What are the potential implications and precautions for my family, including elderly parents with medical conditions, when my child returns to school?

This systematic review found that children have accounted for 1%-5% of diagnosed COVID-19 cases thus far. Compared to adults, severe pneumonia, elevated inflammatory markers and lymphocytopenia were less common. Common symptoms among children included cough, wheezing, pharyngeal erythema, and fever. 

This review states that children may have lower viral loads than adults, however data is scarce. Children often have fewer symptoms than adults, which should decrease the transmission risk. The review states that children seldom caused outbreaks, but that it is highly likely that children can transmit the SARS-COV-2-virus, even if asymptomatic. Further research of viral loads of asymptomatic children are suggested. 

This guidance is for administrators and public health authorities to consider potential risks and mitigation strategies when re-opening schools including: 1) the possible interactions that may occur in a school setting; 2) the risks associated with many people gathering indoors for extended periods of time;3) situations that may make it difficult to maintain physical distancing; and 4) mask wearing.     This guidance notes that since physical distancing is not always possible in schools, it is important to “layer” multiple measures to reduce the risk of COVID-19 spread. For example, 1) physically separating from each other through physical distancing and physical barriers; and 2) practicing respiratory etiquette, hand hygiene and wearing non-medical masks.     The guidance recommends promotion of personal preventative practices for all ages: 1) teaching children about why, how and when to clean hands and to cover coughs, sneezes; 2) implementing a schedule for frequent hand hygiene; 3) reinforcing “no sharing” food and drink policies; 4) having children bring filled water bottles to school rather than drinking directly from water fountains; 5) for younger children, reminding them not to touch others or put toys or objects in their mouths; 6) assisting/supervising when performing hand hygiene, and incorporating fun strategies to encourage compliance (such as humming songs while handwashing); and 7) encouraging older children to leave personal items such as cell phones and head phones in lockers or at home, and not to share these items.  

The CDC has noted several considerations for operating  schools during COVID-19  including: 1) promoting behaviours that reduce the spread of COVID-19 (e.g., staying home when appropriate, hand hygiene and respiratory etiquette, masks, signage); maintaining healthy environments (e.g., cleaning and disinfecting frequently touched surfaces, discouraging the sharing of objects, improved ventilation) and operations (e.g., offering options to staff or students with higher risk of severe illness, cohorting, alternate or staggered scheduling); and for when someone becomes sick (e.g., self-isolation and testing).     The CDC states children are less likely to have severe COVID-19 symptoms than adults or are more likely to be asymptomatic.     The CDC recommends families and staff be educated about when children should stay home, and families should be made aware of policies that encourage sick staff and students to stay home and to notify school officials of illness without fear of reprisal. Students and students’ families should be provided with information on proper use, removal and washing of cloth face coverings or masks.  

The CDC notes the risks and benefits of re-opening schools including the risk to household members and how household can evaluate a school’s plan to mitigate these risks.    The CDC recommends that parents should consider taking extra precautions to separate their child from elderly or other high-risk family members by limiting their duration of contact as much as possible. In situations where the high-risk family member is taking care of the child, one should ensure that their child limits contact with others as much as possible. 

This guidance states that to ensure students and families are supported and respected, in-person school attendance will be optional for the 2020/21 school year in the United States.   School boards should provide parents with a checklist to perform daily screening of their children before arriving at school. Schools are being asked to significantly limit or even prohibit visitors, including parents.     Active forms of travel (e.g., walking and cycling) and private transportation by parents and caregivers, are encouraged where possible, to ease pressure on transportation demand. 

This report states that individuals aged 60 years and older account for the highest proportion of all hospitalizations, ICU admissions and deaths in Ontario as of May 14th, 2020. Few hospitalizations and ICU admissions were among those 19 years and younger.  

This report states that children account for a small number of COVID-19 cases in Ontario, despite representing 21.1% of the Ontario population. The rate of infection among children was dramatically lower than adults, and among children rates were highest among 15 to 19-year old children. The most frequently reported acquisition exposure type in children was close contact with a confirmed case. Children were more likely to be asymptomatic than adults, and less likely to experience severe outcomes.  

This guidance recommends: 1) screening to prevent symptomatic individuals from entering schools; 2) teaching proper hand hygiene; 3) discussing the importance of physical distancing with children; 4) using non-medical masks based on local epidemiology; 5) considering cohorting classes; 6) implementing regular cleaning schedules; 7) improving ventilation; 8) discussing with children’s healthcare providers for high risk students; 9) consulting with healthcare providers for children with medical, physical, developmental and/or behavioural complexities; 10) paying attention to mental health of staff and students,; and 11) ensuring awareness of COVID-19 signs and symptoms. 

This study states that children are at a similar risk of infection to the general population, although less likely to have severe symptoms, and this should be considered in analyses of transmission and control. Household contacts were at higher risk of infection than other close contacts.  

This paper describes a major COVID-19 outbreak in a high school in Israel upon opening in May 2020, involving approximately 260 people infected across students, staff, relatives and friends. The authors recommend for students to study in small groups, minimize student mixing in activities and transportation, wear face masks, practice hand hygiene, and keep physical distance. The paper suggests school attendance should be avoided at any sign of illness. Improved ventilation systems to increase air exchange rate and outdoor air use to decrease air recirculation are also suggested.