Considerations for Returning to School: Protecting your family from COVID-19

This post is targeted to parents of school-age children. I need to preface this update by saying decisions surrounding school for you and your family are exactly that – YOUR decisions. Having a choice, in my opinion, is better than none. While the ideal is a situation where public health drives decisions based on copious science and without political interference, we are not living in that ideal. The following is intended to help frame school decision-making with reminders for how exposures and illness impact your family, schools, and the community.

COVID-19 transmission

Most COVID-19 cases occur through spread of illness within households, families, and close contacts. However, the initial case in a household cluster has to acquire infection from somewhere outside the home. In general, by the time illness is recognized, COVID-19 has already spread within a home.

School-based metrics

Polk County is now publishing Aperio reports on their site - https://www.polkcountyiowa.gov/.../situation-reports-and.../. Please note, Aperio functions as an independent contractor of Polk County Public Health.

If you want to watch a number, the report displays several metrics on the second page. If the metric of average new cases for the previous seven days per 100,000 is more than 100, we are in a situation of uncontrolled spread. We need to aim for less than 100, OR an average of less than 70 new cases per day to be in a situation of control. You can also simply watch the trend on the state site or the NYT.

https://coronavirus.iowa.gov/pages/case-counts

https://www.nytimes.com/.../us/iowa-coronavirus-cases.html

Translating data into action

A. If you, your child, or anyone in your household or immediate family, including anyone you regularly spend time with (neighbors, friends), are at HIGH-RISK for serious COVID-19 illness, you may want to consider online school.

B. If you, your child, or anyone in your household or immediate family, including anyone you regularly spend time with (neighbors, friends), are NOT at HIGH-RISK for serious COVID-19 illness, you may want to consider hybrid or in-person school. Be aware of the potential for exposure and monitor your child, household contacts, and close contacts for illness.

I strongly encourage any parent with a child who has a chronic health condition to confer with his/her health care provider.

Other important considerations include your child’s mental health, your ability to sustain online learning, whether your school has adequate protective measures in place, and how well your child adapts to online learning.

Again, this decision is unique for every family and every family has a different level of comfort.

Your role in controlling spread

It is imperative to take exposures seriously.

What constitutes exposure? Spending at least 15 minutes in close proximity to a person infectious with COVID-19, as well as other close contact (i.e., hugging, kissing, sharing utensils). If an exposure meeting the definition of “close contact” occurs, quarantine is recommended by the CDC.

· Longer exposures are more likely to result in spread of disease

· Exposure in small, poorly ventilated rooms is more likely to facilitate spread

· Conversely, mask usage throughout the duration of an exposure reduces risk. It does not REMOVE risk, nor has CDC altered their exposure guidelines for K-12 [https://www.cdc.gov/.../schools-childcare/k-12-staff.html].

If your child has an exposure to COVID-19, the recommendation to quarantine for 14 days has NOT changed. However, individual schools and districts may handle exposures differently from the current CDC guidance. Parents should still receive notification of any exposure to a case in a school setting.

When is a person infectious/contagious?

Two days BEFORE onset of symptoms through 10 days after onset of symptoms, as long as symptoms are improving with no fever for at least 24 hours prior to 10 days.

For asymptomatic cases confirmed with a lab test, the infectious period is considered two days before positive specimen collection through 10 days after positive specimen collection.

Confidence in school mitigation strategies

It is too early to know whether school mitigation efforts are working to prevent spread of COVID-19. Outbreaks will occur, as will hospitalizations and deaths, when large populations of people of any age are brought together for extended periods of time.

Who is HIGH RISK?

Anyone with a chronic health condition (e.g., obesity, diabetes) and older adults. For a comprehensive list, visit the CDC’s website. For specific concerns, talk with your health care provider.

https://www.cdc.gov/.../need-extra-precautions/index.html...

What is my family doing?

When the time comes for the change, we will opt for hybrid school unless our children demonstrate stronger outcomes with online school. Our oldest is doing well, though misses some interactions such as orchestra. Our youngest needs learning support, but is doing really well with online school. Our children do not have chronic health conditions, nor does anyone in our family. We are careful to isolate from older family members and friends if we feel there is any risk of us exposing them as my husband is a health care provider.

Final comments

We need to keep in mind observational studies, such as a review of incidence comparing four Iowa schools, or a study of only two hair dressers published in a MMWR, do not demonstrate resounding evidence for changing a guideline. I still defer to CDC and the cumulative body of evidence to support the contents of these posts.

Stay safe and health