Every Fall when children return to school they come down with routine colds. Others get runny noses from ragweed allergy. This year, on top of the “typical” fall coughs and sneezes, we have COVID-19 infections, contact tracing and quarantines. As a society, we have failed to provide a safe environment for children to go to school for almost two years now.
According to the Centers for Disease Control and Prevention and the American Academy of Pediatrics, COVID-19 infections can be minimized when schools enhance ventilation, mask everyone in the building and make sure anyone who can be vaccinated is vaccinated. School infections are also directly correlated with the rates of infection in the community, so community mitigation measures are also important, including reducing indoor gatherings, masking when indoors in groups and getting vaccinated. These recommendations are meant to ensure children thrive in school during a pandemic, yet we have failed to routinely implement them throughout our schools.
As I write this, we have plateaued in Maryland with a consistent COVID-19 community transmission rate of around 20 cases per 100,000 population and 800 Marylanders in the hospital. Our state’s high immunization rate has blunted the large Delta variant surge experienced elsewhere in the U.S. However, Maryland’s school-aged children are now a higher percentage of the new cases. This is in large part because they are the least-vaccinated group, with elementary schoolers still ineligible for vaccine, and lower rates of vaccination among 12- to 18-year-olds compared to adults. We are experiencing significant school outbreaks, and the necessary quarantining of “close contacts” (children exposed to COVID-19 classmates) is resulting in lost opportunities for classroom learning and socialization.
As highlighted by The Baltimore Sun recently, this places a sizable burden not just on teachers, administrators and families, but also on our school nurses. In addition to their regular duties, our school nurses have been called into action as contact tracers — identifying children that may have been exposed and determining when quarantined students may return to the classroom safely. This is usually the domain of local health departments, which are also overextended and underfunded.
As pediatricians, we are struggling to navigate a new “back-to-school” environment in which children are simultaneously vulnerable to the common seasonal cold (rhinovirus), an early-arriving RSV season (respiratory syncytial virus) and COVID-19 infections. And influenza is right around the corner. In our typically busy practices, we must juggle caring for children sick with highly contagious and dangerous illnesses with the care of healthy infants and children.
The volume of children needing evaluation, testing and a “return-to-school” note is overwhelming. Rapid COVID antigen tests and the more accurate (but longer to result) COVID-19 PCR tests are in short supply and wait times for results can be as long as four days. Many children are showing up in Emergency Rooms and urgent care centers as well, looking for a test to return to school. Without a system of centralized reporting of results, this is contributing to the long waits and delays in school return as parents struggle to produce appropriate documentation of testing results for the schools.
There does not appear to be consistent state guidance on who gets quarantined, who needs tests and when can children return to school after being ill or coming into contact with someone who is. The Maryland Department of Health has deferred to the local health departments. From our vantage point, it seems like the guidance many schools follow has a default to exclude children from the classroom, rather than keep them in school.
It is time for Maryland to take a proactive and standardized approach to keeping children in schools. Fortunately, we already have a statewide mask mandate. What we need now is a more robust school-based rapid antigen testing program known as “test to stay.” The program starts with the presumption to keep kids in school and gives any asymptomatic child who was a close contact of a COVID-19 case due to in-school exposure an option to undergo daily rapid antigen testing for 7 days following exposure — instead of being sent home for 7 to 10 days and missing school. Finally, we need to better define consistently what truly is an exposure: Is it every child in a class? Or just the ones who are nearby and unmasked? Or better yet: We do not even worry about that and just test all the kids regularly and keep them in school.
Scott Krugman (firstname.lastname@example.org) is vice chair in the Department of Pediatrics within the Herman & Walter Samuelson Children’s Hospital at Sinai and a professor of pediatrics at Georgetown University School of Medicine.