COVID-19 is the new kid in class - and he's a troublemaker


It will be a surreal first day of school in Southern California as students embark on a new year from a computer screen at home.

A surge in COVID-19 cases has shuttered most classrooms for the time being. When, exactly, schools can re-open will depend on how effectively communities curb the spread.

“It’s unfortunate that we weren’t able to control transmission,” says Annabelle de St. Maurice, MD, MPH, co-chief infection prevention officer for UCLA Health. “Other countries have been able to re-open schools and they were able to reduce transmission. The entire country of Italy is having fewer daily new cases than the County of Los Angeles. This should be a wake-up call that we need to do something in order for kids to have a sense of normalcy and be able to learn.”

In July, Gov. Gavin Newsom ordered that public and private schools in communities with high rates of COVID-19 begin the school year online until rates drop. The directive applies to most of the state, including all of Southern California, where Los Angeles Unified already had announced distance learning for the fall.

“You really have to focus on controlling transmission outside of schools and have the support to open schools safely, both in infection prevention measures and contact tracing,” Dr. de St. Maurice says. “Until you have those pieces in place, opening schools isn’t really feasible.”

Even once in-person school resumes, students will encounter the curriculum of a pandemic –masks, social distancing and increased sanitation.

“We can’t make them 100% risk-free, but there are things we can do that will really improve the chances of not having a school-based outbreak,” says Nava Yeganeh, MD, MPH, a pediatric infectious disease specialist at UCLA Mattel Children's Hospital.

Once kids are back in class, parents should recognize schools could close again temporarily or a student could have to stay home after exposure to the coronavirus.

“It’s not going to be like a normal school year,” Dr. de St. Maurice says. “Making sure you have options for child care also makes sense.”

UCLA Health experts say potential risks will vary based on the age and maturity of students.

“The younger you are the less likely it seems you are to spread to other people,” Dr. Yeganeh says. “When you get to middle and high school, your rate of infecting other people becomes more like an adult. For elementary and preschool, the route of transmission will likely be one staff member to another or adults to children.”

Younger grades may struggle more with hand hygiene but in some ways they could be more compliant with following new procedures that could include everything from a temperature check at drop-off to a socially distanced lunch period.

“It’s really about being obedient,” says UCLA Health pathologist Shangxin Yang, PhD. “One of the reasons we can’t get out of this mess is many people didn’t follow the rules.When you look at students, the most obedient are maybe second to fifth grade. They are not too young, so they understand the rules and they are not like teenagers who want to break the rules.”

Yang says class size is also a factor, as some schools have discussed eventually offering hybrid models where kids rotate attending a few days a week and completing the rest of their studies at home.

“Are you talking about 25 students in one room or reducing that to half or even less?” Yang says. “From a purely mathematical model, the larger the crowd, the higher the chance of getting infected.”

To reduce numbers and risk, schools could make decisions such as keeping high school students online only, while providing in-person instruction for lower grades.

“Some children learn better online than others,” Dr. de St. Maurice says. “Certainly if you have limited resources to re-open schools, you want to focus on the people least likely to get sick from COVID, least likely to transmit and most likely to benefit from in-person school.”

As far as school environments, indoors poses a greater risk than outdoors, which offers more space and air circulation. The communal design of a classroom can make separation more difficult than in an office building with cubicles.

Students will also likely find they can’t participate in higher-risk activities such as choir, drama, school dances or certain sports.

Dr. Yeganeh says she would like to see schools find more ways to teach outside, such as by repurposing parks, and to increase building ventilation.

“In Southern California, we’ve been really lucky that we have pretty good weather all year round,” Dr. Yeganeh says. “Schools in Europe, a lot of them are just leaving all their doors open in order to improve air circulation.”

For enhanced classroom cleaning, Yang said he would like students and teachers to work together instead of relying on custodial staff. He says students could take turns wiping down high-touch areas and they could clean their own desks, habits that will serve them well even when COVID-19 isn’t the predominant illness going around.

“It’s also a learning experience for kids,” Yang says. “If they learn very good hygiene and sanitation, I think they would avoid getting infection from other viruses.”

Gov. Newsom’s school order calls for masks in third grade and higher, although the Centers for Disease Control and Prevention recommends masks for children starting at age 2.

UCLA Health experts say they would still like to see younger grades wearing masks as much as possible.

“When the kids wear masks, when they talk, sneeze, laugh, cry or yell, all the droplets that can contain virus are being contained within the mask,” Yang says. “That reduces the shedding of the virus dramatically.”

UCLA experts say face shields, or masks with clear plastic, may be particularly useful in lower grades and for students receiving speech therapy.

“Those younger children, if they can’t wear a mask all day, you could do face shields, potentially,” Dr. de St. Maurice says. “That’s what some schools in China are doing as an alternative. One of the advantages is that you can actually see others’ physical expressions. They don’t itch and make it difficult to breathe. If kids have glasses, they don’t fog up quite as much.”

Dr. de St. Maurice calls the decision to close schools a tough one that will harm some students more than others. The youngest students likely will experience delays in achieving milestones in social interaction, reading and math. Children of color, kids with disabilities and low-income students also will face disparities.

“There’s a lot of evidence showing some kids are disproportionately affected by schools closing,” she says. “There are some children, particularly in Los Angeles, when they go to school, that’s a place where they get a hot lunch and they may be leaving an environment that may not be safe for them at home.”

But Dr. de St. Maurice says she’s cautiously optimistic that community transmission will slow.

“We have a lot more independence and autonomy than young children about whether or not we wear a mask or stay home when we’re ill or who we interact with,” she says. “We should do whatever we can to stop the spread of COVID in the community and try to re-open schools safely.”