Spread of COVID in kids still a big unknown as Texas schools plan August reopening | #covid19 | #kids | #childern

A month before Houston-area schools plan to reopen in August, scientists still do not know the role children play in spreading the disease — and the risk they and their teachers will assume when they return to campus.

“The reality is, we won’t know until we put large numbers of kids close together again,” said Dr. Michael Chang, a pediatric infectious disease specialist with McGovern Medical School at UTHealth. “Our knowledge about the virus is constantly changing. We’re still learning new things every day.”

Texas school districts, however, continue to move forward in releasing plans for resuming classes, including HISD, which is scheduled to announce its reopening guidelines Wednesday. Texas Education Agency officials said last week that public school districts risk losing state funding if they do not offer in-person classes five days each week to all families that want it, with some limited exceptions.

For medical officials, hope for schools is based on data that shows children are far less likely to suffer severe symptoms of COVID-19, the disease caused by the coronavirus. Some evidence suggests children also are less likely to become infected and transmit the virus, but the evidence is limited, partly because most comes from a time when schools were shuttered and kids cocooned with their families.

Unanswered questions include to what extent infected, asymptomatic children are contagious and how effective schools can be at identifying and isolating such cases and the child’s close contacts.

It doesn’t help that Houston’s coronavirus case counts are currently at alarming levels, their ubiquity increasing the inevitably that cases will be brought to campuses. A number of scientists told the Chronicle they wouldn’t send their child to school this week or next, given the continuing escalation in counts.

No other country that has reopened its schools did so with anywhere near the amount of COVID-19 that is currently spreading in the United States.

Still, most everyone agrees there is harm in keeping children out of schools — that virtual education is a pale shadow of in-person learning; that such community is an important component of the socialization of children; that it makes parents juggle jobs and childcare; and that many low-income families depend on school-based meals for their children. The Trump administration cites some of those reasons for wanting to open schools.

Gov. Greg Abbott signaled Tuesday that changes likely are coming to the state’s guidance on reopening schools, with local officials potentially getting more latitude to keep campuses closed in August. Abbott offered few details on potential tweaks to the state’s guidelines, which have drawn criticism from several leading education groups amid the continued spike in COVID-19 cases, but he suggested new regulations could be released in the next few days.


‘Be ready to react’

Guidance released last week indicated school districts could remain shuttered and virtual-only for up to three weeks after their start, provided that all students had at-home access to a computer and Internet. If they stayed closed longer than that, under the current guidance, they would lose state funding.

“The key thing is that schools be ready to react to the data,” said Spencer Fox, associate director of the University of Texas-Austin COVID-19 modeling consortium. “If and when schools reopen, we need to have surveillance systems in place so we can really monitor the situation in real time and react accordingly with what the data are starting to show.”

Q&A

Is there less of a COVID-19 risk in children than adults?

A: The data shows COVID-19 doesn’t infect children as often or cause them near as severe disease as it does adults. But pediatric cases are rising and the extent to which children who have the disease, especially those without symptoms, transmit it to others remains an unknown.

Are there precedents of countries reopening schools?

A: More than 20 countries have reopened, some with strict restrictions and others without restrictions. Outbreaks have followed in some countries but not in others. None of the countries that have reopened have had anywhere the amount of spread currently occurring in the United States.

What is Texas guidance for reopening schools?

A: Guidance released last week indicated school districts could only remain shuttered and virtual-only for three weeks after their start, provided all students had at-home access to a computer and Internet. Any longer than three weeks they lose state funding. But Gov. Greg Abbott Tuesday hinted he plans to give schools more latitude.

Do Texas daycare center portend anything for schools?

A: Daycare providers have adapted to new safety measures, but COVID-19 cases have risen dramatically in the last month. Since March, there have been nearly 2,000 cases at child care centers, up from just a few hundred a month ago. About two-thirds of those are staffers, one-third children.

Fox best articulates the uncertainty of a return to school, noting that there is some evidence that children might transmit the coronavirus less than adults and historic evidence that children contribute heavily to the spread of diseases like the flu and seasonal colds and other bugs. Schools are a major source of the transmission of such viruses, acquiring it from classmates, then passing it on to their families and others.

Here’s what the data shows: In Harris County, 10 percent of people who’ve tested positive are under 18 and 3 percent of those hospitalized for the disease are under 18. Nationally, the latest statistics from the Centers for Disease Control and Prevention show that of 115,000 COVID-19 deaths, 30 deaths involved children under the age of 15. That’s less than die from the flu annually.

But the percentage of underage cases has tripled since early in the pandemic, likely the result of more testing and the virus’ increased prevalence in the area. Scientists worry that trend will continue as children return to school and become exposed to more of the virus.

Foresight in child care?

Child care operations, such as summer camps and daycare centers, may offer some foresight into what Texas schools may encounter.

Since March, a total of 1,997 cases of COVID-19 at 1,235 licensed child care operations have been reported to the Texas Health and Human Services Commission, up from a few hundred a month ago. Of those patients, 1,343 were adult staff members and 654 were children. There are currently 12,230 licensed child care centers in the state.

Many summer camps require precautions like outside pick-ups and drop-offs, temperature checks, regular hand washing and masks for adults. But enforcing admonitions for young children to wear masks and practice social distance can be difficult.

“It’s very hard to keep a mask on a 5-year-old,” said Kenny Martin, programs director of the Quillian Center, a camp run by First Methodist Houston. “We’re doing the best we can to keep them six feet apart, but they’re kids and they like to hug their best friend or just sit next to each other.”

Beverly Okosun, right, program director, records the temperatures of students after they're dropped off Tuesday, July 14, 2020, at the Quillian Center in Houston.

The American Academy of Pediatrics has cited some data suggesting suggesting that even if children under 12 are infected at the same rates as adults around them, they are less likely to spread it. That includes one study of Chicago households that found the virus’ spread went from an adult to a child 60 percent of the time, child to child 13 percent of the time, and a child to an adult 13 percent of the time. But the study was small.

“What we don’t know is how contagious an asymptomatic individual is,” said Dr. Lara Shekerdemian, chief of critical care at Texas Children’s Hospital. “Until we have conclusive evidence to the contrary, I think we have to assume they’re every bit as contagious as someone symptomatic.”

Global experiments

A number of countries — Norway and Denmark, for instance — reopened their schools a month after they were closed and didn’t see a significant increase. They opened them first for young children, in whom infection percentages are the lowest globally, before eventually opening them for older grades, as well as implementing such safety measures as limiting class sizes and keeping children in small groups at recess.

But not all countries have been as successful. Israel, with a higher community level spread, reopened in early May and lifted limits on class size a few weeks later, only to see the virus infect more than 200 students and staff.

In Texas, many educators and school leaders argue the risks of reopening outweigh the rewards. The state’s four largest educator organizations and unions are calling on Abbott to keep schools online-only until the spread of COVID-19 declines. And many school board presidents and superintendents representing large Texas districts want the governor to provide local officials with more authority to remain closed for now.

Gabrielle Griffing, 8, works with teacher Abdoulaye Traore to create a density column during a STEAM summer camp class, Tuesday, July 14, 2020, at IDEA Lab Kids in Bellaire. The business has put numerous protocols into place to try and prevent the spread of COVID-19 between kids, parents and teachers. Check-in each morning happens outside of the business, and temperature checks are made daily as well as requiring masks among the older children and all adults.

“The state has had to reconsider many of the initial findings regarding the reopening of businesses, companies and restaurants,” leaders of the Texas School Alliance, an organization comprised of 40 large Texas districts, wrote in a letter to Abbott. “Districts and their communities are facing the same worsening conditions, and these recent circumstances are far more acute than when school districts across the state were initially closed this past spring.”

If and when schools do reopen, Shekerdemian says the key is that school provide copious amounts of information about the steps they’re taking to prevent transmission.

“The devil is definitely going to be in the details,” she said. “I expect there’s probably more anxiety in some respects than there needs to be and in others there’s probably not enough.”

todd.ackerman@chron.com

jacob.carpenter@chron.com

hannah.dellinger@chron.com


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