What precautions to take when kids go back to school

(CNN) — Many children are returning to school at a time when the number of coronavirus cases is high in much of the United States. Parents and caregivers have many questions about the precautions they should take for their children. Should they go back to wearing masks? How often should your children be seen? Should extracurricular activities be stopped? What happens if your children contract covid-19? How long do they have to stay out of school? And should families vaccinate their children if they haven’t already?

To guide us through this school refresher course, we spoke with Dr. Liana Wen, CNN medical analyst, emergency room physician, and professor of health policy and management at the Milken Institute School of Public Health at George Washington University. She is also the author of “Lifelines: A Doctor’s Journey in the Fight for Public Health” and the mother of two young boys who will soon be going back to school.

CNN: The question many parents and caregivers are asking is about masks. Will you send your kids to school wearing masks?

Dr Liana Wen: No, although I respect other parents and caregivers who make a different decision than ours based on how they see the risk of covid-19 versus the disadvantages of masks for their children.

Masks, especially those that fit well and are of high quality, can reduce the transmission of the new coronavirus. The US Centers for Disease Control and Prevention (CDC) recommends the use of masks indoors based on the level of covid-19 in the community. 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 to school. Using masks will reduce the risk of their children contracting the coronavirus and is still recommended for families where avoiding covid-19 is a top priority, such as those with immunocompromised members at home.

I also think it’s reasonable for parents and caregivers to make a different calculation of risk. Children are already at low risk of serious illness from COVID-19. Vaccination further reduces this risk. Furthermore, the currently circulating variants are so contagious that it is quite difficult to avoid infection. Some families may decide that they no longer prioritize infection prevention and therefore decide not to ask their children to wear a mask to school.

That’s what my family decided. Our views have changed a lot since the beginning of the pandemic, when the impact of covid-19 on children was unknown. At that time, we took very strict precautions, such as wearing a mask all the time indoors and interacting with other people only outdoors. For us, the tipping point was after the omicron variant became dominant because it became even more difficult to avoid covid-19 despite precautions. Vaccinating our children has also given us more confidence that we can substitute the use of masks for the protection that vaccination provides. We know that our children can still get sick from COVID-19, but the risk of serious illness is very low.

There is also the question of the supposed cost of wearing masks for our children. Our children’s school does not require the use of masks and, based on our conversations with other families, very few parents will choose to have their children wear them. My almost 5-year-old son, who is starting kindergarten, has a speech delay that improved after his school made wearing masks optional in the spring. My 2 year old son who just started preschool does not wear his mask all the time. For us, the benefit of requiring our children to wear a mask does not outweigh the inconvenience at this time. This may change if a more dangerous variant emerges in the future.

CNN: Are there any circumstances in which you would advise parents and caregivers to require their children to wear a mask at school?

Wen: It all comes down to how much the family wants to avoid getting sick with covid-19. Let’s say there is a medically vulnerable household member who could become very ill if they contract covid-19. It would be logical for all family members to be more careful not to infect this person.

Families may also choose to wear a mask before visiting vulnerable loved ones. For example, if a immunocompromised grandparent is coming to stay for a week, children can wear a mask to school the week before and during that visit. I would also advise children to take quick tests immediately before Grandpa arrives and that everyone, including adults, avoids closed 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 among their students. Others may simply request that children be tested if they have symptoms or have known exposure. Once again, the extent to which families want to test their children will depend on the extent to which they want to avoid the coronavirus. Many families view covid-19 like any other viral illness, while some remain very cautious in trying to avoid it for a number of reasons, including the unknown future risk of prolonged covid.

CNN: Should parents and caregivers limit their children’s after-school activities or play dates?

Wen: Any decision must weigh the desire to avoid COVID-19 against the downside of depriving children of activities they would like. With our family’s risk assessment in mind, I do not discourage my children’s activities. My son plays soccer, which is sometimes played indoors. My daughter is in a music class with a lot of singing that is mostly indoors. We go out to play, both outdoors and indoors.

Households with vulnerable members may choose 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 does not mean that my family does not follow any precautions. My husband and I wear masks in airports and on trains. We don’t take our kids to the aquarium or the science center when it’s crowded, with tons of people crammed together. We’re not trying to get covid-19, but we’re not going to change our lives like we did for most of the pandemic to try to avoid it. And we fully understand that other parents decide to be more cautious and continue with mostly outdoor activities.

CNN: What happens if kids get sick with COVID-19, how long do they have to stay out of school? What if someone in your family gets sick with covid?

Wen: CDC guidelines say that people who get sick with COVID-19 should self-isolate for five days and then can return to public places wearing a well-fitting mask for the next five days. People exposed to COVID-19, if they are up-to-date on their vaccinations, do not need to be quarantined and can return to public places as long as they wear a mask for 10 days, get tested after five days and remain asymptomatic. This is 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’re following their rules.

CNN: Should families vaccinate their children if they haven’t already?

Wen: Yes. A recent large-scale study just published in The New England Journal of Medicine found that during the dominance of the omicron variant, two doses of the Pfizer/BioNTech vaccine reduced hospitalizations by 83% among children 5 to 11 years of age. Vaccination also reduced infection by 65%. This and numerous other studies show how important vaccination is in reducing the likelihood of serious infections and symptomatic illnesses in children.

Both my children were vaccinated as soon as they were eligible. (My kids are under 5; kids 5 and up can get boosters, though most don’t.) For me, the calculation came down to this. He knew that even without vaccinations, the chance of serious illness was very small. But if I can further reduce the chance of something bad happening, I’d like to do it. And now, with the vaccination, I feel comfortable with my children returning to normal pre-pandemic activities, even during a covid-19 wave.

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