Kids Over 10 May Be More Likely to Spread COVID-19 at Home, According to New Research
You may be still adjusting to the new realities of summer vacation during the novel coronavirus pandemic, but federal leaders and school district officials are busy rolling out back-to-school plans this month, despite rapid increases in new COVID-19 cases across the United States. In Florida, Education Commissioner Richard Corcoran signed an emergency order that mandates that public school districts and charter schools must be open to kindergarten through 12th-grade students on a normal five-day schedule. Parents in Texas will have final say over whether they send kids back to school, and officials have already established a few guidelines (masks will be required). And even though the decision is up to the states, federal officials have voiced support to push school districts to reopen on schedule, according to Associated Press reports: "We’re very much going to put pressure on governors and everybody else to open the schools," said President Trump, during an education roundtable at the White House in early July.
While universities are grappling with new plans for limited re-openings — the Chronicle of Education is tracking more than 1,100 colleges and universities' plans for reopening, and 50% are planning for in-person learning in some fashion — not every school district is following Florida's lead. New York City's public school system, the largest in the nation per The New York Times, will only partially reopen three days a week, Mayor Bill de Blasio announced in early July. More than 1.1 million children will attend reduced-capacity classes at different times during the week, but this plan is still developing and may change again as the pandemic rages on.
Your local school district may have already announced plans to reopen fully or partially with new policies — but even if they do, should you actually send your child back to the classroom? For some experts and leaders, the loss of traditional face-to-face learning seems too detrimental to a student's progress, and teachers struggle to keep K-12 students engaged virtually. But others are worried that there's too many uncontrolled, moving variables to ensure students' safety as well as the teachers, coaches, and school employees who will work to institute new policies. And ultimately, some students may not be equipped to face these new changes (either because they have a pre-existing condition, or because it's too stressful altogether).
Good Housekeeping polled a panel of leading infectious disease experts at public institutions and children's hospitals across the United States on understanding the most apparent risks ahead. Below, we recount these risks, answer commonly asked questions, and give advice for those who are thinking of sending their kids back to school next month and beyond. We'll continue to update this guide as new information becomes available.
What are the most apparent risks in a classroom setting?
There are multiple COVID-19 risk factors associated with sending a student to school this fall, all in varying degrees of severity depending on the individual situation. All of the experts in our panel agreed: School and classroom size, population density, local rates of COVID-19 transmission, and transportation modes greatly influences the likelihood of your child getting sick. Inside the school, however, there are universal risks that parents won't be able to mitigate and will affect nearly every student in the U.S.:
Shared equipment and high-contact surfaces. As school is structured now, students often share desks, tools, and tables across multiple rooms during the day. Charles Gerba, Ph.D., a leading microbiologist and professor of virology and environmental science at the University of Arizona, previously conducted research that suggests classroom desks are the dirtiest surface in elementary schools by far (more so than cafeteria tables and even bathrooms). "It has to do with unclean hands throughout the day," Gerba explains, adding that a hard, non-porous surface like a desk (or a door handle or a pencil sharpener) can harbor many different viable germs for hours or even days. In the case of SARS-CoV-2, the virus that leads to a COVID-19 diagnosis, recent research published in The Lancet suggests that viral particles can live on glass, wood, paper, plastic, and stainless steel all in excess of 24 hours (in some cases, up to a week). This can influence risk if a student were to touch their face with unclean hands at any point during the school day.
Shared air supply in close proximity. The Centers for Disease Control and Prevention do not believe that COVID-19 is spread primarily by rubbing germs into your eyes, nose, mouth, however. The major risk lies in infected individuals breathing highly-infectious airborne particles and droplets into their immediate surroundings. Officials at the World Health Organization recently confirmed at a press briefing that SARS-CoV-2 is indeed airborne in small droplets after reviewing mounting evidence collected during the first four months of the pandemic, CNN reports. While each classroom is different, poor ventilation and prolonged periods of sitting within six feet of one another — previous research suggests particles can be airborne for up to 15 minutes in some instances — is a major risk throughout the day, Gerba adds. "You can only space them out enough so far, as classrooms can get pretty small and facilities are often lacking in unused space as it is."
Shared facilities. Even if you could ensure that each child remains firmly in their socially-distanced seat all day, at some point, they'll have to get up to eat lunch, use special equipment in certain classes, or use the bathroom. Art studios, music halls, gyms, cafeterias, and bathrooms are all examples of shared spaces that can't be as tightly regulated as a classroom. Gerba says there are highly-trafficked points in all of the spaces where germs are bred, and these areas result in more movement, which is an added layer of risk that school officials will have to address.
Shared transportation. Some buses transport multiple groups of kids (high school students first, then elementary school kids) to and from schools on the same day. "That's going to be a major challenge for school districts, because [each bus] may have three trips with three different groups of kids in one day," Gerba says. All of the risks above — shared air supply and viable germs on surfaces like seats and windows — are intensified in a bus, which is much smaller than a classroom. And in rural areas particularly, students may spend a good deal of time per day riding the bus.
Does a school's location or class size influence risk?
Children living in rural communities or attending private schools may face a different threshold of risk than those in cities or populous school districts. Unfortunately, there's not an easy way to understand "when big is too big," says Sharon Nachman, M.D., the chief of the division of pediatric infectious diseases at Stony Brook Children's Hospital in New York. "The idea that rural schools have smaller sizes may not always hold true, because some US districts have smaller school budgets resulting in larger sizes," Dr. Nachman explains. "I suspect that a class size of 12-16 is ideal, but would expect that smaller class sizes are most crucial for younger and mobile kids who like to move around." Older pre-teens and teens, who sit at their desks throughout the day and are potentially more cognizant of the risks, may be better suited to handle larger class sizes, she adds.
Dr. Nachman says the size of your child's school — and how well your community is preventing the spread of COVID-19 — should play a role in helping you decide your child's risk level. But she stresses that even small schools (including private schools) will face the same risks that students at larger schools will run into, in moving around campus and navigating the school day. "Older children can be taught to socially distance and wear masks while walking in the hallway, but this could be a more difficult task for younger students who need more bathroom and activity breaks."
Your child's school building and surrounding campus may play a role in mitigating COVID-19 transmission as well. Joseph Allen, D.Sc., author of Healthy Buildings and a professor of exposure assessment science at Harvard University's School of Public Health, tells Good Housekeeping that holding school activities outside is best, as it may let children cope with mask fatigue — and that some school buildings are better designed to handle respiratory viruses. "Think along the same lines when thinking about time indoors: How can you bring in as much of that outdoor air as possible?" Allen asks, adding that windows, fans, and air purifiers in HVAC systems may bolster air supply, a point that he touches upon in his Washington Post op-ed based on a plan to reopen schools safely. "As examples, swap out close contact sports activities with outdoor games where kids can stay separated. Instead of chorus or wind instruments, consider time spent on music theory or rhythm instruments."
Common questions, answered:
Considering sending your child back to school? These are some of the most frequently asked questions that experts are hearing when navigating a back-to-school plan.
Should my child take the bus? There are bound to be changes to how a school bus works in your community. Behnoosh Afghani, M.D., a pediatric infectious disease expert within the University of California Irvine Health system, says there's already been an official ruling on this from the American Academy of Pediatrics (AAP). "They recommend alternative modes of transportation for students who have other options, especially students who have underlying health problems," Dr. Afghani explains. "However, if no other option is available, a 6-foot distancing rule between the occupied seats in the bus should be followed." It's not as easy to enforce, but face masks should be worn throughout an entire bus ride, and students should remain facing forward in designated seats (tape marks can be used to demonstrate where they should sit). "Parents need to be monitoring their children daily, and shouldn't allow their children on the bus or on public transport if they exhibit any concerning symptoms," Dr. Afghani says.
Should I pack a lunch? Officials at the CDC have established that food itself isn't known to be one of the ways in which COVID-19 spreads within a community, so Dr. Afgahni says parents shouldn't be afraid of cafeteria items on their own. Both Dr. Afgahni and Gerba maintain that current food safety standards should save lunches from being contaminated by harmful germs, but there's still risk in eating food in close quarters in a cafeteria. "To minimize how many students are in the cafeteria, separate lunch periods can be assigned and additional spaces outside of this room can be used for eating," Dr. Afgahni advises. Packing a lunch may allow your child to skip heading to a potentially crowded or busy cafeteria, but you should be more concerned about where they eat lunch (and how many people are around them when they do so).
Should my child participate in sports or extra-curricular activities? Gerba says airborne particles are less concerning outside, and if properly spaced out, exercising shouldn't be a concern (non-contact sports, particularly). "The wind's blowing the virus, and it's getting diluted very fast, unlike a building where it may not be diluted so rapidly depending on your ventilation," Gerba says, explaining that ultraviolet light can also play a role in neutralizing viral airborne SARS-CoV-2 particles. Germs are a concern on playgrounds and on shared sporting equipment (baseball bats, gloves, tennis rackets, and balls of all kinds, for example) but can be mitigated with proper sanitation. Activities that occur inside, however, should be planned in the manner that have teachers moving around the building, not students, Dr. Nachman argues. "It's much easier to move one adult around than to move an entire class, and clean the room completely, before and after they arrive." Special consideration should be given if an activity is impossible to do without sharing materials or staying in closed quarter.
Is there risk involved for family members who share a home with a student? The short answer, yes; especially for those who may be at higher risk (grandparents or those with pre-existing conditions). New research published by the CDC suggests that children between the ages of 10 and 19 may spread COVID-19 at home in a similar fashion compared to adults. Using data sourced from more than 59,000 contacts related to 5,700 COVID-19 patients in South Korea, researchers discovered that transmission between family members and children over 10 "was high" in the household. Interestingly enough, the rate of household transmission fell dramatically for kids under 10, a trend that may influence later decisions regarding which students will go back to school first. "Understanding the role of hygiene and infection control measures is critical to reducing household spread, and the role of masking within the home, especially if any family members are at high risk, needs to be studied," researchers wrote in the journal Dispatch. More research is needed to understand how children of different ages may be more or less likely to spread COVID-19 in and outside of schools, but there is sufficient evidence to suggest they can indeed spread the disease at home.
How can you keep your child safe?
Because there are so many dependent risk factors that are different for each family, all experts agree that parents need to harp on the basics. Teach your child about the proper way to wear a mask, how to wash their hands (and frequently!), and the tenants of social distancing. But more importantly, you should be asking your school's officials about new policies that are being instituted to keep your child safe. "Expect to hear them say we will try things one way, and if it doesn’t work, we will develop a new plan in this manner," says Dr. Nachman. Experts recommend that you ask the following:
Will masks be required? You can learn more about why masks are particularly effective in stemming the spread of COVID-19 here.
What other social distancing measures will be put into place before my child arrives?
How will my student's schedule or day be structured? Staggering schedules on a daily or weekly basis may allow student's class sizes to be smaller, and you'll want to know if they'll be moving about the school (or spending time outside). Class size is also an important factor.
How will drop-off and pick-up change? What is your district doing to keep students safer on buses?
How are facilities being adapted to stem the spread of COVID-19? Planning aspects like distance between desks, bathroom upkeep, lunch and recess, plus basic ventilation and disinfecting schedules can impact risk.
Will the school screen a student's (and staff) health status for COVID-19 symptoms? And what happens if a student becomes sick while in school?
Is distance learning still being implemented in some form? Schools should have a plan to go back online if an outbreak occurs.
What resources do you have in place for students with disabilities? This is particularly important, as these new circumstances and rules may be devastating for those with learning disabilities.
As more information about the coronavirus pandemic develops, some of the information in this story may have changed since it was last updated. The Centers for Disease Control and Prevention have published updated COVID-19 guidelines for schools to consider this year, and you can glean more information for parents and guardians from your local public health department and your state's education board.
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