After surveying employees to see what was weighing most on your minds about the back to school season, it was clear the safety was top of mind.  We've partnered with Mayssa Abuali, MD, Director of Einstein Inpatient Service at St. Christopher's Hospital for Children & Director of Einstein Pediatric New Arrivals Clinic (EMCP), and Eric Sachinwalla, MD, Medical Director of Infection Prevention & Control, EMCP, for a Q&A on back to school safety.

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Please note the information provided here is based on the most recent available medical literature and guidance from the Centers for Disease Control and Prevention (CDC) and the Pennsylvania Department of Health.  Please discuss any questions you may have with your primary care provider.


How does COVID affect children?

Unlike adults, COVID-19 infection is generally mild in children. To date, cumulative cases of children in the US are 9 %. Children are hospitalized at much lower rates than adults 8/100, 000 compared to 164.5/100, 000 in adults. There is a small subset of children that get so sick that they require ICU admission for respiratory support. The mortality rate in children is < 1 %. MIS-C or multisystem inflammatory disorder is a disorder that hyperactivates the immune system affecting many organs including the heart 4-6 weeks after the initial COVID-19 infection. It is rare occurring in 2/100, 000 children. Most children with MIS-C are hospitalized but end up recovering.


What conditions put my child at an increased risk of severe illness from COVID?
Based on the current available data, the conditions that put children at higher risk for severe COVID disease are prematurity, chronic lung disease, and obesity. Asthma has not yet been shown to be a high risk condition. Congenital heart disease, immunodeficiencies, diabetes mellitus, sickle cell disease may be higher risk conditions, but this has not been well established. Children less than 2 years are at higher risk for hospitalization. Please discuss any chronic conditions your child may have with your Pediatrician to help assess risk associated with school return.


Should we worry about kids being asymptomatic?
Yes, children may be become infected with COVID and remain symptoms free. It is not fully clear what role asymptomatic children play in transmission but based on the available studies children do not seem to be driving this pandemic. Household transmission studies show that most transmission occurred from adult to child and not the other way around. Studies in daycares in the US and schools around the world have shown that children, especially those less than 10 years old, are not transmitting virus efficiently in the educational setting.


If my child returns to school in-person, can they still see their grandparents?
No social interaction is risk free. The reality is that grandparents are at higher risk for more severe disease, especially if they have underlying health conditions. The decision to visit grandparents must be made by the family after assessing and understanding the risk. Masking and social distancing and keeping one’s social “bubble” (the number of people one interacts with) small lowers the risk. Outdoor family activities are also much lower risk than indoor ones.


How do I know if the school/childcare center is safe?
The Philadelphia Department of Health in conjunction with CHOP Policy Lab has issued clear guidelines for childcare and schools to keep children safe. Review the safety guidelines with your school including social distancing (keeping desks 3-6 ft apart, use of plexiglass between desks), cohorting into smaller groups that do not intermix, strict hand hygiene, masking of adults and older children, and enforcing vaccinations for all students and a robust sick policy that does not allow sick children to remain in the school/daycare. Good ventilation including an HVAC system and windows that can be kept open and intensive school building cleaning are also key.


What advice do you have for parents/caregivers who feel fearful about their child(ren)’s return to school/childcare setting?
The risk of a child acquiring COVID at school highly depends on the rates of community transmission. If the number of cases is high in the community then the risk is higher. If community transmission is low and the school is adequately taking all safety precautions, then the risk of attending school is low. Again, this a decision that must be made by each family after assessing the risk. Factors to consider: child’s age, child’s health conditions, presence of vulnerable family members living at home, safety precautions at the school, and comfort with virtual learning.


What tips do you have for families to best prepare for return to school/childcare?
Practicing Hand hygiene for 20 seconds, mask training, instructing children to never touch face, talking openly about how different it will be so that they are prepared.


Are there long term effects for children wearing masks for long periods?
No, there are not. Masks are very effective at preventing COVID. Asthmatics can safely wear masks.


What safety measures should we take when child(ren) return home at the end of the day?
COVID-19 is not likely to last long on soft surfaces such as clothes. It is estimated to last on cardboard for 24 hours and plastic/stainless steel for 3 days. The number one safety measure for children is hand hygiene-washing hands with soap and water or hand sanitizer after returning from school.


What are the best ways to encourage socialization with other child(ren) but still remain safe?
Choosing one or two families to create a “social bubble” with an agreement that all members will socially distance and mask during all activities including those outside the bubble. Outdoor activities with other children are much lower risk than indoor ones. Activities that allow children to maintain distance from one another are also safer than activities that require close contact or touching.


Is it safe for my child to ride the bus?
Again, riding a bus is not a risk free activity. Risk can be decreased by keeping windows open, social distancing on the bus, and cohorting through assigned seats.


I am worried about my child(ren) having so much screen time both for school and recreation. Do you think there will be long term impact?
The American Academy of Pediatrics recommends limiting screen time to 1 hour a day as prolonged screen time can interfere with development. However, children can learn from high quality and educational programming and virtual schooling is not likely to cause harm. When not virtually learning, encourage your kids to go outdoors, practice physical activity, and experiential learning through hands on science experiments and art/crafts activities.