What precautions should families take against coronavirus when children return to school?

To guide us through this back-to-school refresher, I spoke with CNN medical analyst Dr. Leana Wen, an emergency physician and professor of health policy and management at the University’s Milken Institute School of Public Health. George Washington University. She is also the author of “Life lines: a doctor’s journey in the fight for public healthand a mother of two young children who will soon be going back to school.

CNN: The question on the minds of many parents and caregivers is masks. Will you send your children back to school wearing masks?

Dr AS Leana Wen: No, although I respect other parents and caregivers who are making a different decision than we are based on how they view the risk of Covid-19 versus the downside of wearing masks for their children.

Masks, especially those that fit well and are of high quality, can reduce the transmission of the coronavirus. The US Centers for Disease Control and Prevention recommends wearing masks indoors based on Community level Covid-19. I think it is reasonable for parents and caregivers to follow the CDC guidelines and decide that if the level of covid-19 is high in their area, they will ask their children to wear masks indoors at school. Wearing masks will reduce your children’s risk of contracting coronavirus and is still recommended for families for whom avoiding covid-19 is a top priority, such as those with immunocompromised household members.

I also think it’s reasonable for parents and caregivers to do a different calculation of risk. Children are already at low risk of getting seriously ill from Covid-19. Vaccination further reduces that risk. Furthermore, the currently circulating variants are so contagious that it is quite difficult to avoid infection. Some families might decide that they no longer prioritize avoiding infection and therefore choose not to wear masks for their children at school.

That is what my family has decided. Our views have changed a lot since the start of the pandemic, when much was unknown 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 was after Omicron came to dominate, because it became even more difficult to avoid Covid-19 despite precautions. Vaccinating our children also gave us even more assurance that we could replace masking with the protection that vaccination provides. We know that our children could still get Covid-19, but the risk of serious illness is very low.

There is also the issue of the perceived cost of masking to our children. Our children’s school does not require masks, and based on our conversations with other families, very few parents will choose to wear masks for their children. My almost 5-year-old son, who is starting kindergarten, has speech delays that have improved since his schools went mask-optional in the spring. Anyway, my 2 year old, just starting preschool, doesn’t wear masks constantly. For us, the benefit of requiring our children to wear masks does not outweigh the disadvantage at this time. That could change if a more dangerous variant emerged in the future.

CNN: Are there any circumstances where you would encourage parents and caregivers to wear masks for their children at school?

Wen: It all comes down to how much the family wants to avoid Covid-19. Let’s say there is a medically vulnerable household member who could become seriously ill if they contract the coronavirus. It would make sense for everyone in that household to be more cautious about infecting that person.

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Families could also decide to mask up before visiting vulnerable loved ones. For example, if an immunocompromised grandparent is coming to stay for a week, children can wear masks to school the week before and during that visit. Additionally, I would recommend that children get rapid tests just before grandpa arrives and that everyone, including adults, avoid indoor gatherings for the week before and during the visit.

CNN: Speaking of testing, how often should families test their children?

Wen: Some schools may have a regular testing cadence or random testing protocol to assess the level of Covid-19 in their student body. Others may simply ask that children be tested if they are symptomatic or have a known exposure. Again, the number of families who want to test their children will depend on the degree to which they want to avoid coronavirus. Many families view covid-19 like any other viral illness, while some are still very cautious about trying to avoid it for various reasons, including the unknown future risk of prolonged covid.

CNN: Should parents and caregivers refrain from extracurricular activities or playdates with their children?

Wen: Any decision-making must weigh the desire to avoid Covid-19 against the downside of keeping children away from activities they would enjoy. Given our family’s calculation of risk, I am not holding back on activities for my children. My son is playing soccer, which sometimes happens indoors. My daughter is in a music class where there is a lot of singing, most of the time indoors. We go on playdates, both outdoors and indoors.

Households with vulnerable family members may decide to focus on outdoor activities for children as a precautionary measure.  Children play at the Betty Price Playground in Worcester, Massachusetts, on October 19, 2021.

By the way, this is not to say that my family is not taking precautions. My husband and I wear masks at airports and on trains. We don’t take our kids to the aquarium or the science center when it’s really crowded, with tons of people crammed together. We are not trying to catch Covid-19, but we are also not going to change our lives like we have for most of the pandemic to try to avoid it. And we fully understand if other parents might decide to be more cautious and stick mostly to outdoor activities.

CNN: What happens if children get covid-19? How long must they stay out of school? What if someone in your family contracts Covid?

Wen: the CDC Guidelines say that people who contract Covid-19 must self-isolate for five days and then can return to public places with a well-fitting mask for the next five days. People exposed to Covid-19, if up to date on vaccinations, do not need to quarantine and can return to public places as long as they are masked for 10 days, get tested 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 vaccinate their children if they haven’t already?

Wen: Yes. To great recent study, just published in The New England Journal of Medicine, found that during a time of Omicron dominance, two doses of the Pfizer/BioNTech vaccine reduced hospitalizations by 83% among children ages 5 to 11. Vaccination also reduced infection by 65%. This and many other studies demonstrate how vaccination is crucial in reducing the likelihood of serious infection and symptomatic disease in children.
my two sons received their vaccinations as soon as they were eligible. (My children are under 5 years old; children over 5 years old are eligible for boosters, although most haven’t got them.) For me, the calculation came down to this. You knew that even without vaccinations, your chance of getting seriously ill is very low. But if I can further reduce the chance of something bad happening, I’d like to do it. And now, with vaccination, I am comfortable with my children resuming their normal pre-pandemic activities, even during a wave of Covid-19.

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