As COVID-19 cases rise in children, a pediatric infectious disease expert offers advice on helping kids return to school safely

Child Health, Coronavirus Updates | 9 months ago

Back to School During Delta: An Expert Shares COVID-19 Advice with Parents

As COVID-19 cases rise in children, a pediatric infectious disease expert offers advice on helping kids return to school safely.

It’s the opposite of what we hoped for: We never wanted to track rising COVID-19 cases in children at the same time we shopped for back-to-school supplies. Parents and caregivers understandably have questions and concerns.

As the more contagious Delta variant of COVID-19 becomes the predominant COVID-19 strain in our area, we asked an expert to explain what that means for our children as they return to school. Here, Amina Ahmed, MD, pediatric infectious disease expert and epidemiologist at Atrium Health Levine Children’s, shares insight, updates and advice to parents and caregivers as they prepare their children for the classroom.

What do we know about how the Delta variant affects children?

Dr. Amina Ahmed: The resurgence in the number of adult COVID-19 cases started in July, and kids are always going to be a month behind. Typically, infection moves from adults to kids. We don’t yet have the data to say for sure that we know that children will continue to do well with COVID-19, but currently, they are, and we're very optimistic that they will continue to do well with COVID-19.

The rise in infection in children is not unexpected because many children are not yet eligible for COVID-19 vaccines, and the Delta variant spreads fairly quickly, especially among the unvaccinated. In the first two weeks of August in the United States, children are making up about 20% of all cases – compared to 1% at the beginning of the pandemic. And we see that locally as well.

Knowing infection typically moves from adults to kids, it’s important for parents to get vaccinated against COVID-19 to protect their children under the age of 12 who do not have an authorized vaccine yet. We are optimistic a safe, effective vaccine will become available for 5- to 11-year-olds in the near future, but until a vaccine is authorized, masking and vaccinating those in the child’s environment who can be vaccinated are the best tools to protect your unvaccinated child.

Which children are most susceptible to infection with COVID-19?

Dr. Ahmed: We are still fairly early in this next wave due to the Delta variant, so we don't have that data yet. Historically, it's been the 12- to 17-year-olds who were most likely to be infected: They’re more social, they behave more like adults and they have higher viral load than younger children. But because the 12- to 17-year-olds are getting vaccinated now, we’re going to see more children in the younger age groups get infected because that’s a group that’s not vaccinated.

We're very fortunate because so far, children have been mildly affected. Having said that, severe illness with COVID-19 is, to a degree, unpredictable. I can't say to you, “This child is a diabetic or asthmatic, so they're more likely to have severe disease.” I can say to you, however, that kids with severe illnesses have been otherwise healthy kids. And so we don't know which kid will end up severely ill from COVID-19. Again, it’s uncommon for kids to experience a severe case, but you don't want it to be your child.

Considering the rise in cases of COVID-19 among children, is it safe for them to return to school?

Dr. Ahmed: We've learned a lot through the pandemic about how to mitigate the spread of COVID-19, and the other thing that we’ve learned is that kids need to be in school. That's why the American Academy of Pediatrics has made it clear that in-person learning is best for the child. So we promote that, and we will also say that we should do our best to prevent the spread of COVID-19, so masking, handwashing and distancing are important. Vaccinating kids who are eligible is equally important. Also, maintain communication with your school and stay up-to-date on the latest policies. School systems need to hear your concerns.

How can children protect themselves and each other as they return to school?

Dr. Ahmed: The CDC has recommended that children two and over in any school or daycare setting be masked, and it went so far as to say that we should have a layering effect, with masking, social distancing, cohorting, and screening to protect kids in schools. The American Academy of Pediatrics has recommended the same. Additionally, any staff or students eligible for vaccines should be vaccinated to prevent spread and protect others. And we know from several well-done studies that a layering effect can mitigate spread. But there’s a study out of Utah that shows that even if all you can do is masking, that will also mitigate spread and prevent spread from going from the community and into the school system. (Related: Find a COVID-19 testing site near you.)

If other children in a classroom are unmasked, will a mask still protect my child?

Dr. Ahmed: Yes. If your child is masked, even if others are not, that's still worthwhile. It prevents other infections, too, which means you’ll have less of a chance of your child getting a fever and then suddenly, you’re not sure if they have COVID-19 or not, which then means you don’t know whether the family should quarantine or stay away from grandma. 

What part of the school day carries the most risk for children?

Dr. Ahmed: Transmission occurs when masks come off, and that happens at meals. If you can stress one thing to your child or to your school, it’s that there should be some separation between kids while they’re eating or in any situation when masks are down.  Outside is going to be less of a risk than inside, and so if you can eat lunch outside, that’s all the better.

Should children and parents disinfect school supplies each evening?

Dr. Ahmed: Handwashing is always much more important than disinfecting, and you don’t need to disinfect supplies if you are practicing frequent handwashing. We’ve learned that the solid materials we touch are less likely to spread COVID-19, as long as we wash our hands. Whatever germs are on those surfaces won’t transmit to us, as long as we wash our hands.

How do masks protect children?

Dr. Ahmed: We are definitely seeing more of other viruses this year, and masking will definitely help protect children against those in addition to COVID-19. When we were masking and social distancing last year, there was minimal flu and RSV (respiratory syncytial virus). When the masks started coming off, RSV came back and came back pretty darn early. In North Carolina, we’ve declared an early RSV season: Instead of the season starting in November like it usually does, it was August 15 here. But hopefully with the masks coming back on, we’ll be able to control that as well.

How often should kids switch out their masks?

Dr. Ahmed: If they wear paper masks, they should switch their mask out every single day – or sooner, if it gets bent or looks worn down. If they wear cloth masks, make sure you’re washing them regularly.

How likely is the risk of heart inflammation like myocarditis in children who get a COVID-19 vaccine?

Dr. Ahmed: Anyone who’s worried about the vaccine causing heart inflammation, like myocarditis, should know that the risk of myocarditis and other poor outcomes is much higher with a COVID-19 infection than it is with the vaccines. (Learn more: Pediatricians and Cardiologists: COVID-19 Vaccine Benefits Far Outweigh Myocarditis Risk)

What advice do you have for parents about protecting their children as they return to school?

Dr. Ahmed: My recommendation would be to do everything you can to layer those mitigation strategies: masking, distancing, handwashing, vaccinating, and staying home if ill. I cannot tell you how many COVID-19 patients I have had whose parents have said, “If only I had known, if only I had known….” You don't want it to be your child who gets sick.

The other important thing to keep in mind is that when a child becomes ill nowadays, it becomes a disruption to the family and to the community that now has to question, “Should I quarantine?” or “Should we keep everyone at home?” It’s a whole different ballgame than it was two years ago. If you do everything you can to keep your child from getting infected, it’ll help your quality of life, you’ll know they’re protected, and you may avoid a bad outcome. (Learn more: Back to School Tips for Parents and Kids as They Transition from Remote Learning)

One of the most powerful tools we have to protect our children and our community is to get vaccinated. Pfizer-BioNTech’s COVID-19 vaccine has been authorized by the FDA for teens 12-17 years of age. If your child falls within this age group, please strongly consider they get vaccinated as they head back to school. The vaccine is safe and effective at preventing severe illness, hospitalization and death.

Learn more about COVID-19 in Atrium Health’s COVID-19 Resource Center, find a COVID-19 testing site, or schedule a vaccination appointment for yourself or for your child ages 12 and older.