarely the source of other people’s infection,” Shaw said. “It is the adults who primarily drive the transfer to others. Children are infected by adults. Therefore, school closures are likely to have minimal impact on the transfer and should be balanced with the benefit of keeping schools open. “

A study conducted in six Asian and European countries found that children and teenagers were half as likely as adults to become infected with the virus. This study also found that almost 70% of people 70 years or older showed symptoms, but only 20% of 10 to 19 year olds did. This may be an important reason why children do not transmit the virus as easily: If you do not cough and sneeze, Shaw noted, you do not spread the virus as easily.

A review of over 700 studies, conducted by researchers in Sweden and New York, concluded that children had lower levels of viruses in the body than adults did, and were rarely the source of an outbreak in households. Children also came into contact mainly with other children and parents, not with the elderly who are more exposed to the disease and its effects.

“It is likely that children are not the main drivers of the pandemic,” the study concluded. “Opening up schools and preschools is unlikely to affect COVID-19 mortality in the elderly.”

According to “The Child is Not To Blame,” an article in the academy’s journal, “Pediatrics,” several studies show that children do not transmit the virus easily

  • A 9-year-old boy in France with the virus exposed 80 classmates, but none of them suffered the virus.
  • In Australia, nine students and nine employees were infected with the virus in close contact with 735 students and 128 employees. Only two more people were infected.
  • At a hospital in China, 65 of 68 children with Covid-19 were probably infected by adults in their households, not the other way around.

In several Northern European countries that have reopened schools, the number of new cases has been relatively small. However, the reopening of schools does not take place in a vacuum, so it is too early to know if an increase in the cases that are spread in schools is masked by a decline in other social areas.

The data is sparse and sometimes contradictory, but largely because schools around the world were closed early in each country’s epidemic, and it is possible that children may be more widely dispersed than studies suggest.

The paper that examined 700 studies warned that children could still transmit SARS-CoV-2, and could do so even if they had no symptoms. A German study in May said that children and adults had the same amount of virus and could therefore be equally contagious.

“Based on these results, we must be cautious about the unlimited reopening of schools and preschools in the current situation,” said the study.

It gets scary: Some studies indicate that elementary school children may be less likely to spread the virus than high school. For example, a New Zealand high school had an outbreak of 96 cases, while a nearby elementary school only had a handful.

Other evidence has emerged that children may be more harmed by the virus than previously thought. Upstate has seen at least two cases of a serious inflammatory disease that the virus can cause in children, and several children in the state have died of it. More than 1,000 children were admitted to hospitals in New Jersey. Of 48 children in a study hospitalized, 40% needed a ventilator.

Of course, schools are also staffed by adult teachers, staff and other staff who can potentially catch and spread the virus. Many employees may also be in high-risk groups. Teachers’ associations are pushing for more funding and a place at the table as they plan how schools will be reopened while keeping them safe.

No matter how easily children catch and spread the virus, even those who want to open schools say that it cannot be done without major changes.

In a report of 6,000 words, the Pediatric Academy recommends that students wear masks and are placed at least 6 feet apart in classrooms and buses. Cabinets should be eliminated or reconfigured so that students do not stand shoulder to shoulder to get their books and coats; teachers, not students, should move from classroom to classroom; and practice social distance in the staff rooms.

“It can’t be as if nothing has happened,” Shaw said.

A leading challenger to what the school will look like is the hybrid method, where students attend schools in shifts. New York City Mayor Bill DeBlasio suggested that students spend half their days at school and half at home and learn online. It frees up the classroom and reduces the number of peers that each classmate comes into contact with.

Triana supports the hybrid method. It reduces concern about the spread of the virus while allowing children into the building at least part of the time, he said.

“I think a start is better than nothing,” he said.

Upstate’s Shaw issued an important warning: Children should return to school buildings only if the epidemic remains under control.

“The opening of schools must be driven by the local epidemiology of the virus,” she said. “In central New York, we have very low transfer rates. We have done a fantastic job of controlling this epidemic, and schools should stay open if the epidemic remains as it is. “

The number of newly confirmed cases has decreased in Onondaga County even with greatly expanded tests. Since mid-May, the average number of cases per day has dropped from 41 to 27.

However, it is not true around the country: Fall explodes in the sun belt; Florida only set the record for the most positive cases in a single day. In late June, Cuomo told “Meet the Press” host Chuck Todd that the national image could delay the school’s opening here.

“If this continues across the country, you’re right, Chuck, kids will be home a long time,” Cuomo said.


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