Interview by Stephanie Desmon
The new school year has already begun in some states. In others, students will soon head back into the classroom, many for the first time in a year and a half. In this Q&A, adapted from the August 16 episode of Public Health On Call, Stephanie Desmon talks to Keri Althoff, PhD ’08, MPH ’05, an associate professor in Epidemiology, and Elizabeth Stuart, PhD, AM, the associate dean for Education and a Bloomberg Professor of American Health in Mental Health, about how kids can return to—and stay in—school in person this fall.
We know how important it is to send our kids back to school, but at the same time, we’re seeing the delta variant kick up more. How safe should we feel sending our kids back to school?
ES: Unfortunately, we’re in a more complicated situation than any of us were hoping we might be in a couple of months ago, but we’re still in a much more knowledgeable place than we were last summer.
We have a number of tools in our toolbox, and they are all important. I think families should really be focusing on these five things: vaccination, ventilation, masks, testing, and avoiding indoor crowding.
When thinking about sending their kids back to in-person schooling, they should ask how those different pieces fit and are working at their school. Are there teacher vaccine mandates? Are the kids old enough to be vaccinated, and are they? Has the building ventilation been improved? Are there mask mandates? Are kids and teachers wearing masks? What kind of testing is possible to identify cases? What are the strategies to keep groups small at lunch and assemblies? Are there attempts to avoid large indoor crowds?
It seems to me that we are actually in a worse position than we were last summer, when most of the kids ended up staying home when school started. So how can we go back now?
KA: I do think it’s important to get the kids back in school. And the CDC has set this as a priority.
What parents need to think through is, how can we evaluate those five criteria that Liz just went through? How can we be a part of the conversation with our schools and our school districts to be sure that they are hearing the voices of parents?
It is not going to be perfect. It is not going to be the way it was in 2019, when kids went to school en masse without social distancing. Now we have not only COVID, but the delta variant, which is highly infectious.
Talk to me a little bit about delta. How much are our kids at risk?
KA: Unvaccinated children are just as at risk for delta as unvaccinated adults. And because children 12 and under are a concentrated population and they are not vaccinated, the virus is going to be able to infect and jump from one person to the next.
The cases among children have skyrocketed—and that has resulted in an increase in hospitalizations among children infected with the delta variant. What we don’t know at this time is if the virus is creating more severe disease. There are studies right now trying to answer this exact question for both children and adults.
Liz, I know you have a younger child who can’t be vaccinated. How do you talk to them about going back to school?
ES: I’m anxiously awaiting when my 10-year-old can be vaccinated. As a family we talk a lot about safe behaviors, and we have a family culture of mask wearing. We have not stopped wearing our masks indoors, partly in solidarity with him.
We’re explicit about things like, “Hey, at lunchtime, clearly you’re going to have to take off your mask to eat. But be mindful about putting it back on quickly.” I think sometimes adults underestimate kids and their resilience in this regard. Once they’re in an environment where the norms and expectations are clear, the kids adapt.
In some places, like Texas, for example, schools are not going to tell parents if there’s been an outbreak, and Florida prohibits mask mandates. That certainly complicates things for families who live there.
KA: We know that testing and monitoring help to stop outbreaks quickly. That is so important for keeping kids in school.
Some choice has been taken away from schools and school districts with some of these state-level mask mandates, and we should really be critical of that. We have been localizing recommendations for what to do when transmission gets high or gets low in your community, in your county, so state-level mandates get really, really tricky. What could be going on in one county may be slightly different in another, especially in states with a lot of land mass. That’s why CDC guidelines suggest adapting mitigation strategies based on what’s going on in the community.
ES: I really encourage families to keep an eye on that level of transmission—whether it’s moderate, significant, high—and keep an eye on whether the school is modulating their mitigation efforts in response to that. As Keri mentioned, the CDC has clear guidelines around different levels of community transmission and what mitigation measures are appropriate for those.
And the transmission we’re talking about isn’t just about what happens in the school building. A lot of transmission potentially is happening in the community as well.
I think families, and really the entire community, need to take responsibility to avoid risky behaviors and large gatherings, especially large indoor gatherings, so that we can avoid high levels of community transmission. We all need to do our part to keep those levels low so that kids can be back in school.
Things really do feel right now like they’re getting worse. In many places, COVID numbers are the highest they’ve ever been. Do you see us going back to virtual school?
KA: I think that question is going to be answered based on what our actions are right now. We are not out of this spike, and it is a steep surge. It is going up and up and up.
Particularly as schools are reconvening for in-person learning, our actions as communities have to support them. We have to do our part to reduce the risk of transmission in those schools by reducing the likelihood that we could be infected and transmit to someone else.
First, eligible people should absolutely get vaccinated. If you are vaccinated but have persons in your household who are not vaccinated, wearing a mask yourself when you go is really important so you don’t bring COVID home and transmit it to family members. COVID transmission is very common within households.
I don’t think many school districts and teachers and families and parents want to convert back to virtual school during the year. There are a lot of families making the choice, if they have the option, to engage with virtual schooling if they are unable to do the face-to-face because it is too high risk for their family. Having that choice is important.
But there aren’t many people who don’t recognize the disruption that is caused when you go back to virtual learning or when you switch formats. In my school district, we had four learning models in one academic year. It exhausted families. It exhausted the teachers.
We have to do everything we can for these kids who sacrificed a lot in most parts of the country by being at home for a lot of the year. It’s their time this year to be back in school. It’s our job to help support them by getting vaccinated, and during the surge, masking up. As parents, as supporters of our schools and our communities, this is our role.
Stephanie Desmon is the co-host of the Public Health On Call podcast. She is the director of public relations and marketing for the Johns Hopkins Center for Communication Programs, the largest center at the Johns Hopkins Bloomberg School of Public Health.
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