How Will Delta And COVID-19 Change This Back-To-School Season?

Getting the kids ready to go back to school each fall is stressful enough in a normal year, never mind in the midst of a pandemic. Between the more transmissible Delta coronavirus variant, rising cases across the country and new masking guidance from the U.S. Centers for Disease Control and Prevention (CDC), there’s a lot for parents to navigate as they plan for schools to reopen this August and September.

On the whole, experts seem to agree it’s time to get kids back into their classrooms. Remote learning set many children—especially students of color—back academically, cut them off from essential social services like free or reduced-cost meals, and took a major toll on their mental health. As many districts have reduced remote schooling programs, even the most reluctant parents may have little choice but to send their kids back to school, short of homeschooling.

The worry, of course, is that in-classroom learning could facilitate the ongoing spread of COVID-19. But on the positive side, a year of scientific progress means that schools may now be better equipped to prevent viral spread in their classrooms, hallways and locker rooms. Public health experts and school administrators now know that layered mitigation methods, including face masks, distancing and ventilation, can help reduce transmission. Additionally, kids over 12, as well as their teachers and parents, can get vaccinated—the best tool to prevent getting sick and to reduce the spread of the virus.

To help parents of school-age children navigate the upcoming back-to-school season, TIME spoke with pediatric infectious disease experts about how to keep kids—and those around them—safe this school year.

What risks does COVID-19 pose to my child?

It’s rare for COVID-19 to cause severe illness among school-age children, but it does happen. Those with underlying medical conditions, such as heart disease, immune disorders and diabetes are at higher risk, according to the CDC. Some 400 children have died after contracting COVID-19 in the U.S., according to CDC data. Of course, while any death is tragic, that figure represents only around 0.01% of children known to have tested positive for the disease. In other words, it’s unlikely that kids will suffer the worst impacts of the virus.

Indeed, while children can also develop “long COVID”—suffering from persistent COVID-19 symptoms long after getting infected—preliminary evidence suggests that the condition is far less common in children than adults. A study by Swiss researchers published in JAMA on July 15 found that only 4% percent of the kids surveyed who had tested positive for COVID-19 were still experiencing symptoms after 12 weeks.

That said, there’s still a lot we don’t know about COVID-19. Dr. Aaron Milstone, a professor of pediatrics at the Johns Hopkins University School of Medicine, notes that some viral illnesses, like measles, can cause harm years after exposure in children, and we can’t know for sure that COVID-19 won’t have future consequences. “I do think it’s important to acknowledge that there are unknown risks, although small,” he says.

How has the Delta variant changed the risk of getting COVID-19 at school?

The Delta variant is more transmissible than the version of SARS-CoV-2 (the virus that causes COVID-19) that circulated for much of the previous 16 months or so, which means that it could spread faster in schools, just like it does anywhere else. Though it doesn’t seem to cause more severe illness (in either children or adults), Dr. Sean O’Leary, a professor of pediatric infectious diseases at the University of Colorado School of Medicine, says he’s concerned that kids could carry the virus back home to vulnerable family members, or in the other direction, putting teachers and staffers at risk. “I think it has the potential to be bad,” he says.

Delta’s emergence is a reminder that schools will need to stay flexible as the virus continues to circulate. Milstone points out that the dynamics of the pandemic are changing over time—vaccine-generated immunity may wane over time, people of mixed vaccination status are increasingly socializing with one another, and fewer people are taking precautions like masking or distancing (though the CDC’s new guidance may help change that). “We have to keep up with the virus,” Milstone says.

The best preventative method, of course, is mass vaccination. And most evidence suggests that Pfizer-BioNTech’s vaccine, the only shot authorized in the U.S. for kids aged 12-15, is effective against the Delta variant. Vaccines aside, schools can help protect students, teachers and staff by implementing “layered” prevention methods, including masks, distancing and ventilation, says Dr. William Raszka, a pediatric infectious disease specialist at the University of Vermont Medical Center. These efforts are especially important for protecting students younger than 12, who can’t yet be vaccinated.

Could my child carry COVID-19 to someone else, like family members or their teacher?

Children can pass COVID-19 to other people, although the risk of transmission tends to be higher with older children, says Dr. Liz Whittaker, a senior clinical lecturer in pediatric infectious diseases and immunology at Imperial College London. A study conducted in South Korea in winter 2020 involving 5,706 COVID-19 patients found that children below 9 years old were less likely to spread the virus to other groups compared to kids aged 10-19, who appeared to spread it as much as adults.

O’Leary says widespread community vaccination is the best way to limit these risks. “What we’ve seen throughout the pandemic, including now with this Delta variant, is that [the number of] cases in kids basically reflect what’s going on in the surrounding community,” he says. “The most important thing to help schools be successful this year is get everyone to get vaccinated, down to age 12.” And, if schools practice layered mitigation methods, it should keep teachers at low risk of infection, says O’Leary, especially if they’re vaccinated.

Parents can take steps to help prevent outbreaks at schools as well. Whittaker urges families to keep their kids home if they seem unwell, and consider having older children wear a mask even if they’re not going into school—and even if they’re vaccinated—in order to keep the people around them safe. And don’t forget the basics, she adds. “Like washing your hands before you eat, which we should do anyway,” she says.

Could schools trigger a COVID-19 outbreak in my community?

So far, schools haven’t been a major driver of COVID-19 outbreaks. Instead, they’re more likely to reflect the level of transmission that’s already happening in a given community.

For instance, in an April study published in Pediatrics, researchers who studied North Carolina schools with 90,000 in-person students and staff found only 32 school-based local infections over a nine week period, while 773 other people were infected elsewhere in the community. However, it’s important to note that the schools studied for that paper practiced mitigation strategies like universal masking, 6-foot distancing and symptom monitoring.

That said, Milstone notes schools “tend to be more conservative” and take more precautions to limit viral spread compared to other institutions. In fact, schools probably aren’t more dangerous than other activities many kids are already doing, he says. “I would say a kid who’s masked in school is less likely to bring [COVID-19] home from school than they are from bringing it home from their Sunday school group or … a birthday party with 10 other kids where they’re probably not masked.”

How can I get ready to send my child back to school during the pandemic?

If your child is too young for the shot, getting vaccinated yourself is one of the best ways to protect them from contracting COVID-19, as it reduces the risk you’ll spread the virus to other people. “If you’re sending a child to school, you absolutely want to make sure you’re vaccinated if the child’s too young to be vaccinated,” says O’Leary.

O’Leary also tells parents that they should take a close look at the mitigation measures their children’s school has in place, including whether face masks are required, and advocate for more precautions. And regardless of the school’s policy, it may be smart to talk to children about wearing face masks. Generally, O’Leary says, kids are “better than the adults at wearing masks!”

And most importantly, if your children are 12 or older and eligible, get them vaccinated—and don’t wait. People aren’t considered fully vaccinated until two weeks after their second Pfizer shot, which is usually scheduled three to four weeks after their first injection. That timetable means you’ll need to go ASAP to ensure your child is protected for their first day of school.

Milstone acknowledges his perspective is skewed as an infectious disease physician; with his career, he sees an unusual number of children very sick with COVID-19. All the same, he says that seeing children die from a disease that can be prevented by vaccination is very difficult.

“I’ve said this my whole career, right?” he says. “It’s really discouraging to watch people die of vaccine preventable diseases. And especially kids, who don’t get to make that choice for themselves.”

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