Back to school: What doctors say about children and COVID-19

President Donald Trump is pressing state and local officials to reopen schools this fall, despite coronavirus infections surging nationwide. While experts say there are significant social benefits to resuming in-person classes, they caution that schools will need to balance those against potential risks to provide a safe learning environment for students — as well as teachers and administrators.

Evidence suggests that children are not as susceptible as adults to COVID-19, the disease caused by the coronavirus. Even among those who have been infected, it’s relatively rare for children to develop serious complications or require hospitalization.

But this doesn’t mean classrooms can be exempt from social distancing and other safety precautions, particularly if schools intend to welcome kids back on site in less than two months.

“It really shouldn’t be a debate of getting kids back to school, but getting kids back to school safely,” said Dr. Jennifer Lighter, a pediatric infectious disease specialist at NYU Langone Health in New York.

Having kids physically present in schools in the fall as much as possible would be an “ideal situation,” Lighter said, but schools will need to implement policies that allow students to maintain some distance indoors and avoid close contact for prolonged periods of time. This could include decreasing class sizes, rearranging desks to ensure kids aren’t clustered together or facing one another and moving gym classes or other recreational activities outdoors, she said.

In the U.S., children make up about 22 percent of the population, but kids account for only 2 percent of coronavirus cases so far, according to the Centers for Disease Control and Prevention.

It’s not yet known what accounts for that disparity, said Dr. C. Buddy Creech, an associate professor of pediatrics at Vanderbilt University Medical Center in Nashville, Tennessee.

“This has been a strange pandemic because usually for respiratory viruses, children are the first and most substantially affected,” Creech said. “This has really been a flip of that, where it’s our adults, and particularly older adults, that have been more affected.”

It’s also unknown how and why the risks aren’t the same for all young people. There are signs that adolescents — particularly those with pre-existing conditions — are at similar risk of infection as adults, though more research is needed, according to Dr. William Raszka, a pediatric infectious disease specialist at the University of Vermont’s Larner College of Medicine.

“The younger you are, probably the less likely you are to be able to transmit the disease,” he said. “Once you get to high school age, you’re going to be a little bit more concerned, [and] once you’re in college age, you’re going to be a lot concerned.”

Schools will have to keep these differences in mind as they craft their safety procedures, Lighter said.

“I don’t think it’s one size fits all,” she said. “Young children are really a different risk category than older adolescents, so the guidelines that we have for elementary [and] middle school children should probably be different than the ones that we have for our high school students.”

In Europe and the U.S., it was reported that some children infected with the coronavirus experienced inflammatory symptoms similar to Kawasaki disease, a result of the child’s immune system essentially kicking into overdrive. More than 100 cases of the complication, dubbed multisystem inflammatory syndrome in children or MIS-C, were reported in New York, which was the epicenter of the coronavirus pandemic in North America in March and April. Though potentially deadly, Lighter said MIS-C is “exceedingly rare.”

She added that in some circumstances, it may be important for schools to reopen because these institutions have important social functions, beyond just providing an education.

“I think children have had significant social and emotional concerns from online learning over the past several months,” Lighter said. “I don’t think online learning works very well for children, especially young children, and especially children that are in poverty.”

Dr. Shilpa Patel, a New Jersey-based pediatrician, said it’s challenging to make predictions because scientists are still learning about the virus. But she said she has no hesitations about letting her kids return to school this fall.

“Nothing will be normal until we get a vaccine,” Patel said. “These are trying times that we’re living in, but yes, I will send my kids back to school in September.”