Returning to school during COVID-19

As parents, we want to do everything we can to continue the education and development of our children, yet we also want to protect them from COVID-19. Many of us remain uncertain about which option is best: keeping our children at home or letting them return to school and risk exposing them to COVID-19.

The importance of classroom learning

Attending school is an essential component of child and adolescent development and well-being. In addition to providing education, school also provides the development of social and emotional skills, security, physical activity and support outside of the home.

The importance of in-person learning is well documented and there is early evidence of negative impacts on children due to the recent school closures. Extensive time away from school has a negative effect on learning and often results in social isolation. Social isolation makes it difficult for schools to identify and address important learning deficits, depression and anxiety, physical or sexual abuse and substance use. Because extensive time away from school can harm children’s physical and mental health, it must be balanced with the risk of COVID-19

COVID-19 risk for children

It appears children are less susceptible to COVID-19 infection than adults and may be less likely to transmit the virus to others as well. Children account for less than 10 percent of COVID-19 infections, and as of July 2020, only 7.7 percent of total cases in Canada were in children age 0-19 years. Those under 19 years of age represent only 1 percent of total hospitalizations, with no associated deaths in the age group.

However, due to the novel nature of COVID-19, we are still finding out more about the virus. Looking into the research done by other countries can help us learn more about how at risk our children really are. A recent study from South Korea, which was conducted with social distancing in place and schools closed, indicates that children ages 10-19 have the same capacity as adults to transmit COVID-19 to others.

Other studies have also suggested that schoolchildren have more personal contact with each other than adults, since they interact with other children for a good part of the day. So, while children may be less likely to contract the virus, the increased contact between children during school may increase their likelihood of spreading the virus.

If children contract COVID-19, they typically have a less severe illness than adults do. There is strong evidence that the majority of children who become infected with COVID-19 are either asymptomatic or have only mild symptoms, such as cough, fever and sore throat. While serious disease requiring hospitalization does occur in children, it is relatively rare and is generally treatable.

How to keep children safe at school

There is a consensus among leading children’s health organizations such as the Canadian Pediatric Society and American Academy of Pediatrics that it is safe to go back to school with the following measures in place:

  1. Keep a safe distance: Place desks two metres apart and practice physical distancing on the playground and while lining up
  2. Hand hygiene: Ensure that there is hand sanitizer available at each desk or classroom to minimize congestion in hallways and bathrooms, and regularly schedule hand hygiene every two hours
  3. One way hallways, and staggered class periods: Tape arrows on floors to reduce congestion in the building and stagger class periods to ensure students do not flood into the hall all at once
  4. Symptom checks: Students and teachers receive a daily email with a checklist of symptoms, and if any symptoms are present, the child or teacher does not attend school
  5. Cohorts: Keep students within the same class group so there is less mixing between classes
  6. Facemasks: Masks are especially important when physical distancing is not possible. Experts advise that facial expression is an important part of communication that children should not be deprived of and thus mandatory use of masks is not recommended. Wearing a mask is considered a personal choice and should not be discouraged
  7. Sanitation: Proper sanitation of commonly touched surfaces and proper ventilation

For more information on changes your child might experience during their return to school, check out the following infographic on how to prepare your child for their return to school.

Children and facemasks

It is important to acknowledge that it may be difficult for most children to wear a mask for a full day. However, while it may be difficult, respiratory droplets are a major mode of virus transmission and wearing a mask places an obstacle in the path of these droplets. Frequent touching of the mask is a concern with children. To reduce face touching while wearing a mask, try to practice with your children at home before school starts to establish familiarity and reduce the novelty factor.

In China, Japan, South Korea and Vietnam where masks are already widely accepted and used during flu season, schools require them for almost all students and their teachers. In China, students are allowed to remove masks for lunch only, when children are separated by glass or plastic partitions.

Lessons from other countries

Some good lessons can be learned from the COVID-19 adaptations other countries have made. Denmark became the first Western country to reopen its schools in April. When reopening, the schools sectioned children ages 2-12 into “micro groups” of twelve. These groups came to school at staggered times, ate lunch separately, and had their own play zones in the playground. Every student was required to wash their hands every two hours, and with desks spaced two metres apart, the children were not required to wear facemasks. Childrens’ educational materials were cleaned twice daily, and if possible, classes were held outside. Parents were also not allowed on school property.

Do the benefits of attending school outweigh the risks?

All of this information suggests that a combination of keeping student groups small (12-15 students being optimal), maintaining physical distancing and preferably using masks can help keep school and communities safe.

Experts also agree that we must keep in mind how the virus is circulating in the community, which affects the likelihood students and staff will bring COVID-19 from their community or home to school.

In areas where infection rates are low and resources to identify and isolate COVID-19 case are adequate, and with some changes to students’ daily routines, the benefits of schools re-opening outweigh the risks.

Guidance for parents of children who develop new symptoms of illness

It is advised that students should stay at home when new symptoms of illness develop. The key symptoms to watch for are fever, chills, cough, shortness of breath, loss of sense of smell or taste, nausea, vomiting and diarrhea.

What to do if you’re sick

  • If the student (or their parent) indicates that the symptoms are consistent with a previously diagnosed health condition and are not unusual for that individual, they may return to school. No assessment or note is required from a health care provider.
  • For mild symptoms without fever, students and parents can monitor at home for 24 hours. If symptoms improve, they can return to school without further assessment.
  • If symptoms include fever, or if after 24 hours, symptoms remain unchanged or worsen, seek a health assessment. A health assessment can include calling your primary care provider like a physician, nurse practitioner, or nurse, calling 8-1-1 line, or going to a COVID-19 testing centre.

When a COVID-19 test is recommended by the health assessment: 

  • If the COVID-19 test is positive, the person should stay home until they are told by public health to end their self-isolation. In most cases this is 10 days after the onset of symptoms. Public health will contact everyone with a positive test.
  • If the COVID-19 test is negative, the person can return to school once symptoms have improved and they feel well enough. Symptoms of common respiratory illnesses can persist for a week or more. Re-testing is not needed unless the person develops a new illness. BCCDC has information on receiving negative test results.
  • If a COVID-19 test is recommended but is not done because the person or parent chooses not to have the test or a health assessment is not sought when recommended, and the person’s symptoms are not related to a previously diagnosed health condition, they should stay home from school until 10 days after the onset of symptoms, and then may return if feeling well enough.
  • If a COVID-19 test is not recommended by the health assessment, the person can return to school when symptoms have improved and they feel well enough. Testing may not be recommended if the assessment determines that the symptoms are due to another cause (i.e. not COVID-19).

Please note, it is expected that these guidelines may change in response to the changing nature of the pandemic.