Risk-benefit analysis: What pediatricians say about reopening schools

Pandemic could have lifelong impacts on mental health and future income
By: | July 15, 2020
Schools in Europe have reopened successfully as community spread has dropped significantly, but there is no data on the situation the U.S. faces: trying to reopen schools in communities where infection rates are climbing rapidly. (GettyImages/Imgorthand)Schools in Europe have reopened successfully as community spread has dropped significantly, but there is no data on the situation the U.S. faces: trying to reopen schools in communities where infection rates are climbing rapidly. (GettyImages/Imgorthand)

School leaders must weigh the risks of COVID infections with the academic, social-emotional and economic benefits of reopening classrooms for in-person learning, a panel of Duke University public health and policy experts recommended during a webinar on Tuesday.

Administrators should be guided not by sweeping federal mandates to reopen schools but by local rates of infection and their community’s ability to cope with new cases in their buildings, said the panel, which comprised two pediatricians and an economist.

“There’s a really strong case for trying to reopen schools because there are so many benefits both for children, not only their academic benefits, but also their health and wellbeing and social/emotional health … and also for families, many of whom are trying to get back to work and reopen the economy,” said Dr. Charlene Wong, a pediatrician and an assistant professor of pediatrics at the Duke School of Medicine.

Lifelong impacts of COVID-19

COVID infections have been least severe in the youngest children, who also don’t seem to transmit the disease as readily, said Dr. Ibukun Christine Akinboyo, an assistant professor of pediatrics in the Division of Pediatric Infectious Diseases at the Duke School of Medicine.


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In a study done in Chicago, researchers found that most household infections started with an adult bringing the disease home and infecting children. However, disease clusters have been seen in U.S. daycare centers, Akinboyo said.

In determining which students to bring back to classrooms, administrators should recognize that, in general, older students are more comfortable with online learning, Akinboyo and Wong said.

On the other hand, older students are more likely to wear masks, they said.

Educators must also use an equity lens to determine which students would be better off in a school environment because they don’t have adequate technology or safe, quiet places to work at home.

The panelists also expressed concerns about lasting social-emotional impacts of the pandemic. Schools and physicians’ offices are often places where neglect and abuse is discovered. However, many cases are going unnoticed with schools closed and families maker fewer visits to the doctor, Wong said.

Children without previous conditions have been newly diagnosed with anxiety and depression, while children already suffering these conditions have had more intense episodes.

“Some of our patients report feeling stuck in an anxiety attack,” Wong says.


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And students graduating high school and entering college may face lasting career setbacks because of disruptions to their education and the economy, said Lisa Gennetian, who studies childhood poverty as an associate professor of early learning policy in Duke’s Sanford School of Public Policy.

“The pandemic will subside and the economy will rebound,” Gennetian said. “But there will be generations of children who will have negative effects. It will be hard to recoup earnings for the children now entering the workforce.”

The community’s role in reopening schools

Employers will also have a role in reopening schools. Administrators and parents can work with employers to prepare for potential quarantines of children, which would require parents to work from home or take time off, Gennetian said.

School closures are likely to have a bigger impact on low-income parents, who typically have less flexibility in missing work or working from home, Gennetian said.

“Children who are previously not poor are going to become poor, and children who are poor are going to be experiencing even further deprivation from poverty,” Gennetian said. “Children of color are going to be hit hard.”


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Increases in testing would be another way to make the school environment safer. In Germany, for instance, new types of tests allow high school students to test themselves regularly, Wong said.

Schools in Europe have reopened successfully as community spread has dropped significantly, but there is no data on the situation the U.S. faces: trying to reopen schools in communities where infection rates are climbing rapidly, Akinboyo said

“One of the main things is the only way to reopen schools safely is to have a comprehensive approach to reduce COVID-19 transmission in our community,” she said. “That requires everyone, every single person who exists in the community has to play a part in reducing transmission.”


DA’s coronavirus page offers complete coverage of the impacts on K-12.