Going Back To School During Delta

Pediatricians believe a healthy, safe, and productive school year is essential and achievable. We just all need to do our part to make it happen.

It’s August, which means that a summer of uncertainty has given way to a school year full of new questions and concerns. For parents of unvaccinated children, like myself, the summer has been an especially confusing time. While older children and adults got vaccinated, shed their masks, and made travel plans, families with unvaccinated children moved about hesitantly. There was relief as more of our population became vaccinated. But then news of the highly transmissible Delta variant and rising case rates among children brought more worry. On top of that, data now shows that although vaccinated people are very well-protected from severe disease, they can become infected and transmit the virus to others, albeit at a much lower rate than unvaccinated people. Many vaccinated parents are putting masks back on indoors and wondering and worrying what the school year will look like for their children.

Parents are understandably frustrated. In the early days of the pandemic, there was a general feeling of shared sacrifice. Children’s lives were disrupted and families really struggled. But there was a sentiment that we were all in this together. Now we see rising case rates in the U.S. in what has been dubbed by officials a “pandemic of the unvaccinated”. But the “unvaccinated” of course includes all children under 12 years of age. For families, this no longer feels like shared sacrifice. This feels extraordinarily unfair.

So here we are. Not Vax Kids’ Summer is coming to an end and we are heading into Not Vax Kids’ Back-To-School season. With news of the more transmissible Delta variant, rising case rates, and variable school guidance across the country, how should parents approach the upcoming school year?

The bottom line is that pediatricians believe we can have a healthy, safe, and productive school year as long as we recognize that schools are a place where more unvaccinated people will gather and that we will need to take extra steps to make sure schools are accessible to all.

For context: I’m writing this from Vermont where we have higher vaccination rates and lower case and hospitalization rates relative to other states in the U.S. We are in an enviable position but also need to be careful and thoughtful in our approach. I’m a pediatric intensivist at UVM Children’s Hospital which means I take care of critically ill infants, children and adolescents in the only Pediatric Intensive Care Unit (PICU) in Vermont. My colleagues and I take care of the sickest kids and we are passionate about prevention. As the President of the Vermont Chapter of the American Academy of Pediatrics (AAP-VT), I have a good sense of what my pediatric colleagues are seeing throughout the state and across the country. I am also the mother of two young children. Both have been attending an early childhood education center full-time in-person throughout the pandemic and one will be moving on to kindergarten in a few weeks. In short: I am invested both professionally and personally in keeping kids safe in schools.

So here are the key principles we should be focused on this school year:

1. Prioritization of in-person learning

You may wonder why, as a pediatric intensivist, I’m listing in-person school as a top priority. Over the last year and a half pediatricians in Vermont and across the country have witnessed a significant decline in the health and well-being of some of our patients. Many became less physically active, more socially withdrawn, and disengaged from academic learning. The pandemic exacerbated the existing mental health crisis among children and adolescents. The long-term effects of the pandemic on young people are unknown and pediatricians are worried. This is why we are advocating for students to be physically present in school full-time.

In-person learning provides a nurturing and stimulating academic and social environment for students. A full-time in-person schedule gives students consistency and support throughout the school year. For these reasons, AAP-VT agrees with the CDC that physical distancing should not preclude full return to in-person learning. We believe students can have a healthy and safe year even with strict social distancing guidelines relaxed as long as we rely on other mitigation measures.

This is no small effort and it will require continued careful attention to the mitigation strategies that we know work: vaccination, staying home when sick, testing, contact tracing, and masking. But keeping the school environment safe and limiting disruptions to the school year is not just the job of schools and families, it requires investment from the community as well.

2. Vaccination, vaccination, vaccination

Protection through vaccination is the only way out of this pandemic. I have been grateful that Vermont has not lost sight of this despite being the most vaccinated state in the country. The Delta variant has shown us that we need as many people vaccinated as possible and the Vermont Department of Health (VDH) continues to offer walk-in and pop-up vaccination sites. You can find opportunities to be vaccinated everywhere you look: county fairs, farmers’ markets, state parks, school clinics, pharmacies and your medical home.

If you work at or attend school and are eligible for the vaccine, please get vaccinated as soon as you can. Now is the time. If you are the parent of an eligible adolescent, please have your child vaccinated as soon as possible. Many parents expressed a desire to “wait and see” when the Pfizer vaccine emergency use authorization was extended to include those 12 years and older this spring. But there is more urgency now to protect children before the school year starts and there is even more compelling evidence that the vaccine is safe and effective in young people. At this point over 11 million young people under the age of 18 in the U.S. have received the vaccine. That’s a lot of reassuring data points. More than two-thirds of Vermonters aged 12–17 have been vaccinated: that’s more than 28,000 young Vermonters. Now is a great time to join this ever-growing group of young people who are protected from the serious effects of COVID-19.

In Vermont, minors need to have parental permission to be vaccinated. Pediatricians are happy to talk to parents about why we think it’s important for children to be vaccinated. Helpful tips for young people on how to talk to parents about getting vaccinated can be found at Teens For Vaccines.

For parents of children under 12 years of age who are waiting for their children to be eligible for vaccination — I feel you. The best way to protect your children from the virus is to ensure that those around them, especially adults, are vaccinated. If you feel comfortable having a conversation with the unvaccinated adults in your child’s life, you may be able to motivate them to get vaccinated. I would avoid getting into arguments or exhausting yourself disputing misinformation. Instead I would simply say, “please let me know when you get vaccinated. Otherwise, until my child has had the opportunity to protect themselves with vaccination, we will need to limit contact with you”.

For those not connected to schools: if you are eligible to be vaccinated and have not yet done so, please know that getting vaccinated now will have a positive impact on the ability of schools to run smoothly this year. Lowering rates of community viral transmission decreases the likelihood that COVID-19 enters the school and childcare settings in our communities. Our children and educators deserve a healthy school year with minimal disruptions. You can make a difference by getting vaccinated.

3. Stay home when sick

This part is going to be hard. Really hard. We will all probably get more colds this year compared to last year. We are currently seeing more cases of upper respiratory infections than we usually do in the summer season. All students and staff, vaccinated or not, should stay home when sick and get tested for COVID-19. The Vermont guidance for PreK-12 Triage, Evaluation, Testing and Return to School Flow Chart will be updated before the start of the school year to reflect current dynamics. It’s helpful to note that VDH COVID-19 testing sites are open for those who are symptomatic as well as those without symptoms. This should allow easier access to testing.

Workplaces will have to remember that the pandemic is not over. Employers should craft supportive sick and family leave policies. Employees should be encouraged to stay home if they are ill or need to care for sick family members. For families with children this may mean lots of sick days this year. This is going to be challenging for families but is an important tenet to the pandemic public health response and beyond.

4. Masking

We are more than a year and a half into this pandemic and we’ve learned a lot about effective mitigation strategies. Masking is a simple and effective tool that reduces the spread of COVID-19 as well as other respiratory viruses that can mimic the signs and symptoms of COVID-19. Students and staff wore masks throughout the school year last year. Continuing the practice makes good, common sense as we start school again in the fall.

There is broad consensus among medical and public health experts about the need for universal masking in schools. The Vermont Agency of Education along with VDH have recommended that school districts require masking of all students and staff regardless of vaccination status at the beginning of the school year. This recommendation is in line with national recommendations by the Centers for Disease Control and the American Academy of Pediatrics as well as AAP-VT. Keeping students in school with minimal disruption is our shared goal and masking can help us do that.

Masking is an important layer of protection in schools even as community and school vaccination rates rise. Vermont state guidance has suggested that after the first 10 school days, schools should stop requiring masks for those over 12 years of age once 80% of the eligible student population has received its second vaccine dose. Vaccinating more of our population is the path forward here and the administration is right to focus on this effort. But given what we know currently about the Delta variant, AAP-VT recommends continued universal indoor masking in the school setting regardless of vaccination rates for now. As we learn more about the potential transmission of COVID-19 among vaccinated people, it makes sense to continue universal masking while we wait for younger children to have the opportunity to be vaccinated sometime this fall or winter.

How should parents prepare for the school year?

• Stock up on masks. The best mask is the one your child will wear. Let your child help you pick out the patterns and colors they like best.
• Have a backup plan for sick days. If your child wakes up with a cough and nasal congestion, they will have to be tested for COVID-19 and stay home until symptoms resolve. This will be challenging for most families. I know how hard this is from personal experience but we have to do this to keep our schools healthy.
• Be prepared for changing guidance. Recommendations change because variables change during a pandemic. It can be frustrating but at the same time we should be reassured when public health guidance changes in response to what’s going on around us.
• Look to your child’s medical provider for guidance. Despite our best efforts at prevention, some of our unvaccinated children will be infected with COVID-19. This is frustrating because at this point in the pandemic it feels preventable. Frustrations aside, if it happens — take a deep breath. We are here for you and your family. Most children get better on their own. Your child’s healthcare provider can guide you through the illness and help you through the back-to-school and return-to-play process. If your child gets really sick and needs more medical support, rest assured that you will be in good hands. Pediatric hospitalists and intensivists, along with our subspecialty colleagues, are very well-trained to care for sick children. In the hospital we work with teams of experts to care for children: nurses, respiratory therapists, pharmacists, nutritionists, social workers, child life specialists, and rehabilitation professionals. Taking care of sick children is what we do all day, everyday, and we’re very good at it. If you need us, we will help you and your family through it.

We can do this

I want to end on a hopeful note. Despite all of the uncertainty, I am very much looking forward to the school year. I’m excited to see my children learn and grow in childcare and school. I know they will gain so much from being around their peers and educators. I know school is the right place for Vermont students to be and I believe that we can do this successfully.

As a reminder: teachers, school nurses, and administrators are already working hard to prepare for the school year. Early childhood educators have been caring for our children nonstop this entire pandemic. Patience and appreciation for the professionals who educate and care for our kids will go a long way as we head into the new school year.