COVID-19 Back-to-School Q&A: Is it safe for unvaccinated children to go to school in person? Is the harm of school closures greater than the risk of viruses?

Back to school is here again. While we would hope that the start of the school year with schools open for in-person learning would set the trend for the rest of the year, the presence of new variants of SARS-CoV-2, the virus that causes COVID-19 is less certain.

Some parents have already decided to keep their children at home for online learning when schools open. Others may revisit these choices as the fall unfolds. Yet many parents must also adapt to what their school system offers them.

With over a year of data on how SARS-CoV-2 infection and disease manifests in children and our experience with school closures last year, we can at least answer some questions. important on the risks of infection in unvaccinated children and the risks of disappearance from school in person.

What are the risks of SARS-CoV-2 infection in unvaccinated children?

Children infected with SARS-CoV-2 may be asymptomatic. A review of several studies found that about half of infected children had no symptoms. A study of children in Alberta found that a third of those infected were asymptomatic.

Children with symptoms of COVID-19 usually have mild illness.

A large study in the UK, which included data up to February 2021, showed that when children between the ages of five and 11 show symptoms, they tend to last for five days. In 3.1% of this age group, symptoms last more than 28 days. This duration can be compared to people aged 12 to 17 years and to adults: 5.1% of the former had symptoms for more than 28 days; 13.3% of adults had symptoms one month after infection. Only six of the 445 younger children (1.3%) included in the UK study had symptoms that lasted longer than 56 days.

In children, the risk of hospitalization, serious illness and death is low compared to adults.

In the United States, 0.2 to 1.9% of COVID-19 cases detected in children have led to hospitalization, including children infected with the currently circulating Delta variant.

In Belgium, rates of hospitalization and admission to intensive care units for children with COVID-19 have been low and have not changed as new variants circulated. A Belgian school study showed that in June 2021, 15.4% of Belgian primary school pupils had antibodies against SARS-CoV-2, which means that they had already been infected with the new coronavirus at some point during the pandemic.

Delta constitutes more than 75% of the cases sequenced since July 5, 2021, in Belgium, and almost all of the cases in the country as of August 16.

In Canada, 0.5% of cases detected and recorded in children under 19 have led to hospitalization, and 0.06% to admission to a pediatric intensive care unit, since the start of the pandemic.

Research suggests that pediatric multisystem inflammatory syndrome (MIS-C), presenting two to six weeks after infection and primarily affecting children aged six to nine, remains rare, with an incidence of three cases of MIS -C for 10,000 cases of SARS-CoV-2. infections in people under the age of 21. Canadian research pending peer review and U.S. research shows that children generally recover quickly from an episode of MIS-C.

As the pandemic progresses, combining multiple data sources will give us a more valid and accurate calculation of the risk of childhood infection and illness.

Is it safe for unvaccinated children to return to school in person with the variants in circulation?

In the United States, the number of pediatric cases of COVID-19 has increased in recent weeks.

Pediatric cases also increased as a proportion of the total number of all cases detected and accounted for 22.4% of the total cumulative cases for the week ending August 19 (up from 14.6% a week earlier). However, this occurs in a context of high community transmission and low vaccination coverage.

When more children are infected, children are more likely to get sick and more seriously, with both acute infection and MIS-C, although this absolute risk is low. The death rate from COVID-19 in children under 17 is less than three deaths per 10,000 cases.

Data from Public Health Canada show a mortality of one in 20,000 in children under the age of 19.

What’s the biggest risk: COVID-19 or school closures?

For children, the risks associated with school closures have outweighed the health risks associated with COVID-19.

Schools provide education that enables students to learn academic skills, but they also help socialize students and teach behavioral skills. The school offers social support and promotes the acquisition of healthy lifestyles. Schools can help immigrant children learn new languages ​​and / or promote their integration into their new communities.

Research shows that long school interruptions have negative short- and long-term impacts on the skills development and academic performance of students, and on how they fare with employment as adults.

The negative impacts of school closings can even be passed on to the next generation.

School closures during this pandemic in Belgium and the Netherlands had negative impacts on children’s learning, with children from vulnerable households more severely affected.

What effects do school closures have on physical and mental health?

The experience of lockdown and school closures last year has provided data on its negative effect on children’s physical health. An increased number of children have developed eating disorders and weight problems.

Physical activity has declined among young Canadians. Screen time was up. Excessive screen time is associated with a sedentary lifestyle and risk factors for cardiovascular disease such as high blood pressure, insulin resistance, and obesity. School meal programs that usually offer some protection against hunger and child malnutrition were not available during the pandemic.

The confinement has also affected the mental health of young children.

A recently published review of several studies on children’s mental health estimated that anxiety affected a quarter of children and that one in five children was depressed during the pandemic, which is double the rate before the pandemic.

We also know that reports of child abuse have declined during school closures, not because these events did not happen, but because teachers and school staff were unable to detect and report abuse.

Can virtual schooling replace in-person education?

There is little research on children and full virtual schooling, but neither preliminary nor peer-reviewed research suggests that virtual schooling can fully and adequately compensate for in-person schooling.

School closures endanger children’s physical, mental and academic development and displace many children from the optimal environment to develop social skills and receive support.

In-person schooling is essential for schools to achieve their various goals and for the well-being of children, especially vulnerable children.

This does not mean that we cannot embrace the positive aspects of online learning or of designing an education different from what we have today. However, including children in decision-making and designing school environments and experiences that meet their needs – and with equity in mind – should also be high on our agenda.