Iowa Specialty Hospital

Safe for Children to Return to School

July 14, 2020

The following is a response from Dr. Michael McLoughlin regarding whether it’s safe for children to return to school this fall:

Decisions about school are very difficult and we can only base our decisions on the information about COVID that we have. For one the American Academy of Pediatrics is advocating that “all policy considerations for the coming school year should start with a goal of having students physically present in school.” There are several important pieces of information to consider:

1) Kids are clearly at dramatically lower risk for severe illness than adults. There are a couple theories as to why this may be. The most likely theory is related to the receptor that COVID-19 requires to enter cells. We know it enters cells by binding to a receptor called ACE2. This receptor has been shown to be less prevalent in the nose of kids and increases with age. This may make it more difficult for COVID-19 to infect younger kids than adults. It also may be easier for kids to fight off the virus even if they are infected when not as many copies of the virus can get into cells.

2) Just because kids don’t tend to get severely ill doesn’t mean they

can’t spread COVID-19 to adults who may be at higher risk. This is a real concern. However, there have been several small studies that looked at households that got infected. When they looked closely at these households, it was far more likely that an adult was the first one to become infected and bring it into the home. Only rarely was a child the person who brought an infection into the home. I will emphasize that these were small studies and I’m not at all suggesting this isn’t still a concern, but there’s real reason for hope that even without precautions kids don’t spread COVID-19 as efficiently as adults.

3) Personal protective equipment works. We’ve seen that when masks or face shields are used by everyone or nearly everyone, it is very difficult for COVID-19 to spread.

4) Having kids learn remotely isn’t as good as in-person learning even if everyone has reliable internet and a computer. And there are lots of side benefits of school (nutrition, social development, allowing parents to work, etc.) that are especially important for the most at risk kids.

The summary of all this is that there is reason to think that with appropriate precautions (masks or face shields, desks further apart, keeping kids together with their own classroom as much as possible) we can get kids back in school in a way that is likely to prevent schools from being a major source of spread. It is convenient that the youngest kids who would have the most difficulty with some of these measures appear to be least likely to spread COVID-19. We have been advising the local school districts as they make these decisions. It is going to be a challenging fall for the schools and I think we are all approaching this with a sense of humility as we try to make the best decisions we can in a situation where we don’t have a perfect understanding of how it is going to go. The local schools all know adjustments may be necessary as we learn more.

We can all help by getting the number of cases down as low as possible before the schools try to restart. Consistent use of masks or face shields anytime we’re in public is the most effective way we can do this.

To go back to the original question, I’ll leave it at this: My daughter isn’t yet old enough to be in school, but if she was I would feel that having her attend was the best option.

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