Many children are returning to school as the number of coronavirus cases is high in most of the United States. Parents and caregivers have a lot of questions about what precautions to take for their children. Do their children have to wear masks again? How often should they test their children? Should they retain extracurricular activities? What if their children get Covid-19 – how long should they stay out of school? And should families get their children vaccinated if they haven’t already?
To guide us through this back-to-school reminder, I spoke with CNN medical analyst Dr. Leana Wen, emergency physician and professor of health policy and management at George Washington University Milken Institute. School of Public Health. She is also the author ofLifelines: A doctor’s journey in the fight for public health” and mother of two young children who will soon be returning to school.
CNN: The issue on the minds of many parents and caregivers is masks. Are you going to send your children back to school with masks?
Dr. Leana Wen: No, although I respect other parents and caregivers who make a different decision than ours based on how they perceive the risk of Covid-19 versus the inconvenience of masking for their children.
Masks, especially well-fitting, high-quality masks, can reduce coronavirus transmission. The U.S. Centers for Disease Control and Prevention recommends indoor masking based on Covid-19 community level. I think it’s reasonable for parents and caregivers to follow CDC guidelines and decide that if the level of Covid-19 is high in their area, they will ask their children to mask up indoors at school. . Masking will reduce the risk of contracting the coronavirus for their children and remains advisable for families for whom avoiding Covid-19 is a top priority, such as those whose household members are immunocompromised.
I also think it is reasonable for parents and caregivers to make a different risk calculation. Children are already at low risk of serious illness from Covid-19. Vaccination further reduces this risk. Moreover, the variants currently in circulation are so contagious that it is quite difficult to avoid infection. Some families might decide that they no longer prioritize preventing infection and therefore choose not to mask their children at school.
That’s what my family decided. Our views have changed a lot since the start of the pandemic, when there were many unknowns about the impact of Covid-19 on children. At that time, we followed extremely strict precautions, including masking indoors at all times and only associating with others outdoors. For us, the turning point came after Omicron’s dominance, as it became even more difficult to avoid Covid-19 despite precautions. Vaccinating our children also reassured us that we could replace wearing a mask with the protection offered by vaccination. We know our children could still get Covid-19, but the risk of serious illness is very low.
There is also the question of the perceived cost of masking for our children. Our children’s school does not require masks and from our conversations with other families, very few parents will choose to mask their children. My almost 5 year old son, who is starting kindergarten, has speech delays that have improved since his schools became mask optional in the spring. My 2-year-old, who just started kindergarten, doesn’t always wear masks anyway. For us, the advantage of requiring our children to wear a mask does not outweigh the disadvantage at this time. This could change if a more dangerous variant were to emerge in the future.
CNN: Are there any circumstances in which you would advise parents and caregivers to mask their children at school?
Magnifying glass: It all comes down to how much the family wants to avoid Covid-19. Let’s say there is a medically vulnerable member of the household who could become very ill if they contract the coronavirus. It would make sense for everyone in that household to be extremely careful not to infect that person.
Families could also decide to mask up before visiting vulnerable loved ones. For example, if an immunocompromised grandparent comes to stay for a week, the children can mask up at school the week before and during this visit. I would further advise that children take rapid tests just before the grandparents arrive and that everyone, including adults, avoid indoor gatherings during the week before and during the visit.
CNN: Speaking of testing, how often should families test their children?
Magnifying glass: Some schools may have a regular testing cadence or a random testing protocol to assess the level of Covid-19 in their student body. Others may simply request that children be tested if they are symptomatic or have known exposure. Again, the extent to which families wish to test their children will depend on the extent to which they wish to avoid the coronavirus. Many families view Covid-19 like any other viral illness, while some are still very cautious about trying to avoid it for a number of reasons, including the unknown future risk of long Covid.
CNN: Should parents and caregivers withhold extracurricular activities or play dates for their children?
Magnifying glass: Any decision-making must weigh the desire to avoid Covid-19 against the inconvenience of keeping children away from activities they would like. Given the risk calculation of our family, I do not retain the activities of my children. My son plays football, which sometimes happens indoors. My daughter is in a music class with a lot of singing, which takes place mostly indoors. We go on play dates, both outdoors and indoors.
By the way, this does not mean that my family does not follow any precautions. My husband and I wear a mask in airports and on trains. We don’t take our kids to the aquarium or the science center when it’s busy, with tons of people crammed in. We are not trying to contract Covid-19 – but neither are we going to change our lives as we have done for most of the pandemic to try to avoid it. And we totally understand if other parents may decide to be more cautious and stick mostly to outdoor activities.
CNN: What happens if kids get Covid-19 — how long do they have to stay out of school? What if someone in his family contracts the Covid?
Magnifying glass: The CDC guidelines say people who contract Covid-19 must self-isolate for five days and then can return to public places with a properly fitted mask for the next five days. People exposed to Covid-19, if up to date with their vaccines, do not need to quarantine and can return to public places provided they wear a mask for 10 days, test themselves after five days and remain asymptomatic. That’s what our family will do if we get infected again.
Some schools have different protocols than this, so be sure to check with your school to make sure you are following their rules.
CNN: Should families get their children vaccinated if they haven’t already?
Magnifying glass: Yes. A large recent study, which was just published in the New England Journal of Medicine, found that in an era of Omicron prevalence, two doses of the Pfizer/BioNTech vaccine reduced hospitalizations by 83% in children 5-11 years old. Vaccination also reduced infection by 65%. This study and several others demonstrate how crucial vaccination is in reducing the likelihood of serious infection and symptomatic disease in children.
My two children received their vaccines as soon as they were eligible. (My kids are both under 5; kids 5 and older are eligible for boosters, though most haven’t received them.) For me, the math came down to this. I knew that even without vaccines, their risk of serious illness is very low. But if I can reduce the risk of something bad happening even further, I would like to do it. And now, with the vaccination, I’m comfortable with my kids going back to their normal pre-pandemic activities, even during a Covid-19 surge.