While we are relieved that COVID-19 has largely spared children in terms of illness, we have seen the troubling effects it has had on them in terms of isolation and loss of community, particularly stemming from the closure of schools and the important developmental, social, and educational engagement that schools provide. With that in mind, we urge deliberate planning now for the physical reopening of schools in the fall, with a virtual option for immunocompromised children and families.
Sadly, over the past few months, we have seen increases in anxiety, depression, and suicidality among the children and adolescents we serve. We have also seen increases in obesity, teen pregnancy, accidents, and food insecurity.
Children rely on schools for education, as well as community, nutrition, physical activity, socialization, and the many small daily challenges and successes that help them grow. Children with disabilities or special needs require services that are extraordinarily difficult to deliver remotely. Additionally, we have grave concerns that the achievement gap is widening due to these school closures. As such, we strongly support schools in their efforts to open their doors and classrooms to Colorado’s children this fall with appropriate steps to lessen risks for children, teachers, and support staff.
Although COVID19 is not yet well understood, we do know that it does not affect children as severely as adults, with children under 20 making up 7% of cases in Colorado (and only 2.4% of cases in children under 9 years old) and only 5.2% of cases in the United States. In addition, children who test positive for COVID are less likely to be hospitalized (0.6% to 3.5% nationwide), or to die (46 child deaths reported in the U.S.).
There is also emerging evidence that unlike other viruses, children are not ‘super spreaders’ of coronavirus, transmitting the virus rarely with one another and even less to adults. The data show that adults are the primary source of household infection. Our decisions regarding school openings should be data-driven and based on facts. It is crucial to recognize that the epidemiology for children is not the same as for adults.
The reopening guidelines for school districts should be based on the best available evidence, with flexibility for local conditions. Like children, no two schools are exactly the same, and we recognize there are important geographic variations. Reasonable safeguards are necessary, and we must not be cavalier. The spread of infection can be mitigated by wearing a mask when possible, frequent hand washing, appropriate disinfection and daily symptomatic checks.
The American Academy of Pediatrics Colorado urges a balanced, collaborative approach involving educators, public health officials, pediatric providers, mental health professionals, and parents. In re-opening our schools, we need to both minimize risk and provide children with opportunities to learn in an environment that encourages developmentally appropriate curiosity, exploration, and learning.
We want schools to know Colorado’s community of pediatric providers are here to help them and their students when it comes to COVID and other viral childhood illnesses. We urge universal influenza vaccination of all staff and students as well.Finally, AAP Colorado strongly recommends having at least one pediatric provider on whatever oversight board will be monitoring school re-openings to provide the most up-to-date specialized guidance focusing on child health, development, mental health, and special needs.
We are eager to partner with Colorado schools to protect the health and wellbeing of all children across our state and strongly urge back to school plans that provide our children the opportunity to return to their classrooms in-person this fall.
Dr. Meghan Treitz is a general academic pediatrician and president of the American Academy of Pediatrics, Colorado Chapter.
Dr. Rusha Lev is a practicing pediatrician, mother of four, and member of the American Academy of Pediatrics, Colorado Chapter.