Q&A: School Safety During the Coronavirus

This is a question we’ve heard over and over from parents wanting to do what’s right for their child – all while facing uncertainty like nothing we’ve experienced in contemporary history. We know that circumstances vary among families, communities and school districts, and we honor this individual decision for each family.

To help decide what’s best for your family, consider the risks of both options and what can be done to decrease those risks. Do your research, and focus on the following areas:

• 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.
• Risk of COVID-19 at school: What is your school doing to help keep people healthy? Ask about symptom screening, handwashing, face coverings, social distancing and learning in cohorts or pods. Look for clear and frequent communication from 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 be the preferred option for children with some medical problems when proper COVID-19 prevention precautions are taken. Families who choose in-person school should talk with their school about their child’s medical condition.
• Family’s risk of COVID-19: If you live with someone who is older or who has a medical condition, 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.
• Challenges with remote school: Remote school affects each child and family differently. Some children have educational, developmental, or mental health needs that are difficult to meet with remote schooling. Some families are not able to stay home with their child or access the technology they need to help children with remote learning. If your child receives special education services or has an IEP (individualized education plan), you should talk with your school to see how the IEP will be followed at school and remotely.

Learn how to support kids with learning disabilities when homeschooling.

We want to give parents and schools the information they need to stay open for in-person learning. But why?

“Shutting schools down has had a negative effect on students, impacting everything from brain development to mental health and wellness to food security,” said Heidi Baskfield, who leads our Child Health Advocacy Institute. “We’ve provided guidance to help school districts make safe decisions to maintain student and community safety, and keep schools open for critical in-person learning. Our goal is to give schools the information and recommendations they need to make the right decision for their communities about staying open for in-person learning.”

So here’s the short answer for parents asking if they should keep or send their kids back to school: In-person learning is a critical component of development for children and adolescents. In-person school helps children in many ways beyond education, such as:

• Children develop important social connections with teachers and classmates.
• Being out of school can be harmful for children’s mental health, particularly during COVID-19 social distancing and isolation.
• Many children receive learning support like physical therapy, speech therapy and mental health services at school and are not able to get this help at home.
• Schools provide meals and physical activity that children may not have at home.
• In-person school is important for racial and social equity.
• Remote learning leaves children behind if their families don’t have access to technology, resources and supervision for learning at home.

Download our free guidelines for safely returning to school (.pdf).

We asked two of our foremost public health and infectious disease specialists how they would handle the school situation with their own families.

“With common-sense practices, we can keep school a great place for kids to learn, to get fed and to receive mental and social stimulation,” said Chris Nyquist, MD, MSPH. “I would be comfortable sending my own kids to school if I knew my school and community were doing a good job of keeping people safe by following the basic principles of infection prevention.”

Principles for lowering the risk of transmitting COVID-19 in schools include:

• Maintaining as much physical distancing as possible between individuals
• Requiring face coverings for students and teachers who are able
• Providing frequent opportunities for proper handwashing
• Requiring influenza vaccination of all staff and strongly encouraging for all students

“When cases in the community are at a low level, I think schools can remain open safely for both students and staff, and I am still comfortable sending my own children to school,” added Sean O’Leary, MD, MPH. “However, I would caution parents to be prepared for a variety of situations. If parents maintain a flexible mindset knowing that schools might be opening and closing on and off throughout the year, they and their kids can be prepared for the ups and downs.”

Again, deciding how to navigate this school year is personal, and each caregiver should carefully consider their unique situation and comfort.

We know this school year 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’re also 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.

These medical conditions may put children at increased risk for severe COVID-19:

• Obesity
• Chronic lung disease (including uncontrolled asthma)
• Heart disease
• Neurologic conditions
• Diabetes (especially type 2)
• Cancer treatment
• Weakened immune system from a medical condition or medication
• Organ transplant
• Bone marrow transplant
• Metabolic and genetic conditions
• Liver disease
• Sickle cell disease

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.

As we continue to move through these challenging times where fluctuating cases of COVID-19 impact our ability to plan for the school year, a thoughtful approach remains critical. Community leaders should support student, staff and family safety while also supporting the long list of rich benefits associated with in-person learning.

The Colorado Department of Public Health and Environment (CDPHE), in collaboration with the Colorado Department of Education, released guidance for the fall 2020 opening of schools. The guidance provides specific recommendations schools should consider based on the number of COVID-19 cases in their communities. Additionally, the guidance has age-group specific recommendations on mask-wearing, physical distancing and keeping students in cohorts (groups).

The guidelines are based on current evidence that suggests the risk of COVID-19 transmission between younger children and from younger children to adults is low, so preschools and elementary schools have different guidelines than middle schools and high schools.

CDPHE also has guidance on how schools should respond when a student or staff member comes to school sick or is diagnosed with COVID-19. This guidance includes how schools should identify contacts and exposures, plus guidelines quarantine related to school exposure.

Additional school safety resources for parents

The Centers for Disease Control and Prevention (CDC) has a variety of resources for parents, caregivers and guardians including:

• A decision-making tool to weigh the risks and benefits of different school options
• Checklists for school planning for in-person and at-home learning
• A portal of information about schools and childcare programs during COVID-19

In addition, Children’s Colorado has the following free resources for schools and parents:

• Guidelines for a safe return to in-person learning (.pdf) developed by infectious disease experts Sam Dominguez, MD, PhD, Chris Nyquist, MD, MSPH and Sean O’Leary, MD, MPH
• A Charting Pediatrics podcast designed to help school administrators and board members determine how they can most safely open their schools for in-person learning
• An article with fact-based advice and tips for helping kids wear their masks.
• A robust hub of coronavirus articles, videos and resources

By combining several of the following strategies, we can decrease the risk of COVID-19 in schools:

• 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.
• Distancing: Staying 6 feet away from other people decreases the spread of COVID-19. However, this is not always possible. When you cannot stay 6 feet apart, 4 feet is better than 3 feet, and 3 feet is better than 2 feet. People should have as much space around them for as much of the day as possible.
• Face coverings: Wearing a cloth face covering or mask helps block the spread of infectious particles from the nose and mouth. Some children may not be able to wear a mask: those under age 2 and any child who has serious trouble breathing or a neurologic or developmental condition that means they can’t wear a face covering without help. Most children with asthma and other chronic lung conditions – and adults – can wear a mask safely.
• Vaccination: Staying up to date on routine vaccines including the influenza (flu) vaccine protects children from serious infections. Many of the diseases that vaccines prevent have similar symptoms to COVID-19 and can lead to missing school and even severe illness.
  
  While we don’t yet have a COVID-19 vaccine approved for children, it is important to stay up to date on all of your child’s other vaccines. Read our FAQ about what is going on with the coronavirus vaccine.
• 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.
• Pods or cohorts: These are groups of children and teachers that stay together at school while minimizing their interactions with other groups. Sticking with these groups lowers the risk of spreading COVID-19. This is because children have contact with fewer people who might be sick. If someone has COVID-19 in a school with strict pods or cohorts, only the people in that group would be exposed, and public health officials can help monitor any potential exposure while keeping others safe.

The most common COVID-19 symptoms are fever, cough, muscle aches, headache and tiredness. Some people have shortness of breath and loss of smell and taste, although these symptoms seem less common in young children.

Many children who have COVID-19 have mild symptoms, and some have barely any symptoms at all.

People can develop symptoms 2 to 14 days after exposure (5 days on average) to COVID-19.

Our experts at Children’s Colorado recommend that students and staff check their symptoms every day at home before going to school. The CDC does not recommend screening upon arrival to school.

A person should stay home if they experience these known symptoms of COVID-19:

• Fever greater than 100.4°F/38°C
• Chills
• New cough
• Shortness of breath
• Body and/or muscle aches
• Fatigue (feeling more tired than usual)
• Loss of taste and/or smell
• Vomiting
• Diarrhea
• New runny nose
• Sore throat

Early in the pandemic, schools were closed in most countries. Now though, children in many places have returned to school. Most countries have not seen large increases in COVID-19 cases after opening schools, but some students and staff have become infected with COVID-19 at school. In general, when cases go up in the community, cases and outbreaks associated with schools have also gone up. The safest thing for keeping COVID-19 out of schools is keeping levels down in the community.

Overall, studies of COVID-19 in schools have found that young children spread infection less often to other children or adults, and adolescents and adults spread infection more often. We are continuing to learn more about the best ways to keep schools safe during COVID-19, and we encourage families to closely follow guidance from your school, district and local health department. 

Childcare centers

Many childcare centers never closed for COVID-19 and most have stayed open safely. Places that reported many COVID-19 cases among children/staff in childcare have had this happen when local community spread of COVID-19 was increasing.

From experience in schools and childcare centers so far, we have learned that the risk of COVID-19 is higher when levels of COVID-19 infection are high in the community, and that the risk may be different for different ages or grade levels.

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. Your school will ask you to check for and report any sick symptoms each day. 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 have confirmed or probable 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. Keep in mind:

• “Confirmed COVID-19” is when a person has a new positive COVID-19 PCR test from a nose or throat swab.
• “Probable COVID-19” is when a person has symptoms of COVID-19 and has been in contact with someone with COVID-19 but has not had a positive COVID-19 PCR test.

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

Learn about COVID-19 testing and antibody testing at Children’s Colorado.

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 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 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). “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 at least 14 days from the last day of contact with that person.

If someone living in your household has confirmed or probable 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 confirmed or probable 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. Students and staff who are contacts of someone with COVID-19 will need to quarantine and stay home from school for 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. Having one case of COVID-19 in a school does not always mean the whole school will close. If a school has several cases within a 14-day period, many people will need to stay home and sometimes a school may be closed.

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 older kids is a higher-risk activity, so try to look for outside sports or clubs when possible.

In general, parents should remember that practically no activities come with zero risk. And because we know that every contact we make with people outside of our household adds risk, families may want to evaluate their priorities when deciding what is more important: in-person school or in-person basketball, as an example.

For 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 the 6-feet apart rule.

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 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 have been following recommended precautions.

“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,” said Dr. O’Leary.

Also, remember to send your child with a freshly laundered face covering. For younger kids, find out the school’s mask policy and consider the developmental age and appropriateness of interventions like face coverings. Face masks aren’t as practical for younger kids when children are touching their faces, adjusting them, or potentially sharing them. If children can’t wear them all day long, ask about certain situations where they can be used, such as shorter periods of time in the hallways or more communal areas.

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:

• A clean face covering (and a spare, if they have one)
• Hand sanitizer with at least 60% alcohol content

“The first thing parents and children should do when they get home is wash their hands,” said Dr. O’Leary. “You can also ask your child to take off their shoes and changes clothes if that makes you feel more comfortable; this isn’t as important as handwashing, and we still have lots to learn about how the coronavirus behaves on fomites, which are objects or materials like clothes, utensils and furniture.”

If virtual learning or homeschooling is what’s best for your child and family, you might be wondering how to juggle all the challenges that come with it. 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.

For parents who elected to homeschool or if schools shut down, many worry about their children making friends, engaging with others, and having a set routine at home. Our mental health experts have created the following resources to help:

• Calming your child's anxiety about the coronavirus
• How to check in on your teen
• Family life during a pandemic: adjusting to a new normal
• Creating normalcy: tips for how to create a schedule and plan activities for children of any age

The risk of catching COVID-19 (and other diseases) at school is related to the risk of disease in the community. When the spread of COVID-19 becomes more common in a community, it may become too risky to keep children in school. Decisions about pausing in-person school should be made by schools or districts in cooperation with public health officials.

It’s likely that the plan for in-person schooling will continue to change over the course of the year in many communities. Families should expect changes as COVID-19 disease activity changes and should think about back-up plans for childcare if in-person schools close.

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