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How do we get kids back in school and prevent them from getting COVID during the Omicron surge?

“Students benefit from in-person learning, and safely returning to in-person instruction continues to be a priority.”
Guidance for COVID-19 Prevention in K-12 Schools

After all, that’s what everyone wants, right?

Is anyone surprised that Texas leads the US in childhood COVID deaths?

It’s hard to see how we can do that safely without a lot more people getting vaccinated and boosted, masking, practicing social distancing, more testing, and following through on quarantines for those who are exposed, and isolation for those who are sick.

“CDC recommends universal indoor masking by all* students (ages 2 years and older), staff, teachers, and visitors to K-12 schools, regardless of vaccination status.”
Guidance for COVID-19 Prevention in K-12 Schools

Still, in most cases, folks don’t want to go back to on-line schooling, especially for long periods of time.

So to get kids back in school during the Omicron surge, parents, students, and staff should all work together to keep their kids safe and healthy by:

going into home quarantine if they have been exposed to someone with COVID and they are not vaccinated (including a booster dose if they are at least 18 years old and are eligible) or have not had COVID in the past 3 months, remaining in quarantine for at least 5 days. After 5 days, if they have not developed symptoms of COVID, they can get a COVID test and if it is negative, they can return to school, wearing a well-fitting mask for an additional 5 days. And of course, they should get tested if you develop symptoms at any time during these 10 days. If they can’t get tested after 5 days, they can still leave quarantine early if they don’t have symptoms and will wear a mask for another 5 days.
going into home isolation if they have COVID, remaining in isolation for at least 5 days, with the ability to end isolation after 5 days if they are fever free for 24 hours, have either had no symptoms or improving symptoms, and will wear a mask for an additional 5 days whenever they are around other people.
keeping away from anyone who is at high risk for severe COVID disease until the full 10 days of quarantine or isolation ends.
maintaining adequate distance from others during times when they have to take off their mask at school and they are still within the last 5 days of your quarantine or isolation, like when they are eating lunch.

And what if they can’t or won’t wear a mask consistently and correctly and are in quarantine or isolation?

Since they aren't allowed to tell anyone to wear a mask, the Texas Education Agency is trying to implement just half of the CDC guidance to end quarantine and isolation early. Unfortunately, it really doesn't work if you don't wear a mask! — Since they aren’t allowed to tell anyone to wear a mask, the Texas Education Agency is trying to implement just half of the CDC guidance to end quarantine and isolation early. Unfortunately, these plans don’t really work safely if you don’t wear a mask!

Then they should finish out their full 10 day quarantine or isolation at home!

“Staying home when sick with COVID-19 is essential to keep COVID-19 infections out of schools and prevent spread to others.”
Guidance for COVID-19 Prevention in K-12 Schools

What else does the CDC recommend to help keep kids in school safely?

“Vaccination is the leading public health prevention strategy to end the COVID-19 pandemic. A growing body of evidence suggests that people who have completed the primary series (and a booster when eligible) are at substantially reduced risk of severe illness and death from COVID-19 compared with unvaccinated people.”
Guidance for COVID-19 Prevention in K-12 Schools

In addition to vaccination, quarantine and isolation strategies, the CDC recommends consistent and correct mask use, physical distancing, screening testing, improving ventilation, handwashing and respiratory etiquette, contact tracing, and cleaning and disinfection, etc.

“Recommend screening testing for high-risk sports and extracurricular activities at least once per week.”
Guidance for COVID-19 Prevention in K-12 Schools

For example, in areas of low to moderate COVID transmission, doing screening tests of kids in high risk sports and extracurricular activities might help prevent outbreaks. On the other hand, when transmission rates are high, schools should probably just cancel or hold high-risk sports and extracurricular activities virtually to protect in-person learning.

Will this work?

Many big city school districts aren’t convinced and are already delaying the start of the second half of the school year…

“With the above principles in mind, the AAP strongly advocates that all local, state, and federal policy considerations for school COVID-19 plans should start with a goal of keeping students safe, physically present, and emotionally supported in school.“
COVID-19 Guidance for Safe Schools and Promotion of In-Person Learning

Let’s hope the COVID surge ends quickly, states and school districts do more to protect our kids, more people get vaccinated and boosted, and we can get all of our kids back in school!

More on COVID School Guidance

For most parents, the ongoing COVID-19 pandemic has complicated their plans to send their kids back to school.

Going Back to School During the COVID-19 Pandemic

We can likely all agree that if it could be made safe for kids, teachers, and other support staff in schools, then kids should go back to school.

So what’s the problem?

Depending on where you live, the size of your school, and the number of cases, etc., it may not be possible to make schools that safe. After all, how much social distancing can you do in a classroom full of kids? And will kids, especially younger kids, really wear a face covering all day?

Sending Your Kids Back to School

On the other hand, if your community is doing a good job of keeping COVID-19 case counts down, then maybe it is safe, or at least, safe enough, to send most kids back to school.

Online or virtual schooling will be a safer option for higher risk kids. Fill out and review the CDC’s Back to School Decision Making Tool with your pediatrician if you aren’t sure what to do about school.

Going back to school might be a good option for:

kids who are healthy, without any high risk medical conditions, like diabetes or poorly controlled asthma
kids who have no high risk contacts at home, keeping in mind that in addition to having a chronic medical problem, the risk increases with age, especially once you reach age 65 years.
kids who have an IEP or get any kind of services or therapy at school that you can’t get at home
kids who did poorly with online school last spring
kids who are eager to go back to school

Most importantly, going back to school might be a good option for your kids if you are confident that your school has a good plan to keep your child and everyone else in the school safe.

Do they have a plan to cohort kids together, so that every kid in the school isn’t mixing with each other? What is their plan if someone gets sick? What is their plan if a lot of kids get sick?

It is also important to remember that virtual school isn’t a good option for everyone. Having a safe school to go to will be important for those kids who don’t have a parent or caregiver at home to help them with school or because they don’t have a reliable internet connection, etc.

Going to the School Nurse During the COVID-19 Pandemic

If your kids do go back to in-person school, what happens if they get sick?

“Immediately separate staff and children with COVID-19 symptoms (such as fever, cough, or shortness of breath) at school. Individuals who are sick should go home or to a healthcare facility depending on how severe their symptoms are, and follow CDC guidance for caring for oneself and others who are sick.”
Operating Schools During COVID-19

Should they go see the school nurse, if your school is fortunate enough to have one?

“School nurses are essential healthcare providers in the community working on the frontlines of the COVID-19 pandemic in schools.”
Considerations for School Nurses Regarding Care of Students and Staff that Become Ill at School or Arrive Sick

In addition to the problem with a bunch of contagious kids in the school nurse’s office, it is easy to see that it will difficult, if not impossible, for health care professionals at school to easily know if a sick child has COVID-19, strep throat, a cold, or the flu, etc.

“The overlap between COVID-19 symptoms with other common illnesses means that many people with symptoms of COVID-19 may actually be ill with something else. This is even more likely in young children, who typically have multiple viral illnesses each year.”
Screening K-12 Students for Symptoms of COVID-19: Limitations and Considerations

There is also the fact that a child who goes to the nurse’s office with a cough, runny nose, or headache, etc., might not have a contagious disease at all, as these symptoms can also be caused by asthma, allergies, and migraines.

“Remember that schools are not expected to screen students or staff to identify cases of COVID-19. If a school has cases of COVID-19, local health officials will help identify those individuals and will follow up on next steps.”
Considerations for School Nurses Regarding Care of Students and Staff that Become Ill at School or Arrive Sick

Fortunately, there are plans in place to deal with all of these scenarios.

Still, everyone should understand that most “sick kids,” whatever they have, will likely be sent home from school, just in case they have COVID-19. While that might sound drastic, the risk of getting others sick if they did have COVID-19 is too great.

“Actively encourage employees and students who are sick or who have recently had close contact with a person with COVID-19 to stay home.”
Operating Schools During COVID-19

So how do these plans work?

Back to School COVID-19 Sick Policies

While each state and school district seems to have their own back to school sick policy, in general, what to do should likely depend on the child’s symptoms, the possibility of an alternative diagnosis for the symptoms, potential for exposure to someone with COVID-19, the amount of community spread in the area, and COVID-19 test results, etc.

The Minnesota COVID-19 decision tree is for people in schools, youth, and child care programs who are experiencing symptoms consistent with COVID-19.

If one thing isn’t clear in all of these guidelines, it is to your pediatrician – we typically won’t be able to simply say that your sick child doesn’t have COVID-19 and can go back to school.

“A doctor’s note or negative test should not be required to return to school. Some tests can yield false negatives if taken too soon, and individuals with confirmed COVID-19 can continue to test positive after the infectious period has passed. Antigen tests currently are not as reliable in determining a true negative.”
Decision Tree Tool for School Nurses

Fortunately, many of the guidelines seem to understand this and don’t require a doctor’s note when kids have very mild symptoms.

“If the person is sent home, they can return to the school or program 24 hours after the symptom has improved.”
COVID-19 Decision Tree for People in Schools, Youth, and Child Care Programs

They aren’t perfect, but hopefully we can use these guidelines to help balance keeping those kids who might have COVID-19 out of school, perhaps learning virtually, while those kids who don’t remain at their desks.

Tag: back to school