COVID-19: Return to School in Fall of 2021

Mary Kiriaku

The whirlwind that COVID-19 threw students, educators and caregivers into in early 2020 was just the beginning of a flow of new but related storms each taking a different twist. Few would have thought that resuming schools after more than a year and a half of distant learning would still need so many checkpoints laden with uncertainty in the fall of 2021. Schools and the learning process were disrupted as families and educators grappled with establishing distant learning programs with minimal preparation or training. Safe transition back to in-person learning will require school districts, school administrators, teachers and individual families to carefully and consistently adhere to guidelines from credible health officials and from the Centers for Disease Control (CDC).

The tide moved from simply understanding how the virus was different from the flu to how it affected the children compared to adults to the most recent surge of the illness due to the Delta variant, particularly among children. There was a brief hopeful season this Summer when the cases went down with the advent of the vaccine and more public awareness of prevention measures. Not only are families dealing with the surge but with the effects of a prolonged pandemic on mental health, financial stability and social support systems. Widespread misinformation and uncertainty about the future have all added to the burden for the families and the educators.

Although the pandemic continues, there is more knowledge of prevention strategies and supportive treatment. It has also become clear that schools and schools supported programs play a vital role not only for academic growth in children and adolescents but fundamental to mental, emotional and social development and wellbeing. As schools continue to re-open, the goal of families and educators is to resume in-person learning while keeping the students and staff safe from COVID-19 this fall.

Recommendations for schools with students in special circumstances

Decisions around the reopening of schools are incredibly difficult after nearly a year and a half of mostly distant learning. The American Academy of Pediatrics has provided guidelines to support families, pediatricians, educators and all stakeholders in addressing the challenge. Growth and development are not the only advantages schools have on children and adolescents. Schools play a crucial role in addressing social and racial inequity. Some families rely on schools to provide a safe, stimulating and enriching space for children to learn with appropriate supervision and guidance. Schools provide access to opportunities for socializing and access to mental, physical, nutritional and health services.

Minority groups

The pandemic has had a huge negative impact on children from minority groups, children with disabilities and children who are English language learners. Unfortunately, when public health expertise is adjusted to fit political interests, the blunt of the damage goes to the children who are also the most vulnerable and the least capable of advocating for themselves. It is therefore the obligation of all responsible stakeholders to seriously consider the factors that can enhance the safety of every student and optimize in-person learning in the school setting.

Students hesitant to return to in-person learning

There is a high likelihood of separation anxiety and students may have difficulties with the unfamiliarity caused by changes in the school environment and COVID-19 prevention procedures. Students with preexisting mental health challenges like anxiety and depression are at higher risk. Students in the autism spectrum may be sensitive to disruption in routines. Students facing food instability, homelessness and those already disadvantaged by other inequalities may need extra support. Schools should be proactive to identify the students at risk for not returning to school and conduct outreaches prior to school return.

Students with disabilities

Many students with disabilities have not only lost instructional time but may have missed related services such as occupational therapy, speech and mental health services. It is crucial that schools review each student’s Individualized education program (IEP) to determine the need for interventions for lost instructional time and related services. Staff and instructors working with some students with disabilities may need to exercise additional or modified COVID -19 safety measures. As an example, the use of face masks by the instructor may impede learning for students with hearing disabilities who rely on facial expressions and lip reading for communication and learning. Face covering with clear panels may be a better option in such circumstances.

Multi-system inflammatory syndrome (MIS-C)

Clinicians noted previously healthy children presenting with multi-organ inflammation concurrent with COVID-19 infection or soon after diagnosis with the virus.

Children with MIS-C present with high fever for 24 hours or more and have inflammation in various body organs such as the intestines, heart, brain, lungs, skin and kidneys. Other symptoms of multi-organ inflammation due to MIS-C include:

Rash and changes in skin color—bluish lips or face
Bloodshot eyes
Abdominal pain, diarrhea or vomiting
Neck pain
Extra fatigue and malaise
Pain and pressure in chest that does not go away
Shortness of breath
Confusion
Excess sleepiness

Most children diagnosed with MIS-C have recovered after getting medical care in the hospital. Early recognition is key to correct diagnosis and successful treatment. The Centers for Disease Control (CDC) recommends close cardiology follow post-hospitalization in case of long-term consequences of inflammation of heart function common with MIS-C. Parents, teachers and care givers should contact the child’s pediatrician as soon as any symptom that could suggest MIS-C is noted.

Sports, recess and extra curriculum activities

Sports and extra curriculum activities promote learning and enhance the healthy social and mental well-being of students in a school setting. COVID-19 prevention strategies should be exercised during these activities. Several factors should be considered when assessing the risk for transmission and the choice of prevention strategy.

Physical closeness during the activity
Number of participants/players
Duration of time of activity
Setting of the sport/activity—indoor versus outdoor
Presence of people more likely to develop severe illness e.g., players who are immune-compromised may need to take extra precautions.

Prevention Strategies

Vaccination

According to CDC Guidance for COVID 19 - prevention in schools updated on August 5, 2021, vaccination is the leading public health prevention strategy to end the COVID-19 pandemic. Promoting vaccination in schools and in the community will enhance safe return to in-person learning as well as extracurricular activities and sports. No vaccine is available for children under 12 yet. This makes it even more important for the adults and older children working with this vulnerable population to get vaccinated to prevent transmission to the unvaccinated children.

The Pfizer-BioNTech vaccine was recently approved by FDA and is available for children between 12-16. Families should be educated and encouraged to obtain vaccines for older children. The school administration should explore channels of communication that resonate with members of the community. Cultural sensitivity and competency will enhance trust in communities and minority groups where historical contexts have led to mistrust of the health care system and the government. Community leaders such as the clergy and public health agencies are valuable partners in vaccine campaigns.

Federal health officials recently reported an association between currently available COVID-19 vaccines and inflammation of the heart muscle and the sac-like membrane around the heart. These conditions are also referred to as myocarditis and pericarditis. Males between 16-24 are more affected than females or adults. Health officials and the American Academy of Pediatrics recommend that all children in this age group should get the vaccine since the risk of getting myocarditis or pericarditis is quite low. Those affected are also recovering well with minimal or no treatment. Follow-up with cardiology post-discharge from the hospital is recommended.

Layered prevention strategies

Schools should maintain at least 3 feet of physical distance between students within classrooms to reduce transmission risk. It is important to layer multiple prevention strategies including screening testing, consistent and correct face covering, hand washing and respiratory etiquette. Students and teachers should be encouraged to stay home when sick. Putting students and instructors in cohorts and minimizing movements across cohorts can further reduce chances of transmission.

Summary

Safe transition back to in-person learning is possible but will require school districts, school administrators, teachers and individual families to carefully and consistently adhere to guidelines from credible health officials and from the Centers for Disease Control (CDC). Multi-layered prevention strategies are more beneficial than a single strategy. School leaders should be aware and address barriers such as inequalities and disabilities that can affect how information is received and utilized.