Back to School
As the beginning of the school year approaches, parents, teachers, school boards, and healthcare professionals are grappling with how to safely and effectively begin the school year. Since schools closed down in early spring with hopes that the pandemic would be controlled by the time the fall semester arrived, the United States and several other countries have seen cases go down and then back up. Healthcare professionals have treated thousands of patients, scientists have studied the virus and have begun to develop vaccines, and businesses and industries have closed down and reopened.
This GLI COVID-19 update aims to help liver patients who may be students, teachers, and family members, or parents of children living with liver disease or at an increased risk to understand a number of key components including immunity of children, children as spreaders, the reality of high risk students, teachers, and administrators, how parents and teachers are responding, how schools are preparing, and how this situation can lead to additional disparities.
Watch our GLI LIVE: College and COVID-19, in which we discuss this issue with students facing these issues.
Key issues in Elementary Schools
Young children are not immune, but may be less susceptible to showing symptoms and are at risk of rare complications. Concerns include how much children may spread COVID-19 to families and teachers, with several teachers unions pushing back on in-person classes. Online education may be harder for younger children and the social impacts of staying home from school are still being measured.
Key issues in Middle and High Schools
Older children show infection patterns much like adults. Incidents of rapid spreading shortly after reopening of high schools as students pass in hallways in close contact unmasked have already been reported.
Key issues in Colleges and Universities
After lawsuits to allow foreign student visas to be granted for online classes were successful; online only, hybrid, and in-person classes have started at many schools. Non-adherence to campus guidelines exemplified by attendance at large parties have transformed multiple campuses into regional COVID-19 hotspots within days of opening.
Risk Factors
While the global health community does not currently have a complete picture of COVID-19 and its long term impacts, the risk that is present for children is largely understood. As we have seen, children remain susceptible to getting the virus, but the severity of sickness is generally less than adults. Researchers do not have sufficient data to conclude if they are major transmitters, like they can be with other viruses. But we have already seen a number of cases of infection and community spread in schools students, as well as to teachers and administrators. Wearing masks and staying socially distant can be very effective, but by bringing the staff, teachers, and students back together, there remains a higher risk for infection in the community. If school districts do not have the money or resources to install new air filters, space students out properly, ensure that they are not sharing books and resources, or provide proper sanitation materials to each classroom, it can lead to an even more unsafe environment. Particularly in overcrowded schools, one student or teacher becoming sick can quickly spread to the entire school and community.
A variety of organizations have identified reasons why not returning to school in the fall could be harmful to students and families. The American Academy of Pediatrics, in conjunction with American Federation of Teachers, National Education Association and The School Superintendents Association, published their recommendations for the fall, which stated that in-person school is the best place for children - academically, socially, emotionally, physically, and equitably. For younger children and those with special needs, the classroom is the best place for them to grow, learn, and thrive. Attending classes online can be extremely challenging for students that need hands-on face-to-face learning. It can also exacerbate the disparities of COVID-19. Not all families have access to technology or the internet, making it impossible for them to keep up with their peers via an online format, or access to the meals and other services that are provided by schools. Reports of child abuse, for example, have declined, raising concerns of underreporting. Persistent school closure can also disproportionately impact families of essential workers who may have to make the decision between going to work or staying home to supervise their younger student’s online learning. Most cannot afford to set up neighborhood pods with other families and hire teachers or tutors as alternatives to attending school. Professional organizations do recognize the need to follow the advice of health experts on the safety of opening schools based on the local community situation, as well as the value of educators taking the lead on outlining reopenings. But to safely do so through following the prescribed guidelines can be extremely costly and schools with fewer resources may not be able to make those accommodations.
Concerns of Teachers and Parents
Parents and teachers across the country are struggling with how to begin the school year while accounting for the health, safety, growth, and unique needs of their students. Many teachers are worried about their ability to keep students properly distanced and fully compliant with the prescribed guidelines.It is estimated to cost $1.8 million per district to bring schools up to the social distancing and sanitation standards. There are also concerns about how they would successfully teach and address the needs of students during a hybrid style school year, including those surrounding extracurriculars, athletics, and quality of teaching. Without access to after school activities like clubs and sports, students may be missing out on valuable social and learning opportunities. Additionally, high school students who are applying to college will not be able to fulfill the requirements to gain athletic scholarships. There are also concerns about the quality of online teaching. When schools went remote in the spring, many parents did not feel as though their children were receiving the appropriate level of face-to-face learning and therefore may have fallen behind. This was reflective in many teachers and administrators struggles to best adapt their lesson plans and instructional time to a virtual format.
Back to School Options
Across the country, states and school districts are working to come up with appropriate plans for returning to school in the fall. Three primary forms that are being considered are fully remote, fully in-person, and a hybrid. Schools must factor in local and federal policies, rates of community spread, numbers of students, needs of students, and financial resources. States are creating unique plans for returning to school with some opting to begin the year online and others starting in person. Many private schools, particularly those with lower enrollment numbers and available funds to implement safety guidelines, are opting to bring students back to school despite public schools in their area remaining virtual, as is being seen in Maryland.
Colleges and universities are facing their own set of challenges with decisions about reopening. Students moving back to campus dorm rooms from across the country, large lecture halls, and dining facilities pose a major problem for keeping them distanced. Many schools are working to figure out how to allow students to remain at home and complete the semester virtually while also providing an on-campus experience for those who wish to return. Some strategies include expanding on-campus housing to allow for single dorm rooms, daily symptom and temperature checks, and live recordings of in-person lectures for students attending them from home. Other schools are opting to only bring back certain class years to campus, like freshman and seniors, and requiring virtual learning for all other students.
What about liver patients and immunocompromised individuals?
No matter what the ultimate decision made for returning to school is, there remains considerable health risks for liver patients and immunocompromised students, teachers, administrators, and family members. Individuals with liver disease and other high-risk pre-existing conditions remain at a higher risk for a more severe course of COVID-19 if infected. Practicing social distancing and isolation when possible remains the best strategy for remaining healthy, but for those returning to in-person classrooms, it could prove difficult to continue to practice those protective measures. Over 25% of teachers and administrators have pre-existing conditions that make them more susceptible to a more severe COVID-19 infection. Many teachers and families who are at a higher risk are choosing to not return to the classroom and are pushing for school districts to provide remote learning and teaching opportunities. Schools must remain vigilant in protecting their most vulnerable populations.
Returning to school virtually, in-person, or a mix of both is a massive undertaking with major risks on all sides. There is no easy solution to this situation. Schools, administrators, health experts, teachers, and parents are making difficult decisions with imperfect information. It is essential that the health, safety, and growth of students from all backgrounds are taken care of, while also acknowledging the unique needs of immunocompromised individuals like liver patients.
Stay safe, well, and connected.
Sincerely,
Donna R. Cryer
Founder & CEO
Liver Transplant 1994 Johns Hopkins