Some kids will get COVID. Here’s how to reduce risk | #covid19 | #kids | #childern

Despite the governor’s executive orders, the state’s pages of guidelines and local school districts’ intricate plans, this much is clear: when schools reopen for in-person instruction next month, some kids will get COVID-19.

But compared to the rest of the country, New Jersey is in relatively good shape. The virus’ rate of spread here is at some of its lowest levels since the pandemic began. And evidence shows that face-coverings, social distancing and symptom-screening significantly reduce transmission.

“We can mitigate the risk, we can’t make there be no risk,” said Dr. Margaret C. Fisher, a renowned pediatric infectious disease specialist and medical director of the Unterberg Children’s Hospital at Monmouth Medical Center.

She expects to see an increase in coronavirus infections in the fall, but adds: “If we wait until we get this so good that nobody gets sick, nobody will get back to school.”

When they do get back, students could be sent home for a cough or runny nose that in pre-pandemic times would have seemed minor. They may be ordered to stay home until the result of a COVID test comes back – and, since labs are overwhelmed as cases ramp up in other parts of the country, who knows how long that will take.

If one kid tests positive, whole classes – or “small group cohorts” in the new lingo – will be ordered to quarantine at home. And if there’s an outbreak, entire schools may be temporarily shut down.  

The severity of the flu season “will be the big wild card,” Fisher said, urging parents and children to get vaccinated against influenza. As doctors and school nurses struggle to differentiate between flu and COVID-19, “It will be difficult for schools.”

School nurses are braced. “We don’t know what to expect when we open our doors,” said Dorian Vicente, president of the New Jersey State School Nurses Association. “We hope and pray that students don’t come to school sick …. [But] we are going to be seeing some sick kids.”

In-person is best, but flexibility required

Why, without a vaccine or guaranteed treatment, are schools trying to reopen? Because in-person education is so much better than the alternative.

Schools provide a setting not only for children to learn, but to socialize and grow emotionally; stay out of harm’s way while their parents work, and connect with caring adults who identify and help meet their special needs.

For many, it’s also where they get breakfast and lunch.

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That whole constellation “cannot be replicated via virtual learning,” said Dr. Tina Q. Tan, a professor of pediatrics at Northwestern University Feinberg School of Medicine.  

But one approach won’t work for New Jersey’s more than 600 schools. Some buildings are old and crowded, others modern and spacious. Some districts already have warehoused face masks and hand sanitizer, others can’t afford to. Families’ ability to check their kids’ symptoms each day and send them off with protective gear or to supervise remote learning, varies widely.  

Gov. Phil Murphy is allowing individual districts to determine whether they can satisfy the state’s guidelines for safe reopening, and if not, to use remote learning in the meantime. Districts may also craft hybrid plans or use staggered start-times, split sessions, or alternating days of in-person instruction. And ultimately, he’s given parents the choice of opting for completely virtual learning for their children.

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State divided into six regions

To respond to varying local conditions, state health officials have divided the state into six regions. Like Smokey the Bear’s forest fire warnings, each region is assigned a COVID-19 risk category weekly – green, yellow, orange or red.

The colors are based on three factors: the number of COVID-19 cases in the region, the rate of positive COVID test results, and trends in the amount of  COVID-19 symptoms observed by school nurses, public health officers, local doctors and emergency rooms.

School nurses, who already participate in the state’s surveillance network for influenza, are a vital part of that monitoring effort, said Vicente.

The risk level – and school plans – in one region will likely differ from another. “If you have an outbreak in one area, you don’t have to close down the whole state,” said Fisher, recalling how North Jersey’s pandemic wave crested weeks before South Jersey’s.  

And with the state Health Department predicting that COVID-19 cases will begin to rise again in October and peak in April, the regional risk color will likely change over time.

Currently, the counties comprising New Jersey’s northwest and northeast regions — Morris, Passaic, Sussex, Warren, Bergen, Essex, Hudson – are in the least restrictive green zone.

The rest of the state is in the yellow zone, where remote learning arrangements are recommended for students and staff at high risk of severe illness, and hybrid arrangements are to be considered for all others. In the red zone, if that should occur, remote learning would be recommended for everyone.

Children and COVID-19: research still needed

Much is still being learned about how coronavirus spreads and the role children play in its transmission. The National Academy of Sciences, which issued a report on reopening K-12 schools, strongly recommended that schools’ experiences in the coming months be used to gather more data.

The comparative effectiveness of various steps to mitigate the spread “really needs more research,” said Enriqueta Bond, chair of the academy’s advisory committee on reopening, noting the substantial costs involved. Are partitions between desks more effective than spacing them 6 feet apart, for example? Does a wearable thermometer work better than requiring parents to screen kids at home?   

Research has shown that children under 10 years old are less likely to develop serious illness or die of COVID-19, though the reasons are not completely understood. Infants, however, and those with underlying health conditions such as diabetes are more vulnerable.

In New Jersey, only two children have died, among a statewide death toll of more than 14,000. Both had other, unspecified conditions that made them more vulnerable, health officials said.

The symptoms of COVID-19 in children are similar to those in adults, with cough and fever most common. But many children are asymptomatic.

Fewer than 3% – or 5,224 – of the total positive diagnoses in New Jersey have been among children 17 years old or younger. They were less likely than adults to be hospitalized for complications of coronavirus, too. The 208 children hospitalized with COVID-19 since the pandemic began accounted for just 1% of the state’s hospitalizations, according to Health Department statistics from July 30.

Some children do develop a rare, serious and potentially life-threatening complication of coronavirus, called multisystem inflammatory syndrome in children. It appears to be a delayed over-reaction by the immune system after the initial illness has passed, and almost always requires hospitalization.

New Jersey has reported 55 children with the syndrome, which disproportionately affected Hispanic and Black children. None of them died, and none are currently hospitalized, state Health Commissioner Judith Persichilli said Friday.  Across the United States, the CDC has confirmed 570 cases in 40 states, with 10 deaths.

Studies in other countries have shown that when family clusters of illness develop, it is almost always the result of an adult who brought the infection home, and not a child who infected the family.

“The rate of transmission among younger children and transmission from students to teachers has been low,” said Tan, of the Feinberg Medical School, “especially when you have mitigation protocols in place and precautions are followed and transmission in the community is low.”

Families need to balance benefits and risks

For families, the decision on whether to send a son or daughter to school requires careful thought.

If the child or a family member has a weakened immune system, from chemotherapy or an autoimmune disorder, or a household member is particularly vulnerable to severe illness from coronavirus, concerns about the student bringing the disease home will be  higher.

On the other hand, if the child has special needs, or online learning is difficult because of Internet issues at home, or no one is available to supervise them, that will influence parents, too. 

“Each family has to really look at their own particular setup,” Fisher said, “and make their own decisions.”  

Lindy Washburn is a senior healthcare reporter for NorthJersey.com. To keep up-to-date about how changes in the medical world affect the health of you and your family, please subscribe or activate your digital account today.

Email: washburn@northjersey.com Twitter: @lindywa 


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