This new virus named SARS-CoV-2 which has plagued the USA since late January 2020 is still running increasingly rampant. We have lost over 139,000 citizens and we continue to lead the world in COVID-19 caused deaths and the total number of cases. Thirty-eight states show increasing case counts. Hospitalizations are rising dramatically, and deaths are ticking up. These grim statistics prove that the still woefully inadequate increases in testing is not the source of the increased number of cases. Some ICUs are operating at 120% capacity. Active duty military medical personnel have been dispatched to assist overwhelmed hospital staffs in Florida, Texas, and Arizona. More refrigerator trucks have been ordered to serve as temporary morgues in Florida, Arizona, and California. The disease remains out of control thus jeopardizing more lives as well as livelihoods. It is a harsh reality that our country has not yet emerged from the first assault from this virus. We continue to needlessly suffer because of a lack of a coordinated federal effort and mixed messaging that contributes to people not following simple proven advice of WEAR masks, WASHING hands, and WATCHING your distance!
Because this pandemic is still roaring, our clear knowledge that our school-age kids need to be back in the classroom and our desire to make it so, is tempered by our concern for their safety. Their well-being and the safety of the teachers and staff must be considered first. Unfortunately, the educational disparities which preexisted COVID-19 are magnified by the school closure mandates and by the measures being proposed to put our children back in the classroom. Those schools with more resources have more flexibility for reopening. In fact, there are private schools which plan to reopen full-time whereas public schools in the same communities are forced to provide part time instruction. Even though schools have been shuttered since March, federal resources and CDC guidance which should have been disseminated to state and local governments, has been thwarted by the White House, so school districts have had to go it alone as they plan on when to reopen schools. The American Academy of Pediatrics states that the feds need to provide schools with over $200 billion so that schools can be opened more safely. The medical community has learned as the pandemic has progressed that children are not infected as frequently as adults, they generally experience less severe ailment when they contact the disease, and children do not drive the spread of COVID-19 as they do with seasonal influenzas. Nevertheless, in situations where there is extensive community spread of the disease, as is the case in much of the United States, placing children back into classrooms is a recipe for increased spread among students, school staff, relatives at home, and thus the community. Reports are that up to 25% of our K-12 teachers have preexisting health conditions which make them more vulnerable to the hazards of COVID-19. As healthcare providers, we recommend that school reopening be delayed until community spread is at an acceptable level.
Returning to school safely requires multiple changes to the traditional classroom. These changes, just as all that we do to live with COVID-19, do not eliminate the risks of contracting the disease, but are designed at lessening that possibility. Conducting instruction and activities outside and improving the ventilation and air exchange in the school buildings would be helpful. Reopening schools more safely can be fit into the three W’s (Wear, Wash, and Watch) that we use to manage COVID-19 in other scenarios. All adults and older students should wear masks. Hands should be washed frequently with soap and water, using hand sanitizer as an alternative when necessary. Disinfecting all high-touch surfaces on a frequent schedule should be completed. Physical distancing means reducing classroom size, increasing spacing between desks, alternating shifts and/or days, as well as changing break and lunchtimes and locations. Communities must plan for and be willing to go virtual if the virus surges. All specific measures that are implemented need to consider the needs of marginalized children.
The physical and mental health of children and adolescents is very much interwoven into the fabric of a society. Getting the kids back to school more safely must depend on pertinent public health data and requires the commitment of leadership, resources, and putting the children above the politics.
Clyde E. Henderson, MD
Cincinnati Medical Association