For children headed back to their classrooms this fall, this much is inevitable: a certain percentage will catch COVID-19 — and there will be some negative consequences of those infections, according to local pediatricians.
But still, they unanimously agree, it is time for the schools to reopen, even in the midst of a pandemic. The benefits of in-person education and socialization outweigh any and all risks, including health and safety concerns, they said.
“There is no perfect answer where everything’s gonna be fine and rosy. That is not possible,” according to Dr. Gail Schonfeld, owner of East End Pediatrics in East Hampton.
“And it’s challenging to look at options where there will be some degree of harm to someone, somewhere, no matter what you do — and that’s a tough position to be in.”
In late June, the American Academy of Pediatrics (AAP), comprised of 67,000 pediatricians nationwide, released the advisory, “COVID-19 Planning Considerations: Guidance for School Re-entry,” which called for schools to reopen and implement policies to curb the spread of coronavirus — acknowledging that every suggested strategy is intended to mitigate, not eliminate, risk.
“The AAP strongly advocates that all policy considerations for the coming school year should start with a goal of having students physically present in school,” the clinical guidance states. “The importance of in-person learning is well-documented, and there is already evidence of the negative impacts on children because of school closures in the spring of 2020.
“Lengthy time away from school and associated interruption of supportive services often results in social isolation,” it continues, “making it difficult for schools to identify and address important learning deficits as well as child and adolescent physical or sexual abuse, substance use, depression, and suicidal ideation.”
If the debate were solely about education, the solution would be simple, according to Dr. Jill Cioffi, primary care pediatrician and medical director of the ambulatory sites at Stony Brook Children’s Hospital. Kids who struggle with distance learning would be prioritized for in-person education, and the rest of the student body could learn at home.
But schools do not just function as educational grounds, explained Dr. Cioffi, who is a mother to four school-aged children herself. They offer students structure, exercise, socialization, special education services, psychological and medical help, and, in some cases, free breakfast and lunch — not to mention, a place for them to simply be while the vast majority of their parents work.
“I think that’s why the AAP has come out so strongly, that they really want us to be cognizant of the entire safety net that schools have provided, because they’ve provided it a very, very long time in communities and, if anything, they’ve gotten stronger and stronger in their ability to help children in areas way beyond education,” Dr. Cioffi said. “And I just would hate for all of that to be lost when people are trying to figure out what’s the best plan for the fall.”
When considering health and safety policies, Dr. Cioffi encourages school districts to break down their student bodies not only by age, but also risk factors, such as regression in children who have individualized education programs, or IEPs.
“I don’t envy the school districts that have this large puzzle to figure out, but I can tell you, having done it on a medical level — having to figure out how to piece together how to continue to provide safe care — we have worked through it,” Dr. Cioffi said. “You have to start somewhere. You have to start with what you know, and what keeps us safe, and you have to identify who you need to see.”
Dr. Schonfeld, who is the chief school physician for the Sag Harbor School District and Springs School, has served as a consultant since the virus first made itself known on the East End in March.
“It’s a very uncomfortable situation to be a part of this, because any decision that is made is going to be met with appropriate criticism that it’s not good enough — because nothing really can be perfect,” she said. “Good enough is about the best we’re gonna be able to do.”
As they now look toward September, she already foresees significant complications for the children who stay home, including continued issues with distance learning and lack of adequate childcare, which will disproportionately impact lower-income families — and is all the more reason to reopen, she said.
“From preliminary data from around the world, it appears that children are not big spreaders, that they generally do not get seriously ill with this virus,” she said. “But it’s not like we have a magic wand here that will decrease the amount of risk to the minimum amount possible. I’ve been trying to say in my meetings with them that there is not going to ever be a point of no risk, and that’s a challenging concept to accept.
“There are going to be some infections,” she added, “and I think there will potentially be some negative consequences of those infections, and what we’re really trying to do is minimize this as much as possible.”
By children returning to school, they are also escaping a host of co-morbidities associated with staying home, explained Dr. Nadia Persheff of Hampton Pediatrics in Southampton, which often present as anxiety, stress on parent-child relationships, loneliness and depression.
“I don’t remember a thing I learned in school, but I remember the socialization,” she said. “I learned how to socialize, how to work together in team sports. Those are the things that, unfortunately, in my daughter’s seventh-grade experience, she’s not probably gonna learn team sports and how to work together, and that devastates me more than anything.
“You have one child and you want them to have this one experience, and they’re gonna miss it. I’m gonna start crying,” she said, taking a deep breath. “I feel like, with my daughter, I have to take the risk and have her go back. Because I just can’t watch it anymore. I can’t watch her not be a kid.”
With the trajectory of a COVID-19 vaccine unknown — “And the East End has a lot of people who are anti-vaccinators,” Dr. Persheff said — parents are left weighing the pros and cons of sending their children to school, especially if they are responsible for immunocompromised relatives or higher risk themselves. However, it appears that transmission is mostly adult to child, not the other way around, Dr. Cioffi said.
“We certainly know that kids don’t bear the highest burden of this illness, meaning that even when they do get sick, they disproportionately don’t get sick as much,” Dr. Cioffi said. “We’re learning about that, I think it’s a receptor that the virus needs [that] is really what’s lacking in kids.
“But as the kids get older, we’re talking about adolescents, that risk factor may change,” she continued. “So the young kids, who everyone kind of fears because they have been the Petri dishes of influenza, do not appear to be as much the ones who are getting everyone sick with COVID. We could have a false sense of that, given that the schools were closed, but I think we’re getting more and more data to support that.”
If, worst-case scenario, the data is wrong and kids prove to be big spreaders, the districts will quickly realize that come fall, Dr. Cioffi said. But as of today, it is in the children’s best interest to get back to school, all three pediatricians said.
“Tomorrow’s another day,” Dr. Schonfeld said. “One thing I’ve learned is that you have to be ready to pivot on a dime, that things just change so quickly and you have to be ready to react appropriately to change, and that you cannot predict the future. As of this moment in time, that appears that is the thing to do.
“Whether that will be the thing to do come September, which is a whole month away, is open to speculation,” she continued. “It really remains to be seen. It’s important that we monitor this closely and be prepared to make changes as best that we can.”