After weeks of insisting that all schools must resume in-person learning on their usual schedules, President Trump acknowledged Thursday that some “may need to delay reopening for a few weeks.”
Trump said state governors should decide when COVID-19 is spreading too fast for children to be in classrooms. His announcement coincided with new and more specific guidance from the CDC.
That guidance covers use of masks, symptom checks and virus testing, building sanitation, and infrastructure preparation — all aimed at limiting the coronavirus’s spread among children, adult school personnel, and the surrounding community. It includes examples of posters and other materials to promote handwashing and mask wearing. It suggests checklists for parents, guardians, and caregivers to divide students into small cohorts or offer a hybrid curriculum with both in-class and virtual learning on alternate days.
In a news conference Friday to discuss its new guidelines, CDC Director Robert Redfield suggested that it’s appropriate for school officials to exercise more caution in areas of the country “where the percent positivity rate within the community is greater than 5%.”
He added, though, that positivity rates are “quite dynamic.” Local school boards and health departments must “look exactly at the data in their environment at this moment in time” in making decisions, he urged.
Redfield said he didn’t have an exact figure, but said “the majority of the nation right now actually has positivity rates that are less than 5%.”
Those comments echoed one of Trump’s statements the previous evening: “The decision should be made based on the data and the facts on the ground of each community, but every district should be actively making preparations to open again.”
“The decision should be made based on the data and the facts on the ground of each community, but every district should be actively making preparations to open again,” Trump said.
While many school districts can reopen safely if they implement protocols to protect families, teachers, and students, “we have to remember that all families should be empowered to make the decision that is right for their own circumstance. This is especially important if a child has underlying health conditions or lives with a parent or grandparent who is at higher risk,” Trump said.
Local leaders should “put the full health and wellbeing of their students first and make the right decision for children, parents, teachers and not make political decisions,” the president said. “This isn’t about politics.”
Trump talked up a Republican proposal announced Thursday that would provide $105 billion to help schools reopen by supporting smaller class sizes, teachers’ aides, and repurposing spaces to encourage social distancing with structural changes to school buildings. A substantial part of the CDC guidance addresses measures that schools should take to maintain distancing in classrooms and other areas where children and staff would ordinarily congregate.
But Trump didn’t entirely back off on his previous threat to withhold federal funding from schools that don’t reopen. He said that, in such cases, those dollars should go instead to parents so they can send their children “to a public private, charter, religious, or home school of their choice, the key word being choice…. The money should follow the student so parents and families are in control of their own decision.”
The president also reiterated previous arguments that children suffer educational and developmental delays from being held out of school and that pediatric infections typically have few consequences for the children or their contacts.
According to the COVKID Project, as of Thursday, 77 children have died from COVID-19 since Jan. 1, and 805 have been admitted to pediatric intensive care units.
Kids’ Vulnerability
During a media briefing Thursday sponsored by the Infectious Diseases Society of America, experts postulated several reasons why in general, most children who become infected with the COVID-19 virus do not appear to get as sick as adults, but offered some important caveats.
Children are not spared from severe illness, said panelist Tina Tan, MD, a professor of pediatrics at Northwestern University Feinberg School of Medicine in Chicago. Nationally, children represent a bit over 7% of all confirmed cases of COVID-19 in states that break out cases by age, with 50,000 new pediatric cases just in the two weeks from June 18 to July 2. Some 3% of total COVID hospitalizations are in children, she added.
Tan mentioned three theories why children may be less susceptible to severe illness:
- Children don’t develop cytokine release syndrome to the same extent as adults
- Children have a greater tendency toward infection “with other viruses that compete with COVID-19 for the ability to infect the child”
- Angiotensin converting enzyme receptor expression — key to viral entry into host cells — is different in children than in adults, “suggesting that this accounts for the decrease in the amount of infection seen in children”
But standing against those theories is the multi-inflammatory syndrome in children, which has become a bigger problem for children since April and so far has been diagnosed in more than 300 children in North America, Tan said. Similar to Kawasaki syndrome, but different in some respects, its symptoms include persistent fever, rash, bloodshot eyes, severe abdominal pain, nausea, vomiting, diarrhea, and heart and blood vessel inflammation.
Those issues remain a risk for children sent back to the classroom, especially in areas where community transmission is widespread or unknown.
Younger children do seem to have lower rates of infection than adults, Wendy Armstrong, MD, of Emory University in Atlanta. But by age 10, she said, that protection may have dissipated.
Several studies indicate that older children and teens do get infected and transmit the virus at the same rate as adults, she said.
She emphasized that so much about COVID-19 in youngsters remains unknown, and that any plans to reopen schools “must be flexible to accommodate new knowledge.”
“What we know about COVID is that what we know today may very well change tomorrow. There also needs to be access to testing that has a rapid turnaround time. Testing with results 8 days later” — the norm in many surge areas now — “is not helpful in this day, and there needs to be access to public health interventions and contact tracing.”
Asked whether it might be feasible to test all school children and teens, and teachers regularly and routinely, Armstrong said that widespread testing in schools “is not feasible and not as helpful as you might think… It tells you about that person at that moment in time,” which may be a week or more earlier.
In the event of an exposure, she said, “schools must have a partnership in place where they have access to testing that has rapid turnaround time.”
Tan said school reopenings in current hotspots such as Florida and California are a bad idea. “When you have such surges of disease in the community, you’re basically asking for trouble if you open schools. You’re bringing in individuals from all across the community that potentially could be exposed to COVID, and you’re putting them in a more enclosed setting. Regardless of what protocols you have in place, you still run a much higher risk of spreading COVID.”
