(CNN) The US Centers for Disease Control and Prevention in mid-February released guidelines for a safe return to school. The agency emphasized five ways to mitigate risk from coronavirus: requiring masks, physical distancing, handwashing, maintaining clean facilities and contract tracing. Since then, the Biden administration has also prioritized vaccination for teachers and school staff. Teachers in all 50 states became eligible to get vaccinated as of March 15.
Many schools already have been open for in-person class part time or full time. And now, President Joe Biden's Covid-19 economic relief package will provide funds to public K-12 schools, as well as private schools, to help implement Covid-19 mitigation strategies. As more schools are offering options for in-classroom instruction, parents will be facing the decision of whether to send their children back to school.
CNN Medical Analyst Dr. Leana Wen, an emergency physician and visiting professor at George Washington University Milken Institute School of Public Health, helps you to navigate this decision.
CNN: What's the latest on children and coronavirus? Can children get coronavirus and spread it, and are school reopenings safe?
Dr. Leana Wen: Children can and do get infected with Covid-19, but the likelihood of severe illness is very low. They can and do spread the virus, though younger children appear to spread it less than older kids. Importantly, schools that have reopened for in-person classes have not resulted in superspreader events as was feared earlier in the pandemic. Numerous studies have demonstrated that in-person instruction can be safe if mitigation measures such as mandatory masking are followed.
CNN: So why is there still controversy about in-person instruction?
Wen: I think this comes down to tolerance of risk and for whom that risk is being placed on. Many people will say that schools are safe because the likelihood of acquiring coronavirus in schools is lower than the risk of getting coronavirus in other community settings. Given the benefit of in-person schooling to children's cognitive and behavioral development, and the importance of school for parents and their ability to work, the benefits outweigh the risks for many families.
On the other hand, educators have said it's not fair that the burden of risk falls on them. I can certainly understand the point of view of a teacher who says that mitigation measures aren't always followed in their school, and that they are safer teaching at home than in a cramped classroom with dozens of children.
This is why I have been a big proponent of prioritizing vaccinations for teachers and school staff who are already in school or are going to return to in-person teaching. If schools are truly essential, as many people would say that they are, then vaccinations for educators should be a societal priority.
CNN: Many educators are now vaccinated, but kids are not. When do you think this is going to happen?
Wen: The Pfizer-BioNTech vaccine is the only one that currently includes 16-year-olds (Moderna and Johnson & Johnson vaccines are authorized for 18 years and above). Studies are ongoing now for younger ranges, and it's likely that by the fall, 12-year-olds and above could be vaccinated. Vaccines for younger age groups may not be available until 2022.
CNN: How should parents think about whether to return their children to school, if kids are not yet vaccinated?
Wen: I'd think about the following three factors. First, what's the health of your child and that of people in your household? If your child is pretty healthy and all the others who live in your household are as well, the risk of severe illness from Covid-19 is low. That risk is decreased further if the adults in the family can be vaccinated. If there are vulnerable adults — for example, an elderly grandparent who lives with you or another adult who has underlying medical issues — they should be vaccinated as soon as possible.
What if your child has an illness, such as diabetes or asthma? The chance of severe illness for children from Covid-19 is still low. At this point, there is no such thing as zero risk, and you need to weigh the risk from sending your child to school with the risk of not doing so (such as the social, emotional and learning deficits that could result). Some families may make the decision that their child is too vulnerable — for example, if there's a child with cancer undergoing chemotherapy. Your school should make virtual learning a possibility for families who choose not to return just yet.
A second factor in your decision is what the mitigation steps are that have been implemented in schools. Take a look at the CDC guidelines and see where your school is in following them. Perhaps the most important is mask wearing. Does your school require masks? How is masking enforced? Are there times when masks are taken off, such as during lunchtime, and how are kids kept safe then? Make sure you are comfortable with the mitigation steps that are in place, since these are key to reducing transmission in schools.
Third is the degree of community transmission. The current CDC guidelines are based on levels of transmission. At low levels, fewer measures need to be in place; at higher levels, more must be implemented. There's growing evidence that even in areas of high community spread, schools can still be safe, but then there must be additional mitigation measures, too. This is something else you can keep an eye on, and if there are high levels of transmission, to make sure to ask the school about their policies and procedures for additional protection for children.
CNN: Those are three great points. Is there anything else parents should otherwise be considering when it comes to the needs of their child?
Wen: Yes, this is a really important point, to consider the specific circumstances of your child and family. There are some kids who have thrived in virtual school. Perhaps the urgency of returning to in-person instruction is not quite as much as for those children who are struggling. The needs of your family are also crucial to consider, too. Many parents, especially mothers, have had to leave the workforce to care for their kids during the pandemic. Then there is the issue of what your children would be doing if they are not in school. Schools can be some of the safest places for kids, if the alternative is that they are seeing friends and going to the mall and other public places.
CNN: What are other questions that parents should ask teachers in making this decision?
Wen: I'd first ask about the options. What are the options for learning? Many schools are remaining hybrid-only with part-time in-person and part-time virtual classes because they don't have space to bring back all kids at once in a physically distanced way. Is it going to stay hybrid-only, or will full time be a consideration later in the year if community transmission decreases?
Also, can you change your mind about the mode of learning? For example, if you have a vulnerable member of your family who is not yet vaccinated, but will be in this month or next month, can you change from virtual learning to in-person class after that happens?
In addition to getting a sense of the mitigation measures already in place, you should ask how often testing occurs. Is this something that happens only when children are symptomatic or is there regular surveillance testing? What happens after a child tests positive — what are the processes for contact tracing and quarantine? What triggers the class to be sent home or an entire school to close? And then ask yourself, too, what happens if that happens. Do you have backup child care just in case?
CNN: What about summer school or summer camp? Should parents sign up their kids for these sessions?
Wen: Again, the answer is that it depends. If there's a summer activity that is entirely outdoors and mask wearing is enforced, I'd say go for it. Otherwise, I'd make sure that the activity requires the same mitigation measures as regular school does, and then also examine the risk-benefit for your own family.
Remember to keep up the mitigation measures in informal, afterschool activities, too. You don't want to undo the good work by the school or camp only to let down your guard in informal settings. If kids are masked in school, they need to be masked around one another afterschool, too, at birthday parties, playdates, extracurricular sports and other activities.
And please, let's all get vaccinated when it's our turn. The key to returning to normality is keeping up mitigation measures like masking and making sure that we are all vaccinated to protect ourselves, our families and one another.