Many children are going back to school, while coronavirus cases are high in most of the United States. Parents and caregivers have many questions about what precautions to take for their children. Do their children have to wear face masks again? How often should they test their children? Should they hold back extracurricular activities? What happens if their kids get Covid-19 – how long will they be out of school? And should families have their children vaccinated if they haven’t already?
To walk us through this back-to-school refresher, I spoke with CNN Medical Analyst Dr. Leana Wen, an emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She is also the author of “Lifelines: A Doctor’s Journey in the Fight for Public Health” and mother of two young children who are both soon going back to school.
CNN: The question for many parents and caregivers is masks. Do you send your children back to school with mouth caps?
dr. AS Leana Wen: No, although I respect other parents and caregivers who make a different decision to us based on how they view the risk of Covid-19 versus the downside of masking for their children.
Masks, especially high-quality, well-fitting masks, can reduce the transmission of the coronavirus. The U.S. Centers for Disease Control and Prevention recommends indoor masking based on the Covid-19 community level. I think it’s reasonable for parents and caregivers to follow CDC guidelines and decide that if the Covid-19 level in their area is high, they will ask their children to mask indoors at school. Masking will reduce their children’s risk of contracting the coronavirus and remains advisable for families for whom avoiding Covid-19 is a top priority, such as those with immunocompromised family members.
I also think it is reasonable for parents and carers to make a different risk assessment. Children are already at a low risk of serious illness from Covid-19. Vaccination further reduces that risk. In addition, the currently circulating variants are so contagious that it is quite difficult to prevent infection. Some families may decide that they no longer prioritize infection avoidance and therefore choose not to mask their children at school.
That’s what my family decided. Our views have changed a lot since the start of the pandemic, when much was still unknown about the impact of Covid-19 on children. At the time, we followed extremely strict precautions, including masking indoors at all times and only interacting with others outside. For us, the turning point was after Omicron came to dominate, as it became even more difficult to avoid Covid-19 despite precautions. Getting our children vaccinated gave us even more certainty that we could replace masks with the protection that vaccination provides. We know that our children can still get Covid-19, but the risk of serious illness is very low.
There is also the issue of the perceived cost of masking for our children. Our children’s school does not require masks and based on our conversations with other families, very few parents will choose to mask their children. My almost 5-year-old, who attends preschool, has speech delays that have improved since his schools became mask-optional in the spring. My 2 year old, who just started kindergarten, doesn’t wear masks consistently anyway. For us, the benefit of forcing our children to mask doesn’t outweigh the downside at this point. That could change if a more dangerous variant were to emerge in the future.
CNN: Are there circumstances in which you would advise parents and guardians to mask their children in school?
female: It all comes down to how eager the family is to avoid Covid-19. Let’s say there is a medically frail household member who could become very ill if he catches the coronavirus. It would make sense if everyone in that household were to be extra careful not to infect that person.
Families may also choose to disguise themselves before visiting vulnerable loved ones. For example, if a grandparent with a weakened immune system comes to stay for a week, the children can put on a mask at school the week before and during that visit. I would further advise that the children do quick tests just before the grandparent arrives, and that everyone — including the adults — avoid indoor gatherings the week before and during the visit.
CNN: Speaking of testing, how often should families test their kids?
female: Some schools may have a regular testing schedule or random testing protocol to evaluate the level of Covid-19 in their student body. Others may simply request that children be tested if they are symptomatic or have a known exposure. Again, how many families want to test their children depends on how much they want to avoid the coronavirus. Many families view Covid-19 like any other viral illness, while some are still very careful to avoid it for a number of reasons, including the unknown future risk of long-term Covid.
CNN: Should parents and caregivers hold back extracurricular activities or playdates for their children?
female: Any decision making should weigh the desire to avoid Covid-19 against the downside of keeping children away from activities they would enjoy. Given our family’s risk assessment, I don’t hold back activities for my kids. My son is playing soccer, which sometimes happens indoors. My daughter is in a music class with a lot of singing, which is mostly indoors. We go on play dates, both outside and inside.
This is not to say that my family does not take precautions. My husband and I mask at airports and on trains. We don’t take our kids to the aquarium or science center when it’s super crowded, with crowds of people crammed in. We’re not trying to catch Covid-19 – but we’re also not going to change our lives the way we did during most of the pandemic to avoid it. And we totally understand if other parents can decide to be more careful and stick to outdoor activities mainly.
CNN: What happens when kids get Covid-19 – how long will they be out of school? What if someone in their family gets Covid?
female: The CDC guidelines say that people who contract Covid-19 should be in isolation for five days and then return to public facilities for the next five days with a well-fitting mask. People exposed to Covid-19, if they are up to date on vaccines, do not need to be quarantined and can return to public institutions as long as they are masked for 10 days, after five days of testing and remain asymptomatic. That’s what our family will do if we get infected again.
Some schools have protocols other than this, so check with your school to make sure you’re following their rules.
CNN: Should families have their kids vaccinated if they haven’t already?
female: Yes. A recent major study, just published in The New England Journal of Medicine, found that during a period of Omicron domination, two doses of the Pfizer/BioNTech vaccine reduced hospitalizations in children ages 5 to 11 by 83%. Vaccination also reduced infection by 65%. This and several other studies show how vaccination is crucial in reducing the risk of serious infections and symptomatic disease in children.
Both of my children got their vaccines as soon as they qualified. (My kids are both under 5 years old; kids 5 and up are eligible for boosters, although most didn’t get them.) For me, the calculation came down to this. I knew that even without vaccines their risk of serious illness is very low. But if I can reduce the chances of something bad happening even more, I’d do it. And now, with vaccination, I am comfortable with my children returning to normal pre-pandemic activities, even during a wave of Covid-19.