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Back to School 2020: Health Considerations in the Age of COVID-19

Recently, Dr. Jim Heise, Chief Medical Officer at Door County Medical Center, and Dr. Amy Fogarty, Pediatrician at DCMC and medical advisor for the Door County school districts, held a Facebook Live Q&A specifically designed to answer parents’ questions as we head into a new school year like no other. The following excerpts and highlights from the Q&A cover the most discussed topics concerning the reopening of Door County schools this fall.

Note: The format that is used below to present questions and answers does not follow the original order and format of the Facebook Live Q&A. Instead, questions and answers have been reorganized so that related topics are covered together. Additionally, content may have been edited for length and clarity.

Deciding whether your child should go back to school

One of the toughest decisions that parents will make this year is whether to send their child back to school or to instead opt for a virtual learning experience from home. “These are tough times,” Dr. Heise notes, “and parents are going to have to make individual decisions as to what’s best for their child and for their family. However, we’re really fortunate that even in a small, rural area, all public schools will have a virtual option.”

Is it safe for children to return to school? Both Dr. Fogarty and Dr. Heise feel it is safe for most children attend school in person this year. In fact, both plan to have their own children attend. Dr. Fogarty points out that the decision to have your child attend is a balancing act—a decision that needs to weigh the benefits of attending school in person with the risks. Some reasons to consider having your child attend in-person classes:

  • Is it possible for your child to stay at home? Some parents need to return to work and that should be taken into consideration.
  • How well does your child interact with online learning? How successful were they with learning remotely during the shutdown in the spring?
  • There are benefits to school outside of academics. We know that social interaction is vitally important to a child’s social development as well as their mental wellbeing.
  • Does your child receive additional help from the school? Do they receive speech therapy or have an Individualized Education Program (IEP)? Both can be difficult to implement virtually.
  • Does your child rely on school lunches? Food insecure families often receive food assistance through school breakfast and lunch programs.

In addition to the reasons listed above, Dr. Fogarty observes the medical community at large believes the benefits of in-person schooling largely outweigh the risks posed by SARS-CoV-2. “I’ve had several conversations with pediatric cardiologists and pulmonologists about specific patients that are in my practice, and I have yet to have a sub-specialist say that a child should stay home,” she says.

Under what circumstances should children not return to school? While there are many reasons for children to return to school, circumstances when it may make more sense for them to learn at home generally involve underlying medical conditions, including:

  • Children with severe respiratory issues—children on ventilators, children with tracheostomy tubes, and children that are unable to protect their airway.
  • Children with cognitive or sensory delays—these children may not interact well with masks.
  • Children that are immunocompromised—examples include: children undergoing chemotherapy, children that have received organ or bone marrow transplants, and children with pediatric immune deficiencies.
  • Children that live with at-risk relatives—if a child lives with grandparents or parents with an underlying medical condition that puts those relatives at high risk for developing severe COVID-19 symptoms, then those parents may want to consider having their child learn remotely.

Safety Protocols: What measures will be put in place to keep students and staff safe?

Do not send you child to school this year if they are sick! “The most important thing this year” Dr. Heise says, “is keeping your kids at home if they don’t feel well. It could just be a cold or the flu, but out of an abundance of caution, keep them at home if they seem sick.” Dr. Fogarty adds, “This is one policy that all of the school districts are extremely serious about. We know we don’t want sick kids in the building—that’s going to be your biggest risk.”

Which symptoms should a parent look out for? Pay attention to COVID-specific symptoms like:

  • Fever
  • Shortness of breath or difficulty breathing
  • Cough
  • Sore throat
  • Body or muscle aches
  • Loss of taste and smell

Is it allergies or is it COVID-19? Dr. Fogarty points out that allergy symptoms tend not to get worse over time. So, if the severity of symptoms that can occur with both COVID-19 and allergies—like a cough, sore throat or runny nose—is increasing, take them seriously.

What if my child comes down with symptoms of COVID-19? Dr. Fogarty encourages parents to call the COVID-19 Hotline to help determine whether a test should be performed. “Those are the experts,” she says. “They’ve been trained in how to answer questions and figure out who should get tested.”

A “layered approach” to preventative measures is how Dr. Fogarty describes the combined effect of social distancing, hand washing and masking. “Washing your hands,” she points out, “won’t keep you safe if you’re not wearing a mask. And, wearing a mask won’t keep you safe if you’re not practicing social distancing or washing your hands,” she continues. “It’s really about adding those preventative measures, one on top of another, in order to get the best effect and keep kids, teachers and staff safe.”

What if the virus is introduced into the school? Dr. Fogarty notes that stopping the spread and keeping the school open “will depend on how much safety protocols are being maintained by the schools and the students. If guidelines are being followed—students are wearing masks, social distancing and washing hands—the school will be much better off if the virus is introduced into that setting.”

Masks: what you need to know

Why do masks play such an important role in controlling and stopping the spread of the SARS-CoV-2 coronavirus? As Dr. Heise points out, masks do not act as a filter, keeping the wearer from getting sick. Rather, a mask acts as a barrier that blocks aerosolized saliva droplets that leave your mouth as you breathe, talk, cough or sneeze. Without a mask, these droplets can travel up to 6 feet or more, creating an invisible “cloud of viral particles” that can spread the coronavirus to others. More recently, scientists have discovered that people who show no signs of having COVID-19 can transmit SARS-CoV-2 to others. In fact, it is believed that up to 45% of all coronavirus transmission involves people with no symptoms.

What is the best kind of mask for my child? There are many types of masks that can be purchased online or made at home. It is important to note that wearing a mask all day is safe and will not affect you child’s ability to breath. The best masks tend to be multi-layered and include:

  • Surgical masks—have a thin, inner layer of statically charged fabric that can capture and filter some (but not all) small particles that travel in through the mask.
  • Homemade, cloth masks—like the surgical mask, a good homemade, cloth mask should fit well, and have three layers: two outer layers, and an inner layer—sandwiched between the outer layers. The best material for the inner layer is two layers of quilting cotton stitched together. For the outer layers of the mask, tightly woven fabric is recommended. Bandanas, folded handkerchiefs, gaiters and face shields provide little protection.

How many masks will my child need? Parents should plan on their child wearing one mask a day, and having an extra in their backpack. Additionally, the state of Wisconsin will be providing two white, cloth masks to each student, which will most likely be considered backups.

Teaching your child how to wear a mask is perhaps one of the most important things a parent can do as we get closer to the beginning of the school year. Start by teaching them how to wear a mask correctly:

Over the nose, over the chin, and covering the mouth, making sure that both mouth and nose are completely covered.

Additional suggestions for helping kids learn to wear a mask include:

  • Practice putting masks on and taking masks off—do this multiple times a day.
  • Wearing masks for short periods of time—gradually lengthening the amount of time that they’re in the mask, even wearing a mask on trips to the store.
  • Try different types of mask—Loop straps? Elastic straps? Straps that tie behind the head? Try to figure out what works best for your child.

“Kids are amazingly flexible and teachable,” Dr. Fogarty remarks, adding, “This is something that kids can learn to do—just like doctors have learned to do it.”

“School districts have been working tirelessly to get things set up for school this year. It’s been really impressive, the work that they’ve done,” Dr. Heise remarks. “This is about everybody working together as a community,” Dr. Fogarty says, “it’s not just about the kids wearing masks or being socially distanced, it’s about parents following those protocols as well. Stay at home when you can, and make sure your children stay home when they’re sick, so that everybody in the community can be safe.”

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