“We fear that it will be much worse, between getting together for the holidays and then getting back to school,” said Dr. Stanley Spinner, Chief Physician at Texas Children’s Pediatrics & Texas Children’s Urgent Care in Houston.
In Washington, DC, all public school students and staff must show evidence of a negative Covid-19 test before returning from winter vacation.
In New York City, public school students who test positive will receive a one-week home test so they can know when it is safer to return to school.
Here’s how several pediatricians and health experts answered some of the most critical questions from parents:
Shouldn’t children return to the classrooms yet?
Health experts are divided.
In areas with very high transmission, it may be too early to resume personal learning, said pediatrician Dr. Peter Hotez.
“I would not do it now,” said Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine.
“You’ve got a screaming level of transmission in the Northeast, in New York City and Washington, DC. When trying to open schools at this point, it’s hard to imagine how things will go well.”
But the U.S. Department of Education is urging school districts to take safety precautions and ensure classrooms are open to personal learning.
Pediatrician Dr. Paul Offit said it is important for children to be able to stay in classrooms – and not just for their academic health.
“There are so many benefits to learning on the spot. Children need the socialization that comes with being in school,” said Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia.
He said many children are also addicted to school meals. And in some cases, signs of child abuse are only noticed while they are in school.
But many students return to the classrooms on Monday – just two days after the New Year celebration, said Dr. Lawrence Kleinman, Vice President of the Department of Pediatrics at Rutgers University.
And because Covid-19 tests may not detect new cases until a few days after infection, some schools or parents may choose to postpone the return for a few days to allow more time for testing, Kleinman said.
Should children be tested before returning to school?
“Getting children back in school must be No. 1 – but making it safe must be critical,” said epidemiologist Dr. Abdul El-Sayed.
“So I think it’s a cautious approach to require a negative test before going back to the classroom.”
Offit said he does not believe children necessarily need to be tested before returning to school unless they have recently had contact with someone who had Covid-19 or if they have symptoms.
“If you’re otherwise healthy, you do not really need to test,” he said.
But if a child has symptoms “and if you can not test them, then assume it is Covid,” Offit said.
Can parents feel safer if their children are vaccinated?
“Absolutely,” said pediatrician Dr. James Campbell. “Their sigh of relief should be to know … that even if a child gets a breakthrough infection, they will probably only get cold symptoms from it.”
While Omicron is more contagious than any previous variant, children who have been vaccinated have a major benefit.
“Previously, they did not have access to a vaccine or were not vaccinated, they would have had a higher risk of potentially being hospitalized,” said Campbell, a professor of pediatrics and pediatric infectious disease specialist at the University of Maryland. “But now that risk is far down by being vaccinated – even with this new variant.”
But because Omicron is much more contagious than Delta, doctors say the raw number of children admitted in the coming months may be higher.
And nearly all of the children currently hospitalized for Covid-19 have not been vaccinated, the president of the American Academy of Pediatrics said.
“What we hear from hospitals across the country – and this is very consistent – is that the vast majority of children who are admitted are unvaccinated,” said Dr. Lee Savio Beers to CNN Thursday.
“Being unvaccinated significantly increases your risk of hospitalization.”
In some cases, children starting with mild or no Covid-19 symptoms end up being admitted weeks or months later with a condition called MIS-C – multisystem inflammatory syndrome in children.
Should fully vaccinated children still wear masks at school?
All pediatricians interviewed for this article said yes.
“We have layers of protection. And getting vaccinated is perhaps the most important of those layers,” Kleinman said.
“But it’s not fully sufficient because it’s imperfect. They’re all imperfect layers,” he said.
“This is a Swiss cheese model … each (layer) has the holes in it, just like Swiss cheese.”
So while the vaccination layer has the smallest gaps, other layers – such as masking and distancing – are also important, Kleinman said.
Furthermore, it is not yet clear how much vaccinated children may be able to spread the Omicron variant to others – such as younger siblings who are too young to be vaccinated, Kleinman said.
While some vaccinated children may be disappointed to hear that they still have to wear a mask in school, “simple explanations work quite well with them,” Campbell said.
“And it is that the virus has become smarter. And it infects people better. Your vaccine will definitely protect,” he said.
“But you can still get infected, which means you can still catch a cold, you can still get a fever. You can still feel a little bit sick.”
There is also a broader reason why students should avoid getting infected – even if they do not get sick, Campbell said.
Reducing infections is crucial to prevent new variants that can prolong this pandemic further.
“If the virus kind of shuts down to the point where there is very little circulation, the less circulation, the less replication,” Campbell said. “The less replication of the virus, the less chance it has of mutating.”
What kind of masks should children wear now?
Much has changed since last school year. The once dominant Alpha variant has been replaced by the more contagious Delta variant, which has been surpassed by more infectious Omicron variant.
“They’re pretty effective – at spreading Covid,” she said.
Instead, three-layer surgical masks with an adjustable nasal thread and KN95 masks are much more useful, Carnethon said.
“It really is what you need to prevent air from leaking out,” she said.
More than ever before, a good fit is important, Carnethon said. One way to test the fit is to have a child put on a mask and then put on glasses or sunglasses. If they can feel air escaping or misting up the glasses, it is not a good fit.
Should activities like choir and basketball be put on the sidelines for now?
“I think it’s a really difficult question,” Kleinman said.
Ideally, students in activities involving heavy breathing will be vaccinated – along with coaches, instructors and other adults nearby, he said.
“Testing is the other thing that is a friend to all of these activities,” Kleinman said.
The answer should also depend on how violently Covid-19 spreads in a community, Campbell said.
“Maybe they should just say, ‘Well, we’ll have to suspend (certain activities) for some time, “he said.
“But I think it’s probably a mistake to stop all after-school activities at this point.”
Children who are frustrated with ongoing Covid-19 safety measures should take comfort in knowing that they may not last too long, Offit said.
Like several other health experts, Offit said he expects the current rise in Covid-19 cases will begin to decline within the next few months.
“So just stay there for six weeks if you can,” he said. And by that time, more children are likely to be vaccinated as well.