Six Pediatricians at Valley Medical Center Advocate for In-Person Classes this Fall
Six Pediatricians at Valley Medical are advocating for the return of an in-person, near-normal school experience for children this fall. They submitted the letter to local school superintendents, as well as the Lewiston and Clarkston School Board members and the State of Washington's Superintendent. The letter is provided below thanks to Dr. Coral Tieu of Ear, Nose & Throat Surgery.
As local pediatricians, and with many of us having children and grandchildren attending, or having attended, all of our local school systems, we write this letter in the hopes that our schools will be open for full participation this fall.
Many of you know us, as our kids have grown up with your own children.
These are unusual times, with the declaration by the World Health Organization of a coronavirus pandemic on March 11th. Two days later, the United States declared a national emergency. On Sunday, March 15th, the decision was made to close Lewiston schools one week earlier than Spring Break. Clarkston and Asotin closed their schools soon after. As we all know, schools remained closed for the rest of the semester.
Now that we have entered summer, planning has begun on how to safely reopen schools this fall. We believe that there is now very encouraging data pointing towards a safe, in-person return for children this year. Many European countries, after initially enacting strict lockdowns, returned their children back to school in April and May. So far, this strategy has been successful, with only minimal new cases of coronavirus disease. We feel strongly that we can have a successful return as well.
The main reason for the recommendation to originally close schools was to hopefully reduce transmission of the virus. This was based purely on our experiences with prior influenza epidemics. Influenza is a disease of school-aged children, and they are important vectors of the disease. In April, 2009, a novel influenza virus (H1N1, "swine flu") appeared in Mexico. This new strain of influenza virus quickly spread, and was declared a pandemic by June. In the Lewiston-Clarkston area, we began seeing increased cases in late summer that year, with a peak in mid-October. We weren't able to get a vaccine for H1N1 until late October, when the pandemic was largely over. Despite no vaccine, and the knowledge that children are highly susceptible to, and extremely efficient transmitters of influenza, we sent our children back to school on the regular schedule that fall. Fortunately, H1N1 turned out to be a mostly mild disease, but we did have some very sick children, including a few that needed transport to Spokane for respiratory complications. Coronavirus is not influenza, it has been a much milder disease for young people, especially school age children. According to the CDC's weekly surveillance summary of U.S. COVID-19 activity ending June 12: " For children (0-17 years), cumulative COVID-19 hospitalization rates are much lower than cumulative influenza hospitalization rates at comparable time points during recent influenza seasons." Our own local experience this spring has been no hospitalizations for children with flu-like symptoms.
There is much evidence and research showing children are much more likely to have serious illness from influenza than from coronavirus. Children can get COVID-19, but they are minimally affected and usually have asymptomatic disease or mild symptoms. There has been recent concern over a possible relationship between a "hyperinflammatory syndrome" and coronavirus infection. This syndrome is similar to known diseases such as Kawasaki disease and toxic shock syndrome. These cases have been rare, and the children have had almost uniformly good outcomes. It is not clear if there is a definitive causal relationship between these syndromes and COVID-19.
Since children are at a very low risk of serious illness with COVID-19, and they don't seem to be important transmitters of the disease, there are few reasons to not let them return to school. One concern is that they might give the disease to an adult who is more vulnerable. We now know that age is the single biggest factor in whether a person will have serious illness if infected with coronavirus. Locally, there have been no COVID-19 deaths in Washington state under the age of 20, and no deaths under age 50 in Idaho. The risk to persons under the age of 50 is less than the risk of a bad flu season. As the majority of parents or guardians of school aged children, as well as their teachers, will be in the 25-45 age range, the risk to them is also likely to be small. For older staff, or those with serious chronic illness, we should find ways to accommodate them if they feel unsafe (e.g. medical-grade face masks for these persons, creative distancing measures, staggered work hours, etc.). In regards to social distancing measures and masking, there seems to be little reason to do either except for the concern that the child may bring the disease home and spread it to a vulnerable adult. Although this hasn't been the case thus far in Europe, it is a possibility and should be weighed against the downsides of enacting such measures.
In summary, we feel children will be safe returning to an in-person, near-normal school experience this fall.
(Listed below are some research facts in support of re-opening schools. The premier teaching children's hospital in Toronto, Canada (Toronto "SickKids") has an excellent guide for school opening and is included in the references below. This guide is available online, heavily referenced, and well worth reviewing)
Thanks for your consideration,
Craig Ambroson, MD
Darby Justis, MD
R. Todd Parkey, MD
Natale Carasali, MD
Ted Krisher, MD
Angie Roth, MD
1. Children appear to be significantly less susceptible to SARS-Cov-2, and, if infected, seem to be less likely to transmit the disease versus adults.
2. Children seem to have less chance of contracting COVID 19, even in a household with a positive family member.
3. Of the rare child who becomes severely ill, most have existing comorbidities that make them susceptible to most respiratory viruses. Even these critically ill children have mostly good outcomes.
4. School closures appear to have had minimal impact on fatalities, especially when compared to other social distancing interventions.
5. COVID-19 is a disease that rarely causes serious illness requiring hospitalization in school-aged children. There have been only rare fatalities in children (fewer than influenza)
6. The risk of pediatric inflammatory multisystem syndrome (PIMS) in children who have COVID-19 is low, and their outcomes are usually good.
7. The negative effects of prolonged school closure may include less effective education, loss of "safe space" and increased exposure to domestic violence, psychological impact on demotivated students, excessive screen time, lack of peer-to-peer learning and loss of social relationships, increased disparity with low-income children due to lack of access to technology, etc.
8. COVID-19: Recommendations for School Reopening, By Toronto, CA children's hospital "SickKids". PDF at www.sickkids.ca
1.Meta-analysis of contact tracing studies (preprint)
2.Israeli study on intrafamilial spread. The Pediatric Infectious Disease Journal: June 1, 2020
3.Characteristics and Outcomes of Children With Coronavirus Disease 2019 (COVID-19) Infection Admitted to US and Canadian Pediatric Intensive Care Units.JAMA Pediatrics. Published online May 11, 2020
4.School closure and management practices during coronavirus outbreaks including COVID-19: a rapid systematic review. Lancet Child Adolescent Health, 2020;4:397-404
6. European Centre for Disease Prevention and Control. Paediatric inflammatory multisystem syndrome and SARS-CoV-2 infection in children -15 May 2020. ECDC: Stockholm; 2020."