COVID-19 outbreaks in children complicate school reopening plans

School children arrive at Liberty Elementary School on the first day of class Monday in Murray, Utah

"What we're seeing is in many of the states where the public schools are back in session with in-person school or a hybrid - that's been a big driver of infections," said Dr Shawn Nasseri, an ear, nose and throat surgeon in Los Angeles.

Initially, evidence suggested that COVID-19 had minimal effects on those under the age of 18, and that they did not spread it easily, but new studies are challenging that view.



"It was thought that kids would not be exposed or transmit the virus as efficiently as adults - which is true," Nasseri told Al Jazeera, "but now it is understood that the viral load in the nose of children even those under 5 years old is significantly higher in the first days of infection, and that teenagers can basically transmit the virus like adults."

An instructional assistant helping a student at Wilson Primary School in Phoenix, Arizona, US [Cheney Orr/Reuters]

The US Centers for Disease Control says the number and rate of cases in children "have been steadily increasing" since March, and that previous low rates of infections were due to mitigation measures such as stay at home orders and school closures.

More than 75,000 children in the US tested positive for the coronavirus between July 30 - August 13, a 24 percent increase from the two weeks prior, according to the American Academy of Pediatrics and the Children's Hospital Association.

By Wednesday, a total of 406,109 cases were reported among children since the pandemic began - more than 7 percent of total cases in the US, raising concerns that the number of infected children will continue to climb as more schools open their doors for the school year.
Benefits of schooling

Children often learn better in school, education experts say, where they have direct contact with their teachers and can have the social-emotional learning they need by being around their peers. "Schools are key to the cognitive development of children," according to a recent report by Johns Hopkins University in Baltimore.

But sending children back to school also risks spreading the disease to relatives, teachers and other families.

"Children can be like conveyor belts, taking the disease back and forth," said Dr Pranatharthi Chandrasekar, chief of the Division of Infectious Diseases at the Wayne State University School of Medicine.

"Children get the virus then they shed it, and therefore they can be a risk to other people who they pass the virus on to," Chandrasekar adds, "it is a problem, opening schools, particularly in areas where the infectivity rate continues to be high."

But the issue of school reopenings has turned into a controversial political debate in the US, one President Donald Trump sees as key to his re-election bid in November.

Last week, Trump reiterated the false claim that children are essentially immune to the virus, and that schools should reopen for in-person instruction.

Students return to Greenbrae Elementary School in Sparks, Nevada for the first time since March with mandatory masks and social distancing. Schools in the district are using a combination of classroom instruction and distance learning [AP Photo/Scott Sonner]

"I think, for the most part, they don't get very sick," Trump said during a media briefing in the White House, "It's also a case where there's a tiny fraction of death, tiny fraction, and they get better very quickly."

He and his administration have been pushing for schools to reopen so that parents can return to work and the economy can get back on track.

The issue has also ignited intense debates in school districts between some parents who want their children to go back to school so that they can go to work, and teachers who are concerned for their own health. Many teachers have threatened to strike, quit or call in sick if they are forced to return to the classroom.

In some smaller towns and in rural areas, schools are offering in-person instruction this term, albeit with mandates for masks, hygiene, screening and social distancing. But most districts, especially in large and urban cities, will conduct virtual teaching.

New York City is the only major urban area still intending to start some classes at schools, offering a hybrid of online and in-person instruction, a decision that has drawn fierce criticism from teachers' unions.

The US's top infectious disease expert, Dr Anthony Fauci, said while the nation's goal should be getting children back to school even as a vaccine is still months away - the decision to reopen schools must be based on the infection rate in that community.

His team has designated zones as either red, yellow, or green to aid determinations in allowing students back into classrooms.

Green zones have a test positivity rate lower than 5 percent, and "should be able to open up safe and clear," Fauci said during a Facebook Live last week. Yellow zones with a 5-10 percent test positivity rate, could opt for virtual learning or a combination of in-person and virtual, while red zones with a 10 percent or more test positivity rate in the community would be unsafe to reopen.
'Bringing it home'

Although most children who contract COVID-19 recover, some have died, and others have developed severe complications after they appeared to have healed.

Similar to adults, children face higher risks of developing severe symptoms if they have underlying medical conditions such as cancer, asthma or lung disease. But some children with none of those conditions can still end up in intensive care units because of COVID-19.

In the US, at least 86 children have died from the coronavirus, according to the American Academy of Pediatrics and the Children's Hospital Association, including a nine-year-old girl in Florida who had no underlying medical conditions.
Liberty Elementary School sign welcoming students back on the first day of class in Murray, Utah [AP Photo/Rick Bowmer]

"There is a quite small, but very concerning group of kids who are previously healthy who get very serious complications from COVID-19," Dr Michael Wilkes, professor of medicine and global health at UC Davis told Al Jazeera.

"We've to date not been able to predict who those are," Wilkes adds, "most of those kids are surviving, but they require hospitalisation and it looks like they have long-term sequelae."

Even more worrying, Wilkes says, is the fact that the true numbers of infections among children is likely much higher, amid limited testing and the fact that most who contract the virus have only mild symptoms, such as a runny nose, cough and sore throat - and some, displaying no symptoms at all.

"From a public health perspective what is most concerning is kids passing the infection back and forth in school, on the playground or playing sports, and bringing it home," Wilkes said.