By Sujata Gupta
AUGUST 11, 2021 AT 6:00 AM
Last fall, my husband and I managed our children’s first run-of-the-mill cold masquerading as COVID-19 with ease. We took them for the requisite tests and waited for the results. Meanwhile, the kids stayed home from school, using screens to answer math problems or watch educational programming. At least schools in Vermont, where we live, were mostly open, we said. At least the kids were getting some in-person education and social interaction. At least we were getting some uninterrupted work time.
Then we got our first “close contact” call from school, informing us that someone who had been near one of our kids had tested positive for COVID-19. We were told to wait seven days after exposure and then get a test or wait 10 days with no test before sending them back to school. Soon came the second call. Then a mystery case of diarrhea. The missed school days started piling up. Our ease became uneasy.
Elementary schools in our area remained open, initially for two days and then four, for the entire 2020–2021 school year. Even now, after a chaotic year where each kid missed weeks of in-person school, I remain thankful for the schools’ heroic efforts to maintain some semblance of normal during a very abnormal time. But as schools across the country reopen this fall, our rocky experience serves as an example of what other families could go through.
“Large numbers of students are going to be vulnerable to frequent quarantines,” says pediatric infectious diseases specialist Adam Hersh of the University of Utah in Salt Lake City. “That is going to be incredibly disruptive.”
In some ways, opening schools this year is even more precarious than last fall. The super contagious delta variant has become the dominant coronavirus strain across the United States (SN: 7/30/21). Some medical experts are predicting an uptick of colds and other seasonal respiratory illnesses that have symptoms mirroring those of COVID-19, which could mean even more missed school as kids wait for the all clear. And few states are requiring protective masks, even for unvaccinated students, while several states have even banned school districts from issuing mask mandates.
As children return to school, here are answers to some common questions parents may have.
How can children be kept safe in the classroom?
Masks, masks and masks. That’s especially true for the unvaccinated under-12 set. And given low vaccination rates for teenagers across the country, masking remains the best mitigation strategy even for middle and high schoolers, Hersh says.
Masks also make other, harder-to-implement mitigation strategies less vital, say Hersh and others. For instance, last fall, the U.S. Centers for Disease Control and Prevention recommended spacing children in school at least six feet apart as one COVID-19 precaution. But newer evidence suggests less distancing, or even no distancing, is safe, as long as everyone wears a mask.
“Almost every new study that comes out looking at spacing has shown the three feet of spacing to be just as protective as the six feet of distancing” when there are masks, says John Bailey. He is a domestic policy expert with the American Enterprise Institute, a think tank based in Washington, D.C., that researches education policy and other public policy–related areas.
For instance, Dana Ramirez, a pediatrician at Children’s Hospital of the King’s Daughters in Norfolk, Va., and colleagues tracked nearly 1,200 students in grades one to 12 attending a single, private school in Virginia from August 24, 2020, to March 19, 2021. The roughly 460 students who rode buses sat two to a seat — about 2.5 feet apart — and wore masks. Regular COVID-19 testing — every two weeks at first and then weekly — identified 39 students who rode the buses while infected. But the researchers, whose findings appear July 20 in the Journal of School Health, identified zero cases of transmission.
Similarly in North Carolina, researchers have been tracking COVID-19 precautions and rates of transmission in the state schools since July 2020. That effort is part of the ABC Science Collaborative, a multistate partnership where scientists and medical doctors collect data within schools and then inform educational leaders about best pandemic practices. It now includes 100 of North Carolina’s 150 school districts and over a million staff and students. This spring, with so many children back in school in North Carolina, some school districts reduced required distancing to less than three feet. But even at such close proximity, and with many classrooms lacking adequate ventilation, universal masking kept the odds of a COVID-positive person transmitting the virus to a close contact at less than 1 percent, the researchers note in a June 30 report to lawmakers in North Carolina.
As for classrooms, if “you have to cram 30 people into a really, really tiny room and much less than three feet apart, as long as everyone is masked, that’s cool,” says Kanecia Zimmerman, a pediatrician and epidemiologist at Duke University and cochair of the ABC Science Collaborative.
Besides masking, what else can schools do?
Deploy widespread preventive screening of all students, whether symptomatic or not, says pediatrician Lynn Silver of Berkeley, Calif. Silver is referring to rapid antigen tests, which deliver results in 15 minutes. Children as young as age 3 or 4 can administer these tests themselves, Silver says. And federal funding is available to interested districts.
Silver directs the Safely Opening Schools project, a collaboration between the Public Health Institute, headquartered in Oakland, Calif., and the California Department of Public Health. She headed a screening project from January to July across 10 school districts in five California counties. Schools generally tested students, who all wore masks, once or twice per week, and administered almost 100,000 tests.
The team found that positive cases within schools remained extremely low, with only a 0.1 percent of over 27,000 tests in the pilot study coming back positive. Subsequent PCR testing, a more accurate but slower testing method, revealed few false positives. The screenings also helped ease parents’ concerns, with some 90 percent saying that the tests helped them feel more comfortable with in-person schooling.
“Screening is particularly valuable in elementary schools where all the kids are unvaccinated,” Silver says. And the tests are considerably more effective at identifying positive cases than current protocols, such as symptom and temperature checks.
Still, this sort of regular screening is labor-intensive. Caregivers must consent to their children being screened. Trained staffers are needed to administer the tests and screening takes time away from education, both Hersh and Zimmerman say.
“Screening becomes all the more important in a setting where masks are not going to be required or used at high rates,” Hersh says. But “I don’t think you could choose screening over masks and expect that you could keep the school environment safe.”
Are disruptive, “close-contact” quarantines necessary if everyone is wearing masks?
That’s ultimately a decision left up to school districts and states. But the CDC offers guidance.
The agency defines a “close contact” as “someone who was within six feet of an infected person … for a cumulative of 15 minutes or more over a 24-hour period.” And the CDC currently recommends that close contacts who are not fully vaccinated, which would include anyone under age 12 for now, should quarantine at home from seven to 14 days after exposure.
When a child or adult in a classroom tests positive, that can mean the entire class has to quarantine and test before returning to school. My son’s third-grade class and my daughter’s kindergarten class both shut down repeatedly for this very reason. Similarly, Zimmerman and her team found that a single positive case within a given school triggered quarantines for over 100 people.
But because COVID-19 transmission in schools is so low when everyone wears masks, the CDC should consider eliminating quarantine recommendations in masked environments to avoid unnecessary disruptions, Zimmerman says. “My hope is the CDC will continue to move in the way of existing science.”
Absent such a change, this school year could become very fragmented, especially with remote school less available than in 2020 in some places, says epidemiologist and demographer Jennifer Dowd of the University of Oxford. “It will be back like the old days when kids just missed school.”
What if masks are optional at our child’s school?
The CDC recently changed its guidance to recommend that everyone in schools should wear a mask, regardless of vaccination status (SN: 7/27/21). The American Academy of Pediatrics recommends that everyone older than age 2 wears masks in school and care settings this fall.
But the decision on masking in schools is ultimately left to the states themselves, with less than a dozen mandating masks as of early August. In Florida, Texas, Arizona and a handful of other states, officials have expressly forbidden school districts from mandating masks in classrooms, even for children too young to be vaccinated.
That reality changes best practices entirely, Zimmerman says. Without universal masking, all the other COVID-19 precautions become essential, including six-foot distancing, those dreaded quarantines for close contacts, widespread and regular screening for teachers, staff and students and even limiting or canceling sports and music, activities that have shown conducive to high rates of COVID-19 spread, she says (SN: 8/6/21).
But some states are neither requiring masks nor other measures like quarantines for close contacts. For instance, in Texas, keeping a child who has been exposed to COVID-19 home is a choice, not a requirement. “Parents of students who are determined to be close contacts of an individual with COVID-19 may opt to keep their students at home during the recommended stay-at-home period,” reads an Aug. 5 statement from the Texas Education Agency.
These political realities can make for complicated decision making for parents and caregivers living in such states. For instance, data on rates of transmission when some children are masked and others aren’t not available. But children in such situations should still mask, Hersh says.
Does the delta variant change things?
Most experts concur that even with the highly transmissible delta variant of the coronavirus circulating in the country, schools should remain open. But COVID-19 mitigation measures become that much more important.
“Schools were relatively safe places, even during the height of the pandemic. We don’t want to tell anyone to keep their kid home out of fear. But they can be made safer by strong masking policies and by use of testing,” Silver says.
Evidence from school this summer in Los Angeles suggests that spread even with the delta variant remained relatively low with universal masking and regular screenings, says Daniel Benjamin, a pediatrician at Duke University and Zimmerman’s cochair at the ABC Science Collaborative. The Los Angeles Times reported August 4 that 44,000 staffers and K–12 students attended classes from late June to late July. At the beginning of summer school, 1 in 1,000 tests came back positive for the coronavirus compared with 6 in 1,000 at the end of the program. Most people who contracted COVID-19 did so outside of school, the paper reports. This case study suggests that delta isn’t better at evading masks than other variants, Benjamin says.
Dowd concurs. “Delta does seem way more transmissible but … it can’t defy the laws of physics.”
What should we do when our kid gets a cold?
Medical experts worry that the pandemic’s protracted period of social distancing could make children more susceptible to colds and other common respiratory infections this fall and winter. Worse, there’s no surefire way to distinguish between cold and COVID-19 symptoms.
For that reason, “it’s never a bad idea for a symptomatic individual to get tested,” Hersh says.
But for unvaccinated children, all those sniffles could add up to a lot of missed school as kids wait for a negative COVID-19 test result. Last school year, it typically took two to four days to receive my kids’ PCR test results.
To avoid contributing to the spread of these other respiratory diseases, “I hope parents are a little more sensitive about keeping kids home if they’re sick,” Dowd says. But, she adds, “for so many reasons, that’s not always practical. Kids can have sniffles for months on end.”
One bright spot this year, potentially, is the widespread availability of rapid antigen tests. While these tests can deliver false negatives in asymptomatic individuals, they are almost 100 percent accurate at identifying COVID-19 in symptomatic individuals, according to a Jan. 1 study in Morbidity and Mortality Weekly Report. For that reason, Dowd and others recommend that parents keep some of those tests at home. But they can get pricey. My local pharmacy sells two-packs for around $20 to $25. Schools, though, can utilize federal funding to stock those tests and use them when a kid shows up with a stuffy nose.
I used the experts’ advice immediately. In mid-July, my son woke up with a scratchy throat and we went to the clinic for a PCR test. His thankfully negative result took 48 hours to come in, resulting in two days of missed camp and the all too familiar work-parenting juggle. By the time my daughter got sick a few days later, though, I had purchased the rapid antigen tests. Fifteen minutes later, I had her negative results in hand.