Kids Are Going Back to School. How Do We Keep Them Safe?

As the Delta variant rages and vaccination rates remain low in many parts of the United States, worried parents have one pressing question: How do I send my child back to school safely during a pandemic?

Next week, a number of school districts in the South where case counts for Covid-19 are on the rise, including several in Alabama and Georgia, will begin the 2021-22 school year. Even more schools in Covid hot spots around the country, including districts in Texas, Louisiana and Florida, will welcome students the following week.

While much of the public health conversation has been focused on booster shots and breakthrough infections, parents are frustrated at the lack of advice for families, particularly those with children under 12 years old, who are not yet eligible for a Covid vaccine. On social media and at school-board meetings, parents say they face an impossible choice: send kids to school and risk a Covid-19 infection, or keep kids home and jeopardize their mental health and educational development.

“It’s sad to me that this has to continue to be a white-knuckle ride for families,” said Liz Stuart, professor of mental health at the Johns Hopkins Bloomberg School of Public Health, who has an unvaccinated 5th grader and vaccinated 8th grader heading back to school. “I think in many places children and families have not been prioritized in terms of thinking through what is needed to help them return to school.”

While public health officials generally offer reassurance about the safety of children headed back to school, the advice varies depending on the conditions in your state. Here are answers to common questions parents have about sending kids back to school.

How can it be safe for children to go back to classrooms during a pandemic?

Surprisingly, schools have not been a major cause of Covid spreading events, particularly when a number of prevention measures are in place. A combination of precautions — masking indoors, keeping students at least three feet apart in classrooms, keeping students in separate cohorts or “pods,” encouraging hand washing and regular testing, and quarantining — have been effective. The American Rescue Plan also allocated $122 billion to help school districts pay for health and safety measures, and the Centers for Disease Control and Prevention has allocated $10 billion for screening testing for teachers, staff and students.

“We did a good job last year keeping schools open,” said Dr. Albert Ko, a physician and epidemiologist at the Yale School of Public Health. “We learned a lot during the pandemic. We know what things have worked in the past.”

A study of schools conducting full in-person instruction in Missouri, where mask use was required and 73 percent of schools enforced distances of three to six feet between students, found that secondary transmission was rare. Studies in Utah and North Carolina showed that even during times of surging case counts in the community, school transmission remained low when schools took multiple Covid precautions. In a study of the Archdiocese of Chicago Catholic Schools, one of the largest private school systems in the United States, the attack rate for students and staff was lower than the rate for the community overall.

Parents should expect interruptions to in-person school when Covid cases surge in the community. Several studies have shown that risk to students increases as community transmission rates rise and when schools relax Covid restrictions. In Israel, one school was closed less than two weeks after reopening in May 2020 after two students with cold-like symptoms were sent to school, leading to a Covid-19 outbreak involving 153 students and 25 staff members. Notably, the school had grown lax on enforcing prevention strategies, including lifting a mask requirement during a heat wave and allowing crowding in poorly ventilated classrooms.

While many of these studies were conducted during times of very high community transmission, it’s not clear how effective these measures will be now that the highly contagious Delta variant has become the dominant cause of coronavirus infections in the United States. At the same time, far more people, including teachers and staff, now are vaccinated, which should also help reduce transmission rates in schools.

What are the risks of Covid-19 and the Delta variant to children?

Overall the news is reassuring when it comes to children and the risks of serious complications from Covid-19. New research suggests the Delta variant may cause more serious illness in adults, but it’s not known if the variant puts children at greater risk of more serious illness. Compared to adults, children diagnosed with Covid-19 are more likely to have mild symptoms or none at all. Children are also far less likely to develop severe illness, be hospitalized or die from the disease. Out of about 3.5 million cases of Covid-19 in children in the United States, the National Center for Health Statistics has reported, as of July 28, that 519 children have died from Covid-19 (fewer than 0.015 percent), including 346 children 5 to 17 years of age, and 173 children 4 or younger. Children with underlying medical conditions are the most likely to be hospitalized. Black and Hispanic children also had higher rates of hospitalization, although overall risk remained low.

Some children infected with Covid may develop a rare but serious inflammatory syndrome. By the end of June the C.D.C. had documented 4,196 cases (about 0.1 percent of all pediatric Covid), including 37 deaths.

While any death of a child is devastating, it may help parents to think about other risks to childhood health compared to Covid-19. The C.D.C. estimates there were 480 deaths among children from influenza during the 2018-19 school year. Injury is the leading cause of death among children — about 12,000 children and young adults 1 to 19 years of age die in accidents each year, including more than 4,000 deaths in car crashes, 900 drowning accidents and 761 unintentional poisonings or drug overdoses.

Public health experts say that, in most cases, the risk of educational and mental health setbacks associated with keeping kids home appears to be far higher than the risk of complications from Covid-19 among young people. A number of studies show the pandemic has taken a toll on childhood mental health. And recent findings show that students fell four to seven months behind in math and reading compared to similar students in 2019.

“We’ve scared parents so much they don’t know what to do, and a lot of them are thinking about keeping children at home,” said Neeraj Sood, a professor and vice dean for research at the University of Southern California and director of the Covid Initiative at the U.S.C. Schaeffer Center. “We have to think about children as a whole and taking care of their total welfare.”

What precautions can we take at home to lower a child’s risk?

The most important step is to vaccinate everyone in the family as soon as they are eligible. This will lower the risk of a child getting infected at home and protect family members if a child brings coronavirus home from school. In addition, everyone in the family should get flu shots this fall.

Parents of school age children should remember that risk is cumulative. Lowering your risk at home by avoiding crowds and enclosed public indoor spaces where you don’t know the vaccination status of others can help reduce the whole family’s risk. Paying attention to the community transmission and vaccination rates and wearing masks in risky settings can also help.

“Think through what you do have control over and what you can do yourself,” Dr. Stuart said. “Try to minimize unnecessary exposure. Think of school as an essential activity. The school might be one source of risk, but minimize the other potential sources for the household.”

Home testing is also an option, although it can get costly at about $12 per test. Regular testing of school-aged children, at weekly intervals or before a family visit, can give parents peace of mind when families spend time with people outside their households. While schools may adopt their own testing protocols, there’s no general public health recommendation for regular home testing, which isn’t practical or affordable for most people. You can learn more about home testing here.

And of course, keep children home if they have any respiratory symptoms, remembering that other viral respiratory infections, including respiratory syncytial virus (R.S.V.), are circulating as well.

What should parents do if their school district doesn’t have a mask policy?

The American Academy of Pediatrics has recommended that everyone over age 2 wear masks this fall in school and care facilities. The C.D.C. recently changed its guidance to recommend masks for all children returning to school this fall, but school policies related to masking and Covid precautions are decided by individual states, and they vary widely. In Arkansas, state lawmakers have banned mask mandates, tying the hands of school board members who want to allow local school leaders to make the decision. Parents in New Jersey and California are suing to prevent mask mandates. And at a recent school board meeting in Orange County, Fla., parents clashed over whether masks should be required in schools. The school board voted two weeks ago to end its mask mandate.

“With school starting and the change in the mask policy and with the growing numbers, I am having literal angina,” said Rebecca Jacques, an Orange County, Fla., resident whose 11-year-old daughter turns 12 soon, but won’t be fully vaccinated by the time school starts Aug. 10. “They are responsible for providing a safe learning environment. What’s safe about this?”

Most public health experts agree masking is a good idea, and the C.D.C. has said mask mandates in schools are associated with a roughly 20 percent reduction in Covid-19 incidence. But even in schools with mask mandates, compliance by children is never 100 percent. And masks are only one of many possible precautions schools can take. Parents in school districts without mask mandates should learn what other steps are being taken, including regular testing and ventilation measures. Parents can ask their own children to wear masks in schools, but masking is far less effective if most kids aren’t doing it.

And parents should also know that not everyone agrees that masking is the most meaningful intervention. Dr. Sood argued in a recent editorial in the Orange County Register that masks are a bad idea in schools given the low risk of Covid complications in children and the social toll masking can take.

“I’d rather take the small risk of my child getting Covid rather than my child’s emotional well being suffering because she can’t make friends or have a connection with their teacher,” Dr. Sood said.

Should children spend time with grandparents once school starts?

The answer depends largely on the overall community transmission and vaccination rates and the underlying health of older family members. When everyone is vaccinated, families should feel comfortable spending time together. If younger children are unvaccinated in a fully-vaccinated family group, the risk is low, but some families might want to take additional precautions, like spending time together outdoors, masking in enclosed indoor spaces or using home testing before visiting grandparents to confirm that no one in the family is infectious.

“That vaccinated grandparent should be protected against severe disease in the unlikely circumstance that the child gets infected with Delta, is asymptomatic and brings that home,” said Dr. Paul Skolnik, an immunovirologist and chair of internal medicine at the Virginia Tech Carilion School of Medicine. “Anything you can layer on top to decrease the risk, like testing and masking, might give people peace of mind.”

What about children with special medical needs?

Parents of children at very high risk for complications from Covid-19, including children with sickle cell anemia or compromised immune systems after cancer treatment, may make different decisions about sending children back to school right now. The decision should be made based on advice from the child’s pediatrician and specialists, factoring in local conditions and the precautions being taken at schools.

“That’s a very difficult one. How do you provide the best education for those who have underlying medical conditions that place those children at risk for severe complications of Covid?” said Dr. Ko. “Unfortunately because each condition is different, there’s not a one solution fits all scenario. It requires a very personalized risk assessment and understanding from a health care provider and a discussion with schools about what’s being done to keep children safe.”