Mixed Feeling About School

Earlier this summer I joked that we needed to add half an hour to every appointment to allow time to talk about school. The concerns, the fears, the anxieties. I’ve heard yours and am certainly feeling my own. On top of everything else 2020 keeps throwing at us, worrying about making good choices for school feels overwhelming at times. I’m here to break down my thoughts and hopefully give us all a little perspective. Let me start with my 2020 mantra:

We are in this together… and we’re all doing the best we can.

Let’s just all take a moment and acknowledge how difficult last spring was. Looking back it seems so long ago, and we were different people then. Pandemic newbies. Everything was scary and everything felt hard. Schools and districts were innovating, families were juggling, workplaces were scrambling, and kids were adjusting. It was hard, friends. None expressed what we went through more eloquently than this music teacher in her heartfelt original song:

https://youtube.com/watch?v=Zy_y9yOrgxk%3Fautoplay%3D0%26mute%3D0%26controls%3D1%26origin%3Dhttps%253A%252F%252Fwww.eastportlandpeds.com%26playsinline%3D1%26showinfo%3D0%26rel%3D0%26iv_load_policy%3D3%26modestbranding%3D1%26enablejsapi%3D1%26widgetid%3D15

But we made it through. Granted, each with varying degrees of success or ease or participation, but we did it. It reaffirmed my desire to never, ever homeschool, but we accomplished much more than that. We flattened the curve in Oregon, and by doing that we protected our loved ones, our communities, our first responders, and we saved lives. It did not come without a cost, as I know personally, and I’ve had the honor of walking through the consequences with many of you. This leads me to the words I have been sharing with my children and as many patients and families as possible…

Thank you for your sacrifice.

You are a true superhero!

We can do hard things.

By no means do I want to gloss over the fact that this was traumatizing for many children and families. One thing this pandemic has done is amplify the cracks in our society. Equity gaps widened, socioeconomic differences increased, racial disparities in health care, education, and employment were magnified, individuals and families without supports and resources faltered, and the mental health burdens on many of our young people escalated. We have a lot of work ahead of.

And then, we relaxed. Unfortunately but predictably, as restrictions loosened, COVID-19 was able to regain a foothold. For many, the exhaustion, the confusion and mixed messaging, and the politicization of science and public health led them to ignore social distancing and infection control precautions. For a virus that is unrelenting and highly contagious, this was a golden opportunity.

So here we are, in a situation where it is impossible to safely open schools. Don’t get me wrong, I want schools to open. Our children need school. My kids and my patients need to be in school! Schools provide more than education. Schools teach children socialization, conflict resolution, relationship building. They expose our children to a diversity of people and ideas. And for many, our schools provide safety, food, and support they can’t get elsewhere. For these reasons I have spent much of the last few weeks alternating between despair and rage. As I have shared with many of you, it feels like we are back in first grade and because of a few kids not following the rules, the whole class has to stay in from recess. One mom took this analogy further when she replied, “Now we all have to sit at our desks with our heads down and the lights out. It is maddening.” Yep, I feel you (and hi, you know who you are!).

As maddening, despairing, and harmful keeping schools closed is, it is without a doubt the right decision. It is absolutely not safe to open schools with the current rates of COVID-19 spread. This was obvious in July, even with what little we know about COVID-19. While the disease burden is less in children, it is far from non-existent. And children are far from the only ones present at school; there are teachers, custodial and kitchen staff, para-educators, and administrators, all of whom are susceptible to the virus. In July the American Academy of Pediatrics (AAP), in conjunction with educators and school superintendents, released the following statement:

“Returning to school is important for the healthy development and well-being of children, but we must pursue re-opening in a way that is safe for all students, teachers and staff. Science should drive decision-making on safely reopening schools. Public health agencies must make recommendations based on evidence, not politics. We should leave it to health experts to tell us when the time is best to open up school buildings, and listen to educators and administrators to shape how we do it.”

What does the science tells us? From the CDC:

• Fewer cases of COVID-19 have been reported in children (age 0-17 years) compared with  adults.
• The true incidence of SARS-CoV-2 infection in children is not known due to lack of widespread testing and the prioritization of testing for adults and those with severe illness.
• Hospitalization rates in children are significantly lower than hospitalization rates in adults with COVID-19.
• Children are still at risk of developing severe illness and complications from COVID-19.
• Hospitalization rates in children are increasing.
• 1 in 3 children hospitalized with COVID-19 in the United States were admitted to the intensive care unit, which is the same in adults.
• Children with certain underlying medical conditions and infants (age <1 year) might be at increased risk for severe illness from SARS-CoV-2 infection.
• Similar to adults, children with severe COVID-19 may develop respiratory failure, myocarditis, shock, acute renal failure, coagulopathy, and multi-organ system failure.
• Children infected with SARS-CoV-2 are also at risk for developing multisystem inflammatory syndrome in children (MIS-C).

A large study in South Korea that tested over 59,000 contacts of COVID-19 patients found that compared to adults in their 30s and 40s:

• Children ages 0-9 years transmitted COVID-19 less than half as often.
• Children ages 10-19 years transmitted COVID-19 to others more than adults of any age.

Keep in mind that the above data is primarily in the setting of school closure. What is more worrisome is what we have learned since schools in some areas have reopened. COVID-19 infection rates in US children analyzed by the AAP and the Children’s Hospital Association show that infection rates in children increased by 90% in the 4 weeks leading up to August 9. On a local level, here in Oregon where schools are not yet in session, we have seen a steep increase in pediatric COVID-19 cases since mid June. Almost half of the cases are due to household contacts, but there has been a fair amount of community spread and outbreaks at camps.

The Oregon Health Authority has a report specifically tracking pediatric data.

Suffice to say that opening schools can be expected to lead to more pediatric cases, more infections in school personnel, and by extension, more exposures in families. This scenario would be further complicated by the inadequate access to testing and longer result times we are currently experiencing. Beyond what we do know already, the unknown sequelae are even more concerning. We are only now beginning to learn of long term (in months) medical complication from COVID-19 infection, even in people with few original symptoms. We have no idea what to expect years after the infection in adults, much less in children. On a psychologic level, as a family that has been grieving the death of a young friend for three years, I can’t even begin to imagine the trauma of our children dealing with death on a larger scale.

In July I was fortunate to be part of a statewide webinar on school reopening with pediatricians, infectious disease experts, public health officials, and educators. While we all acknowledged the need for the services schools provide, the message was very clear that it is important to take that step only when it is safe to do so. We are fortunate to live in an area where the leaders making decisions are willing to listen to the medical public health experts. As I have shared with many of you, that is the one thing that has helped keep me sane and hopeful these last few weeks. We are also fortunate that we have a number of other countries who have managed to get disease rates down low enough to open schools safely, and we will have their examples to learn from.

As we move forward in this continued reality, I have appreciated the words of Andy Slavitt,

I think about the things we all try to teach our kids. -being safe -following the golden rule -showing consideration -using evidence -looking out for those less fortunate

Can we use this moment as an opportunity to improve? To innovate? Can we not just teach, but live out with our kids how to come together for a greater purpose? Can we work harder to protect and lift those that need it most? Are we brave enough to lay aside privilege and raise up those in our communities who have been racially or economically or socially oppressed? Can we raise another Great Generation that will look back on 2020 as the difficult year that led to great change? I have no idea how to do this. Here’s what I do know. Not having school sucks. It is bad for children and teens and many families. It hurts our communities. But it is also the best, safest, right decision to make right now. Where do we go from here? Here’s what this sad pediatrician and mom is going to focus on as the next best steps with school looming.

• Remind the people we know of the importance of masks and social distancing. If we can’t get this one thing down, if we can’t bring down the case rates, and we won’t have school all year. Working together, we can make a difference for all.
• Normalize wearing masks with your kids. If we model, explain, and set expectations, our children adapt well; better than us, typically. Wear masks frequently. If school can start, masks will be an important part of infection control for some time. We wear our masks going on family walks, and even our child with special needs does well with it. I love the idea a dad shared on FaceBook of having kids wear a mask during screen time! Don’t be afraid of face masks; children in other countries wear them routinely for reasons of illness or pollution, as do countless children with cancer or immune diseases. Our kids can do this!
• Make sure we are all getting good sleep. Not only does sleep boost our immune system, it helps us learn, regulate emotions, and deal with challenges. Distance learning has the advantage of letting many sleep in a little later. But we want to make sure our kids have regular bedtimes and waking times, as well as getting enough hours of sleep.
• Make family dinner a habit. It can be homemade, take-out, or cereal. You can sit around the table, on the floor, or on the front steps. Numerous studies have shown that when families eat dinner together most nights it improves our children’s emotional health, academic abilities, and nutrition. Need inspiration?
• Don’t forget breakfast! Kids need to eat before school! And if we eat together, they eat better. It can be simple and fast, but some fruit and a protein (milk, yogurt, egg, peanut butter, nuts!) is a great way to start the day.
• Set routines. Have a schedule for the day. For young children a visual schedule is helpful, as is reviewing it in the morning and marking off what has been done. Have a set place where kids can do their schoolwork. Ideally it should be different from where they play video games or sleep (for example at a desk in their room instead of on the bed).
• Be flexible. Distance learning will be different this year, and attendance will be required. Grades will be assigned. But if someone needs a mental health day, take it (that goes for parents too!). Look for flexibility in work schedules if possible. Find learning in other places. Make some no-bake cookies with your kids, then make a double batch (math!). Need some harder math? Make 1/3 batch and watch them calculate 1/3 of 1/2 a cup. Tour a museum or a country online. My 6th grader has been designing her own Amazing Race. Let their natural curiosity guide them.
• Give yourself grace around screen time. This has been a big source of stress and guilt for parents. But imagine living the last few months back when I was a kid. We would be spending all day playing Pong and fighting over the kitchen phone. I am so grateful my children can connect to others and to the world through technology. Still, there are some ways we can moderate it. Prioritize high quality screen time: connecting with friends and family, family movie night, learning, creativity (learning a craft or recipe, playing Minecraft rather than watching YouTubers playing). Establish screen free time at meals, during family activities, and longer times as well. Take breaks during screen time as well to move and stretch (and blink those eyes!).
• Encourage your children to connect with others. Let them have a GoogleMeet with friends, Zoom with the grandparents, and make sure they know how to contact their teachers and the school counselor.
• Get outside! Our bodies need it, our brains need it, and even our eyesight needs it! Playing outside, taking a walk, going for a bike ride. These activities play a big role in maintaining good mental health. Be active indoors as well with dancing, exercises and whatever creative play you can do safely at home. Taking a walk before school and at lunch helps brains learn better. Younger kids can do active brain breaks; get some inspiration from GoNoodle. If your child is old enough to take a walk alone, this can be a good time for a solitude break and promoting independence.
• Encourage creativity. Learn a new hobby or craft. Teach household skills such as laundry, cooking, changing the batteries in a smoke detector. Try out a new recipe. Learn something in a YouTube video… tap dancing, Qi gong, juggling, jewelry making. Build with Legos or blocks or recycling. Do art projects. Get creative about creativity!
• Talk to your school. Let them know if there are barriers you are facing with distance learning. Let the teacher know if your child is struggling. Reach out to the school counselor if you have concerns about your child. Push them if you feel your child’s special education needs are not being met. Encourage them to be innovative. In-person school doesn’t have to be an all-or-nothing. Maybe we get to a point where younger children, or those with special education needs or those unable to access school from home can go to school while other stay online.
• Model learning from failure. Talk to your kids about your struggles with working from home, or adapting to change, or messing up in school. How did you dust yourself off? What did you learn from that? Acknowledge that what they’re doing is hard. If last spring was a bust, what’s one thing they learned from it? What worked? What didn’t work? Set a goal for this school year… I will log on every day. I will learn a new way to organize my work. I will reach out to my teacher if I’m stuck.
• Check in with your child. Start now and see what they’re looking forward to and what they’re worried about. Here is a great resource for guiding this conversation with younger students. Keep checking in with them throughout the school year. How are things going? Are they feeling discouraged? Stuck? What’s going well? What is something cool they learned? Do they need more help? A better place to study? Don’t be afraid to ask about their mood. Be on the lookout for anxiety and depression. Make an appointment if you are worried about your child.
• Remind your children of the greater good. As hard as what we will be doing is, they are literally saving lives. What kids in any other time can say that?
• If things are going well at home, look outward. Who can we encourage? Make cards for a nursing home or healthcare workers. Find some safe ways to contribute to your community. Our school collects donations of toys and books for those who need it. Support a Black-owned local business.
• Weigh personal risks and benefits. Is anyone in your family high risk for COVID-19 complications? Then you might need to be more restrictive socially. How high is the mental health toll on your teen? Maybe you can find a way for them to safely meet with friends outdoors. Have an only child? Can you form an isolation pod with another family? Struggling to balance your work and their schooling? Maybe you can create a distance learning pod with one or two other families.
• Get your flu shots. Getting influenza and wondering if your child has COVID-19 is something worth avoiding. And last spring there were cases of co-infection with influenza and COVID-19. For safety, we will be hosting Drive Thru, Stop the Flu clinics in our parking lot beginning in September. Make an appointment now!

We’ve got quite the journey ahead of us. Remember that we are in this together. While we don’t have all the answers, your pediatricians are here to help you sort through the confusion. Bren will be posting some back-to-school resources soon, so stay tuned for that. I am looking forward to learning more about this disease, having clearer guidance, and getting back to some degree of in-person school… someday! In the meantime, here’s some mood-boosting pandemic music. Because we all need a little pick me up right about now!

https://youtube.com/watch?v=gtr3zRDNoXU%3Fautoplay%3D0%26mute%3D0%26controls%3D1%26origin%3Dhttps%253A%252F%252Fwww.eastportlandpeds.com%26playsinline%3D1%26listType%3Dplaylist%26list%3DRDEMY9gGlwB7utxAiBMhatq9TQ%26showinfo%3D0%26rel%3D0%26iv_load_policy%3D3%26modestbranding%3D1%26enablejsapi%3D1%26widgetid%3D17

https://youtube.com/watch?v=LJxVHzARMmE%3Fautoplay%3D0%26mute%3D0%26controls%3D1%26origin%3Dhttps%253A%252F%252Fwww.eastportlandpeds.com%26playsinline%3D1%26showinfo%3D0%26rel%3D0%26iv_load_policy%3D3%26modestbranding%3D1%26enablejsapi%3D1%26widgetid%3D19