Children cannot afford to wait: We need to all work together to help schools reopen

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I hesitated to write this because I am just a pediatric neurologist and epidemiologist.  Plus, I didn’t have any time until I dropped my kids off at school.

Yes, you read that correctly.  I just dropped my kindergartener and third-grader off at school.  Because they are extremely privileged to go to a private school that acknowledged the science last summer and worked hard to put procedures and policies in place to safely bring kids back to campus, before there was even a vaccine on the horizon.  Families were given the opportunity to choose to remain in remote learning or return, and I was grateful to even have a choice.  Some of you have questioned the safety of returning to campus.

Do you think I am willfully putting my children in danger by sending them to school?  Statistics show they have a greater chance of being struck by lightning than contracting COVID-19 from school and dying from it.  Instead of looking at the 0.002% chance something could happen (the current fatality rate for children under 10), let’s look at the 99.998% chance it won’t.  What about MIS-C?  99.94% chance of not dying.  In this terrible pandemic that we are all facing, let’s try to look for the silver linings.  Let’s give families this data in this positive framework and let them make their own decisions about whether or not to send their children to school.

As many working mothers have experienced during this pandemic, in the Spring, I contemplated quitting my job to stay home and help educate my children because our family could remain more than comfortable on a single income.  Many working mothers have not had the luxury of this option.  Many of the single mothers I have spoken to have been faced with a choice: put food on the table or support their child’s learning.  They had to choose to put food on the table and leave their child either home alone or with a family member who may not speak English.  We are not protecting these families by keeping schools closed.  Studies have shown us that child-adult transmission happens at lower numbers than adult-adult and adult-child transmission, likely because of the age-dependent expression of ACE-2 receptors.  Many of these families have a parent working outside the home and have a greater risk of infecting their children and households than their child would if they went to school.  The 1 in 10 asymptomatic positive children tested by LAUSD reflects this – those children contracted COVID-19 during remote learning (at home).  So those children should be kept home to “protect” their families while my children with two physician parents who could also bring COVID home get to go to school?  That doesn’t seem equitable at all.

If we can’t trust large, population-based studies to give us data, then let me give you a few anecdotes. Some children are certainly thriving in remote learning – many of my patients with school-related anxiety are having fewer headaches.  But many are not.  Children with special needs are regressing; other children are having headaches and aches and pains from sitting in front of a screen all day, and having non-epileptic seizures triggered by zoom. Every single day, whether it is in my clinic in Santa Monica or my county clinic in Sylmar, children as young as eight are telling me they would rather die.  The emergency room statistics only account for the children that show up to the ER, not the ones we are talking out of suicide in the clinic.  We have COVID-positive pediatric patients admitted not because they are sick, but because they can’t go home while actively suicidal and can’t transfer to psychiatry while actively infectious.  More children have died of suicide in Nevada than of COVID-19, prompting a call to re-open schools.  At what point will we need to start addressing children’s risk of keeping schools closed?

Certainly, some teachers are afraid to return, and we can all empathize with them, having gone through similar fears last spring.  We appreciate the hard work teachers put in to adapt to distance learning. But it’s now almost a year later.  When interacting in close quarters with asymptomatic children, we know effective PPE is a surgical mask and eye protection.  We know children can transmit, but less often than adults, and are not the viral vectors we feared they would be when it comes to COVID-19.  Greater than 70% of our deaths are in people over the age of 65, which is why age was prioritized for vaccination, and therefore the teachers and staff at greatest risk of death are eligible for vaccination right now.  If we have to wait until every single teacher is vaccinated, then the goalpost might be moved to every single child vaccinated, and then schools will never reopen.  We only have a 57% vaccination rate for influenza, do you really think we can achieve greater than 70% vaccination rates for COVID-19?  Those of you who address vaccine hesitancy every day are probably already dreading this conversation with parents.  Let’s not use vaccination as a tool to hinder school re-opening, but to support it.

Children cannot afford to wait, especially our youngest learners who have difficulty engaging on a screen.  We need to all work together to help schools reopen, especially in low-income communities that are disproportionately suffering and may lack the resources.  I stand with the AAP, CDC, European CDC, WHO, and UNICEF to support safe school re-opening.

Lekha M. Rao is a pediatric neurologist.

Image credit: Shutterstock.com

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