Q&A: Back to School in Year Two of the COVID Pandemic

At Children’s Colorado, we’ve advocated strongly for schools to re-open to in-person learning with proper precautions in place. Why?

Here’s the short answer: In-person learning plays a huge role in the development of healthy children and adolescents. Learning in-person helps children in many ways beyond education. When in school:

• Children develop important social connections with teachers and classmates.
• Many children receive learning support like physical therapy, speech therapy and mental health services that they are not able to get at home.
• Many kids have access to meals, physical activity and technology that they may not have regularly at home.

And for all the reasons above, in-person school is important for racial and social equity.

Because schools play an essential role in many children’s access to technology, mental health services, physical activity and even food, learning in-person is key, and data show it can be done safely. (More on that below.)

“Vaccinations and masks are our best tools for getting us safely back to in-person learning and keeping schools open, which is crucial,” says Jessica Cataldi, MD, a pediatric infectious disease expert at Children’s Colorado.

Guidelines released in July from the American Academy of Pediatrics (AAP) and the CDC recommend that all staff and students eligible for authorized vaccines be fully immunized before attending school, and that all students and staff wear masks indoors while at school—regardless of whether or not they are vaccinated.

There are several reasons for this guidance:

• While the authorized vaccines remain remarkably effective against severe illness, hospitalization and death, recent evidence shows that a small number of vaccinated people are getting the more contagious delta variant of COVID-19 and can spread it. This leaves people who aren’t eligible to be vaccinated particularly vulnerable.
• Though adolescents ages 12 and older are eligible for Pfizer’s COVID-19 vaccine, uptake rates are still lower than among adults. It will take time to vaccinate more kids and teens within this age group. (You can find the current uptake rate by state and age group in the New York Times’ interactive data page and via CDPHE's vaccine data dashboard.)
• It’s challenging to know who’s vaccinated and who isn’t, particularly in a school setting. Until the vast majority of the population is vaccinated, it’s safe and simple to require masks indoors, where the risk of transmission increases.

Masks are a simple and effective tool to protect kids and staff, especially children under 12 who are not yet eligible for vaccines.

The risk of returning to in-person school – even with the delta variant – is low when proper precautions are in place. Multiple, layered precautions make school even safer.

“We know that COVID-19 still poses a risk to kids, which is why we recommend that children return to school with precautions in-place to protect them,” says Dr. Cataldi. “Of those precautions, vaccinations and masks are our most important tools for success, along with handwashing, testing, distancing, improving ventilation, and quarantine and isolation, when needed.”

First, parents should ensure that children who are eligible for the authorized COVID-19 vaccine are fully immunized before school begins, says Dr. Cataldi. People are considered fully vaccinated two weeks after their second dose of the two-dose Pfizer vaccine.

Here’s how to sign up to get vaccinated at Children’s Colorado.

Along with immunization, the most effective ways to protect kids from COVID-19 are:

• Encouraging mask use.
• Handwashing.
• Physical distancing.
• Staying home when sick.
• Using cohorts (“pods”) at school.
• Avoiding large, crowded indoor gatherings.

Safe in-person school is the best choice for kids, and it’s what pediatric experts are recommending and aiming for. It’s natural for parents to worry about the risks of COVID-19, but the good news is that in-person learning can be done safely when proper precautions are in place.

Here are a few considerations to help parents and schools determine the risks and the benefits of in-person learning – and what to keep an eye on as the situation changes this schoolyear.

• COVID-19 in the community: When there are larger numbers of people who have the coronavirus in the community, the risk of being exposed to someone with COVID-19 increases with any social interaction, including at school. As the delta variant surges in parts of Colorado that have lower vaccination rates, keep an eye on the case counts and COVID-19 positivity rates in your county and increase your precautions when more people in your community have the virus. If your child has a health condition that makes them more vulnerable to COVID-19, consult your pediatrician to help you weigh the benefits and risks of in-person school.
• Risk of COVID-19 at school: What is your school doing to help keep people healthy? Ask about symptom screening, handwashing, face coverings, testing requirements, social distancing and learning in cohorts. Look for clear and frequent communication from school and rely on your school nurse as a resource.
• Mask up and take precautions as a family: The AAP and CDC recommend that all kids — both vaccinated and unvaccinated — wear face coverings at school. Wearing a mask is especially important for unvaccinated children, but as the delta variant of COVID-19 proves more effective at evading the currently authorized vaccines, even vaccinated children should wear masks indoors at school.
• Your child’s risk of COVID-19: If your child has a medical condition, talk with your doctor to see if they are at higher risk for severe COVID-19. In-person school may still be the preferred option for children with some medical problems when proper COVID-19 prevention precautions are taken. Once you make your decision, talk with your child’s school and the school nurse about your child’s medical condition.
• Family risk of COVID-19: If you live with someone who is unable to get immunized due to a medical condition and is more at-risk from COVID-19, you may think about the risk of in-person school differently. The risk of a child bringing COVID-19 home may be serious for other people at home even if it is low risk for your child.
• Access to online learning or homeschooling: Many of the virtual learning systems that were put in place last year will not be offered widely this year. Check with your child’s school about what they are offering. If, after careful consideration, you choose to homeschool your children due to the pandemic, make sure to reach out to your school district and community for as many educational and support resources you can find in order to support your child and yourself throughout the year. You can also explore ways to support kids with learning disabilities when homeschooling.

The AAP, CDC and the National Association of School Nurses all recommend masking in schools to prevent the spread of COVID-19. Their guidelines state that everyone over age 2 should wear masks that cover the nose and mouth while at school, especially indoors.

Why? Face coverings are a proven tool to get kids back to in-person school safely and to protect students unable to get the vaccine yet. They also protect vaccinated children and staff from breakthrough COVID-19 infections due to more contagious variants such as delta.

When masks fit well and are worn correctly and consistently, they’re effective at preventing transmission throughout the school day. The vast majority of children, even those with medical conditions, can safely and effectively wear face masks with practice, support and modeling by adults (for example, even children with developmental challenges can take advantage of workarounds such as masks that have clear panels to enable lip reading).

For helpful tips about encouraging your child to wear a mask safely and effectively, read our guide to masks and kids.

Now over a year into the pandemic, we have more scientific data that can help inform policy. Consider the following findings from the scientific literature on masking in schools:

• The AAP, CDC, and the National Association of School Nurses all recommend masking in schools to prevent the spread of COVID-19.
• School-associated COVID-19 transmission is low when risk mitigation measures, including universal masking, are used. Schools with universal masking policies experience an extremely low secondary transmission rate (1-4%, as demonstrated in articles 2, 3 and 4, below) compared to schools without masking (11-27%, as shown in article 1).
• If everyone is masked there may be flexibility to institute modified quarantine protocols (see article 4) and reduced distancing (articles 3, 4 and 5).

Sources:

1. COVID-19 in Primary and Secondary School Settings During the First Semester of School Reopening- Florida
   • This study followed more than 2.8 million registered students in 6,800 public, charter and private K-12 schools in Florida. Most schools resumed in-person learning in August 2020.
   • About 60% of districts did not require masking.
   • Incidence of school-related COVID-19 infection among students was higher in schools that did not require masking (1.7% vs. 1.2%).
   • Of 86,832 school-contacts of school COVID-19 cases, 43% got tested and 27% were positive. This means secondary transmission of COVID-19 to school contacts was between 11% (if everyone un-tested was negative) and 27%.
2. COVID-19 Cases and Transmission in 17 K-12 Schools - Wisconsin
   • This study followed 4,876 students and staff at 17 K-12 schools in rural Wisconsin. Precautions implemented were:
     1. Masking (92% compliance).
     2. Students cohorted in groups of 11-20.
     3. Staff maintained 6 feet of distance, if possible.
     4. Quarantined students and staff after exposures.
   • Results: During a 13-week period, 7 of the 191 cases of COVID-19 among the student population were linked to in-school transmission. Zero staff acquired COVID-19 during that time; no spread is known to have occurred to or from staff in school, despite the relatively high community transmission during that time.
   • This study demonstrates that, with precautions in place, including masking, in-school transmission of SARS-CoV-2, the virus that causes COVID-19, appeared to be uncommon.
3. Low SARS-CoV-2 Transmission in Elementary Schools
   • This study investigated a convenience sample of 20 elementary schools (K-6) in Salt Lake County after reopening to in-person learning; it followed a total of 1,214 staff members and 10,171 students.
   • There were 51 index cases: 40 students and 11 staff. Those cases had 1,041 school contacts; 71% of those contacts were tested . The secondary transmission was 0.7%.
   • Mask use among students was high (86%) and most schools used 3 feet distancing for students and 6 feet for staff.
   • Despite high community incidence and an inability to space students’ classroom seats at least 6 feet apart, this investigation found low transmission and no school related outbreaks in 20 Salt Lake County elementary schools with high student mask use and implementation of multiple strategies to limit transmission.
4. Pilot Investigation of SARS-CoV-2 Secondary Transmission in Kindergarten Through Grade 12 Schools Implementing Mitigation Strategies
   • This study investigated participating teachers, staff and students with COVID-19 from 22 schools over a 2-week period. The precautions in place were universal masking, increased ventilation, 3 feet distance.
   • There were 56 cases with 270 contacts identified; 102 contacts were tested and 2 were positive. The secondary transmission was 1 to 2%.
   • Despite high community transmission, SARS-CoV-2 transmission in schools that implemented COVID-19 mitigation strategies, including masking, was lower than that in the community.
   • One school district implemented a modified quarantine (in-person learning with masking, no extracurriculars, 6 ft distance from anyone at lunch, daily symptom screening, and testing 5-10 days after exposure) for certain students. They permitted 42 student contacts to continue in-person learning during their quarantine period; 30 of these contacts were interviewed, and none of the 21 students who received testing had a positive test result.
5. Effectiveness of three versus six feet of physical distancing for controlling spread of COVID-19 among primary and secondary students and staff: A retrospective, state-wide cohort study Clin Infect Dis. 2021 Mar 10:ciab230. doi: 10.1093/cid/ciab230. Epub ahead of print. PMID: 33704422; PMCID: PMC7989511.
   • This study compared incident rates cases of SARS-CoV-2 in students and staff in Massachusetts public schools (251 districts, 537,336 students, 99,390 staff) among districts with different physical distancing requirements (3 feet versus 6 feet). During the study period there was a state masking mandate for all school staff and students grade 2 and higher; the majority of school districts required universal masking for all students.
   • They concluded that lower physical distancing can be adopted in school settings with universal masking policies without negatively impacting student or staff safety.
6. Zimmerman KO, Akinboyo IC, Brookhart MA, et al. Incidence and Secondary Transmission of SARS-CoV-2 Infections in Schools. Pediatrics 2021;147(4). doi:10.1542/peds.2020-048090
   • This study was conducted in North Carolina over 9 weeks with 11 school districts including more than 90,000 students and staff who attended school in-person.
   • Among that group there were 773 community-acquired SARS-CoV-2 infections; 32 infections were determined to be acquired within schools (secondary transmission). Most of the secondary transmission cases were related to non-compliance with masking.
   • Enforcing SARS-CoV-2 mitigation policies – such as mask wearing, hand washing and distancing – resulted in minimal clusters of SARS-CoV-2 infection and low rates of secondary transmission in schools.

Download this school health literature review.

No. Masks are not harmful to children’s mental health. There is no scientific evidence to support this claim.

“Kids are resilient and are able to tolerate and wear mask without negative consequences to their mental health,” says Jenna Glover, PhD, MS, a child and adolescent psychologist. “Emphasizing the importance of helping others by wearing a mask is a great way to reinforce this safe behavior with kids.”

Getting back to school safely – in masks – will benefit children’s mental health after more than a year of uncertainty and strain.

“Children and teens need to be back in school and have connections with other kids and adults to improve their mental health,” says Dr. Glover. “And right now wearing mask is the best way to ensure that will happen.”

In addition to vaccination and face coverings, the AAP recommends that schools take the following safety precautions:

• Physical distancing: Students should remain at least 3 feet apart within classrooms when possible. The CDC recommends people who are not fully vaccinated maintain physical distance of at least 6 feet from other people who are not in their household. However, studies from the 2020-2021 school year show low COVID-19 transmission levels among students in schools that had less than 6 feet of physical distance when the school used other prevention strategies, such as the use of masks. Schools should use outdoor and unused spaces for instruction and meals to help with distancing. Activities like singing, band and exercising, for example, are safest outdoors and spread out.
• Classroom routines: To limit student interaction outside of classroom cohorts, schools should consider having teachers move between classrooms, rather than having students fill the hallways during passing periods. Students should eat lunch at their desks or in small groups outdoors instead of in large, crowded lunchrooms. And because of the need to remove face masks while eating, it's best to keep unvaccinated students 6 feet apart during lunch.
• Ventilation: When the weather and air quality allow it, open windows and doors to improve air circulation and place strategically located fans to increase air circulation and enhance outdoor air circulation.
• Testing: The CDC recommends offering screening testing to students who have not been fully vaccinated when there are higher levels of COVID-19 cases in the community. This type of regular testing can also offer added protection for schools that are not able to provide optimal physical distance between students. To be effective, the screening program should test at least once per week, and rapidly (within 24 hours) report results. Diagnostic testing is recommended if a student or staffer has COVID-19 symptoms, or recent known or suspected exposure to the virus.

Good handwashing and watching for symptoms remain important, too:

• Hand hygiene: Frequent handwashing (with soap and water or hand sanitizer with at least 60% alcohol) decreases the spread of infections at home and at school.
• Checking symptoms and staying home if sick: Checking for symptoms and keeping people at home when they have symptoms lowers the chance of bringing COVID-19 into school (and communities).
  • Anyone who is a contact of someone with confirmed or probable COVID-19 should also stay home, including children, until that contact is fully recovered.
  • To keep schools healthy, families and staff must report any sick symptoms, even mild symptoms like a runny nose or sore throat. If your child has any symptoms or is feeling sick, call their doctor to see if they should be tested for COVID-19.

CDPHE released guidance for the fall 2021 opening of schools. Guidelines from the Colorado Department of Education are also available.

CDPHE’s guidance provides specific recommendations schools should consider based on the level of COVID-19 transmission in their communities – it is not one size fits all.

Essentially, CDPHE recommends that communities and schools with lower vaccination rates and higher community transmission incorporate additional layers of protection to limit transmission and protect students and staff.

It is up to individual school districts to institute policies, and precautions are likely to vary between districts. The Denver Post is reporting mask requirements by Denver-area school district.

CDPHE’s guidance considers the following criteria as higher risk:

• The community has a vaccination rate under 70% among individuals age 12 and older. (Find vaccination rates by county via CDPHE.)
• The school has a vaccination rate under 70% among staff and students age 12 and older. (This information would come directly from the school.)
• The community’s transmission rate is above 35 cases per 100,000 people over a seven-day period. (You can find the 7-day community transmission rate via CDPHE.)

CDPHE’s guidance calls for districts and local public health agencies to keep an eye on community transmission and to increase precautions if community transmission reaches certain thresholds. According to their guidance:

“When schools and/or their communities have low vaccination rates and are experiencing high rates of community transmission (defined as 35 cases per 100,000 people over 7 days), the local public health agency should work with schools and school districts to institute higher precautionary measures, such as:

• Masking.
• Increased physical distancing.
• Serial COVID-19 testing.
• Contact tracing.
• Targeted quarantining.
• Limiting high risk activities.”

When trying to decide if your child should play basketball, return to dance class or join the chess club, go back to the basics and remind yourself what situations and activities pose the greatest risk. The general principle is that close physical proximity for an extended amount of time in an enclosed place without masks increases the risk of spreading and contracting the coronavirus.

For kids and adults alike, outdoor activities are the safest choices for recreation because the fresh air doesn’t allow respiratory droplets to linger like in confined spaces. Indoor physical activity for unvaccinated kids is a higher-risk activity, so try to look for outside sports or clubs when possible and have your child wear a mask when participating in indoor sports or extracurricular activities.

Learn more about masks and sports.

In general, parents should remember that practically no activities come with zero risk, and many come with benefits, including for your child’s mental health. If you are having a hard time determining risk vs. benefit of a certain activity for your child, we recommend speaking with their pediatrician.

For young kids, especially preschoolers and elementary-age children, it’s difficult to stay apart and still be together. Kids naturally want to play with their friends, and it’s easy to forget to leave space.

This is where adults in the building will make the greatest impact on keeping the situation safe. Talk to your child’s daycare, preschool or elementary school about the expectations for all teachers, adults and staff in the building.

Also, to avoid helicopter parenting and constantly having to say things like “No, don’t touch that” or “No, don’t hug her,” parents can facilitate situations that are safe and set their children up for success in a more controlled environment. For example, play outdoors or with a small group of trusted friends or relatives whom you know are vaccinated and have been following recommended precautions.

We know this pandemic is especially difficult for parents of children with serious or chronic health conditions. Like other kids, these children also benefit from being in school, but they may also be at an increased risk for more severe disease. Therefore, this is an individual decision that should be made with input and careful consideration from the family, their pediatrician and the school.

As new information comes to light and the situation changes, families can revisit this conversation with their pediatrician and continue ongoing dialogue throughout the year.

Here’s a list of medical conditions that may put children at increased risk for severe COVID-19.

When assessing your child's risk, consider the severity of your child's underlying condition, if they have multiple conditions that increase risk, and how suppressed their immune system is. Your child’s pediatrician can help guide you.

Get more information for families of children with special healthcare needs from the American Academy of Pediatrics.

If your unvaccinated child is exposed to someone with COVID-19, the safest thing to do is to quarantine for 14 days. Revised CDC guidance recommends that anyone who is not vaccinated and is exposed to someone with COVID-19 should quarantine for at least 10 days and continue to closely watch for symptoms up to 14 days after exposure. In some cases, you may be able to end your child’s quarantine after 7 days if they have a negative test at that time.

“Contact” means being closer than 6 feet OR for more than 15 minutes over the course of the day (such as 5 minutes in the morning and 10 minutes at night). In school settings, a different definition of contact may be used if other precautions are in place. Your school nurse can help explain how they determine contacts and exposures at school.

“Quarantine” means staying at home and staying home from school. If someone living with a child has confirmed or probable COVID-19, then that child is a household contact of the person who is sick, and the child will need to quarantine for 14 days from the last day of contact with that person.

If someone living in your household has COVID-19, you should contact your child’s doctor and school to decide exactly when your child can return to school.

If someone at school has COVID-19, your school and local public health department will determine who may have been exposed or were contacts of this person when they were contagious. Unvaccinated students and staff who are contacts of someone with COVID-19 may need to quarantine and stay home from school for up to 14 days since they last interacted with the person who was sick. The number of people who will need to stay home will depend on the number of contacts in a classroom or a cohort, what type of exposure they had, what protection strategies were in place (like masks or testing), and community levels of vaccination and COVID-19 circulation.

A child with any symptoms of COVID-19 should stay home. To keep everyone healthy at school, it’s important that no one comes to school when they are sick. If your child has symptoms of COVID-19, keep them home and contact your doctor to see if they should be tested. For children who test positive for or are diagnosed with COVID-19, they should stay home from school for at least 10 days after symptoms started AND 24 hours after last fever AND until symptoms are better.

If a child has symptoms of COVID-19 and a negative COVID-19 test, families should talk with their doctor about what is making the child sick and when they can return to school.

“The biggest thing parents should do every day is to make sure their child is not sick before going to school – and if they’re sick, keep them home,” says Sean O’Leary, MD, MPH, another infectious disease expert.

Also, remember to send your child with two freshly laundered face coverings that fit along with hand sanitizer.

Just like planning for lunch, parents should help their kids bring what they need to stay safe and healthy. During the pandemic, kids should bring the following items to school:

• Two clean face coverings
• Hand sanitizer with at least 60% alcohol content

Testing is an important tool for preventing and minimizing the spread of COVID-19 in schools and within families. You should have your child tested in these three scenarios:

1. When they have any symptoms of COVID-19 (see below).
2. When they have had close-contact exposure to someone who has confirmed COVID-19. Timing of testing depends on their vaccination status (see below). Note that school policies may vary, so call your school if you have questions about exposures.
3. When their doctor, school or a public health agency recommends it. Recommendations may vary by school district and based on how quickly COVID is spreading in your immediate community. In this case, follow the instructions of the person requesting the test.

Review the general scenarios and steps in the chart below. Remember: Your child’s school may have additional guidelines. Consult the school nurse if you have specific questions about what’s required for school or your child’s pediatrician if you have questions about testing.

Reason for testing	Definition	Timeline	What to do while you wait for test results	What to do based on the results	When your child can return to school
They have any symptoms of COVID-19.	Your child has any of the following symptoms: Fever and chills with a temperature of 100.4 or higher. New or worsening cough. Shortness of breath or difficulty breathing. Loss of taste or smell. Sore throat. Runny nose or congestion. Muscle or body aches. Headache. Fatigue. Nausea or vomiting. Diarrhea.	Get them tested as soon as symptoms appear.	Follow isolation guidelines and keep them home from school.	If positive (molecular test or antigen test): Continue to follow isolation guidelines. If negative antigen test: You should almost always get a molecular or PCR test to confirm. If negative molecular or PCR test: Keep them home until symptoms resolve. They will not be able to return to school until they are symptom-free. Ask your doctor or school nurse if you have questions.	Check with your child’s school or school nurse about their policies for returning to school.
They had a close-contact exposure outside of school and are fully vaccinated.	Your child has had close contact (within 6 feet for 15 minutes or more over a 24-hour period) with someone with suspected or confirmed COVID-19.	If they are fully vaccinated: Get them tested 3 to 5 days after the date they were exposed to the person with suspected or confirmed COVID-19.	Fully vaccinated individuals don’t need to quarantine after an exposure, but they should wear a mask in public  for 14 days or until they receive a negative test result.	If positive (molecular test or antigen test): Follow isolation guidelines. If negative antigen test: You should almost always get a molecular or PCR test to confirm. If negative molecular or PCR test: Return to normal. Ask the school nurse about returning to school.	Check with your child’s school or school nurse about their policies for returning to school.
They had a close-contact exposure and are not fully vaccinated.	Your child has had close contact (within 6 feet for 15 minutes or more over a 24-hour period) with someone with suspected or confirmed COVID-19.	If they are not fully vaccinated: Get them tested as soon as you find out they were exposed, and again: As soon as they develop any symptoms. If they do not show symptoms, 5 to 7 days after the date of their last exposure.	Follow current quarantine guidelines and keep them home from school.	If positive (molecular test or antigen test): Follow isolation guidelines. If negative antigen test:  You should almost always get a molecular or PCR test to confirm. If negative molecular test: Quarantine for 14 days after the date of exposure. Note: Some local public health agencies may allow shortened quarantine in some situations. Ask your school nurse.	Check with your child’s school or school nurse about their policies for returning to school.

Learn the difference between quarantine and isolation.

Additional information about testing is available from the CDC and CDPHE.

If your child has symptoms of COVID-19 or has been exposed to the virus, it’s important to have them tested. You need a viral diagnostic test that detects current infection. This test checks specimens from your nose or your mouth to find out if you are currently infected with the virus that causes COVID-19. Viral tests can be performed in a laboratory, at a testing site or at home.

There are two types of viral diagnostic tests: molecular (this includes PCR and NAAT tests) and antigen tests.

Molecular tests:

• Most accurate results.
• Done by a healthcare provider.
• Usually processed in a lab.
• Results may take up to 24 to 72 hours.

Antigen tests:

• Less accurate than molecular tests. 
  • Good option for quickly finding positive cases.
• Results in about 15 minutes.

Given these differences, our experts recommend that if you test your child using a rapid antigen test (this includes at-home antigen tests), you may need to confirm the results with a PCR test administered by a health professional. A positive result from a rapid antigen test is almost always reliable, but a negative result from a rapid antigen test may need to be confirmed.

See an in-depth comparison of the kinds of COVID-19 tests and when to use them.

Real-world scenarios:

Let’s say your child has symptoms of COVID-19. “In this case, it’s important to get your child tested as soon as they have symptoms.  If your child gets tested with a rapid antigen test and they test positive, you can safely assume the results are accurate and follow isolation guidelines,” Dr. Cataldi says. “But if the results of the rapid antigen test are negative for a child who is having symptoms, then they should get a molecular or PCR test at their doctor’s office, here at Children’s Colorado, or at  a community COVID-19 testing site to be sure.”

Now let’s say your child has been exposed to COVID-19 at school but they do not have symptoms. Do they need to get a COVID-19 test?

“This becomes more complicated because it depends on vaccination status and each school district does it a little differently,” Dr. Cataldi explains. “Sometimes the recommendations for what to do when exposed at school may be different from exposure outside of school. You should look to your child’s school district and ask your school nurse about whether they were truly exposed, whether they need to stay home from school and whether they need to be tested for COVID-19 before returning to the classroom.”

If your child needs a COVID-19 test but is otherwise well, do not go to urgent care or the emergency room. Several convenient and cost-effective testing options are available:

• First, call your primary care provider to ask about testing options. Many primary care offices now provide COVID-19 testing.
• Children’s Colorado offers PCR COVID testing for kids in Aurora and Colorado Springs. (Referrals and appointments are required.)
• CDPHE has more than 80 free COVID-19 testing centers around the state. These sites do not require identification, insurance, or a doctor’s note.

If your child has COVID-19 symptoms, they should isolate and be tested as soon as possible. (You should get them a viral diagnostic test, not an antibody test.) Start by calling their doctor or going to a community testing site to find a convenient and cost-effective testing option.

While you wait for the results, your child should stay home and isolate from others as much as possible. If the test is positive, make sure your child remains home and isolates for 10 days starting at the onset of symptoms. If you use an at-home rapid antigen test and the result is negative, you may need to confirm that result with a PCR or molecular test administered by a healthcare professional. If you’re not sure whether your child needs a test before going back to school, you can ask your school nurse or your child’s doctor.

You can refer to this Return to Learn guide from CDPHE for general guidance on when kids need testing to return to school. Note that while most Colorado schools use this guide, some may have their own version.

If a child gets sick with suspected coronavirus during the school day, they need to be immediately removed from the classroom environment and sent to an isolated location where they can’t expose other people until a parent or guardian picks them up. If your child has symptoms of COVID-19, keep them home and contact your doctor to see if they should be tested.

If your child has been exposed, they should be tested based on the guidelines above. (See “When should I get my child tested?”)

Recommendations for what to do when exposed at school may be different from what to do after an exposure in the community. Ask your school nurse or your child’s doctor for specific guidance.

Our mental health experts have created the following resources to help:

• Supporting your child's mental health during the pandemic
• How to check in on your teen
• Creating normalcy: tips for how to create a schedule and plan activities for children of any age

Based on the pace of ongoing clinical trials and safety studies, we expect the vaccines to be available to children under 12 as early as the fall or winter of 2021.

Since having your child immunized as soon as the vaccines are authorized is the number one way to protect your child from COVID-19, we recommend vaccinating your child as soon as possible. Having them vaccinated also means fewer logistical headaches such as quarantines if they’re exposed to someone with COVID-19. Long-term, more vaccination also means fewer new variants that will be able to evade vaccines. If you have questions about getting your child vaccinated, speak to your child’s pediatrician, who knows them best.

For updates on the coming vaccines for young children, keep an eye on our our COVID vaccine updates FAQ.

The risk of catching COVID-19 (and other respiratory illnesses) at school is related to the risk of disease in the community. If the spread of COVID-19 becomes more common in a community, it may become too risky to keep children in school; however this is less of a concern for communities with higher vaccination rates. Decisions about pausing in-person school will be made by schools or districts in cooperation with public health officials.

Families should be prepared for changes as COVID-19 disease activity changes and should think about back-up plans for childcare in the event of quarantines or school closures.

See Colorado COVID-19 data and an outbreak map from CDPHE.

Though the need for virtual learning is much lower thanks to vaccines, online school may be an option or even a necessity depending on your child’s age and vaccine eligibility, community spread and local vaccination rates. Check out our tips on how to support your child while homeschooling during the pandemic.

The American Academy of Pediatrics also offers resources on working and learning from home during the COVID-19 outbreak.