AAP Voices Blog

The summer of 2020 was like no other. Family vacations were cancelled, grandparents missed seeing their grandchildren, and kids played in backyards instead of playgrounds.

As a parent and a pediatric infectious disease physician with a background in epidemiology, I had a pressing decision to consider that weighed heavily on my mind: Should I send my children back to school?

In other parts of the world, such as the UK, school was already in session and the data was surprising. It appeared that adults were more likely to spread COVID-19 to other adults or children, rather than children spreading it to others. When there were outbreaks in schools, they occurred in communities where there were high rates of infection.

In our state, New York, we saw a surge of COVID-19 infections in the spring of 2020, but the number of pediatric hospitalizations were a small fraction and lessened considerably until the end of the year. In 2021, we saw more children being hospitalized and infected; some children were infected even if they attended school remotely. It is most likely that, as restrictions were lifted in communities, children were infected from a family member who acquired COVID-19 outside the home, especially with the spread of highly transmissible variants as the virus attempted to infect more people.

“Infection prevention strategies are making a world of difference in schools, camps, day care centers, and other places.”

So, what is making a huge difference in helping to prevent the spread of COVID-19 in a classroom? Infection prevention and control policies and procedures, including masks. Wearing a mask also has changed our children’s lives by preventing respiratory infections. While we normally see thousands of cases of influenza in children in the winter months, we were down to hundreds last season. 

Many schools now are offering hybrid education to reduce the number of on-campus students and staff and limiting interactions with infected or quarantined children by creating web-based learning environments. Also, school districts with resources are able to have 3-6 feet of space between desks, cohort children in the same classroom, screen students for fever and symptoms prior to entering the building, and require testing for symptomatic teachers and students. Many of these schools that are successfully back to in-person learning also are being vigilant about hand-washing and sanitization of shared areas.

Infection prevention strategies are making a world of difference in schools, camps, day care centers, and other places. As pediatricians, we can promote best practices for infection control in our practices and workplaces to also help reduce the spread of COVID-19. We can help shape policy at school board meetings, educate during PTA gatherings, and assist school physicians working in the local department of health to identify children who have been infected.

Every school-aged child has a unique situation -- perhaps an immunocompromised sibling, an elderly grandparent, or a chronically ill family member lives at home. As pediatricians, we should keep that in mind as we offer advice to families on returning to in-person learning. While adhering to physical distancing as well as avoiding crowds and travel will help to protect these high-risk individuals, school has not been shown to be a place of rampant spread or large outbreaks of COVID-19.

When I was making this decision for my own children, I considered my own parents, who have multiple co-morbidities and a higher likelihood of hospitalization if infected with COVID-19. Yet, the decision seemed to still lean in the direction of sending my two boys to school.

There were many reasons. First, in a home with two working parents, our ability to make sure our children were educated in addition to supporting our family seemed to place us in a stressful situation. Second, we were seeing increased screen use, lack of physical activity, and poor social skills appear, even with our best efforts to keep our children occupied with daily routines. Third, we believed the trade-off between limiting visits with grandparents to socially distanced, outdoor, masked events was worth the amount of social, emotional, and academic stimulation they would experience in school. 

Overall, the benefits appeared to far outweigh the minimal risk of attending school with all the modifications in place in our district. So, we sent our boys back to in-person school in September 2020, when the rates of transmission were low in our area, the school had assured us that they were taking all precautions to protect students, and a system was in place to keep ill children out of school.

Now, I am vaccinated. Many grandparents are vaccinated. There is hope on the horizon that our children will be vaccinated soon. With more immunity in the population as more people get the vaccine, we can dream of resuming our pre-pandemic lifestyle soon and be ready to embrace it with open arms. Until then, continued infection prevention and control policies and procedures will be critical to reduce the spread of infectious diseases and keep our children in schools.

A few helpful resources for pediatricians and their patients’ parents:

CDC’s Project Firstline

Operating Schools During COVID-19

AAP Interim Guidance for Safe Schools

HealthyChildren.org Article on Safe Schools