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Dr. Sanjay Gupta: Why am I not sending my children back to school

Many schools across the country have already made the decision for students. At least 63 of the 101 largest school districts in the country decided to start the year with virtual learning. There are other school districts that have decided to go in person, albeit with many virtual opportunities. My children’s school left the choice to individual families, and while it is difficult, I am thankful we have the opportunity. Families across the country are struggling with access to childcare, technology and even food – all of which can make physical return to school a necessity.

Knowing my family will have to make a decision about school, we started doing our homework a few weeks ago, looking at existing data and criteria, to come up with the best science-based choice for us.

For starters, I visited my children’s school and spent time with the school principal to better understand the safety precautions they were putting in place. They are very much in line with the recommendations of the American Centers for Disease Control and Prevention. There will be a mask mandate, many hand hygiene stations, physical distancing plans, frequent surface disinfection, and even outdoor classes when possible. Students will have lunch in class and there will be no mass meetings or assemblies. While physical distance is the most challenging challenge, the school has creatively utilized space in libraries, gymnasiums, and cafeterias to obtain the necessary square footage to test and address this. It has been a Herculean endeavor in recent months, but of course, none of this works unless the students themselves are diligent in following these practices on buses, in hallways, and in classrooms.
Our school also took the additional testing step of all students and faculty and staff this past week, and the results were made available within 96 hours. My daughters tested all negative, and this gives us some reassurance for those kids who choose to go to school, as those students who test positive will be asked to isolate themselves at home. I fully understand this kind of “safety” testing unfortunately is not yet nearly available enough in this country, and also not a perfect tool. Some tests are known to give a significant amount of false negatives, depending on the type of test you take and how early you take it. And while one can test negative today, there is no guarantee that they will not test positive for the virus tomorrow.
Much of the discussion about going back to school revolves around the risk to our children’s health. According to the CDC, the largest pediatric study from China found that 90% of children with Covid-1
9 develop mild or moderate symptoms, 4% were completely asymptomatic, and 6% became severely or critically ill.
By the first week of August, 90 children in the U.S. had died from Covid-19, representing less than 1% of all deaths, according to an analysis by the American Academy of Pediatrics and the Children’s Hospital Association.
A 12-year-old girl survived cardiac arrest.  Doctors say she had Covid-19 and a Kawasaki-like illness
As of August 6, MIS-C, a multi-system inflammatory syndrome, has been identified in at least 570 children nationwide, ranging in age from less than 1 to 20. About two-thirds of these children did not have basic conditions before being diagnosed with MIS-C, like Juliet Daly, a 12-year-old from Louisiana, who nearly died in April.
It is true that children are much less likely to get Covid-19 than adults, but they are not immune at all. They can become infected and can spread quickly. A widely cited study from South Korea showed that children 10 to 19 were spreading the virus just as much as adults. In fact, they had the highest level of Covid-19 among contacts with families. Interestingly, in the same study, children younger than 10 did not account for a significant amount of viral spread. This was surprising because a recent study published in JAMA Pediatrics concluded that younger children may carry higher amounts of the virus in their nose, compared to adults. And every parent will tell you how easily young children spread viruses in their homes. (When our children were very young, a single cold in each of them meant that the whole family would soon be infected.)
So, I decided to take a look at the South Korean study and noticed a very important detail: It included less than 30 positive cases younger than 10 years old. Of the nearly 60,000 contacts that were tracked in that study, only 237 were from children under 10 years of age. The low prevalence rate among young children may not have been because they are less likely to transmit the virus, but because they have mostly been at home in recent months, and there was little contact as a result.
There has been a 90% increase in Covid-19 cases in American children in the last four weeks, the report said.
As our children become more mobile, they will become part of a larger national experiment, and there is little doubt that the rate of infection will increase. Over the past four weeks, the number of infected children in the United States has increased by 90% in more than 380,000 cases, according to the same analysis by VET and CHA. While some of this increase may come due to adult testing, young children starting to leave their homes for the first time also play a role. And, for most of the country, schools have not even reopened yet.
It is also important to remember that a school community is made up of more than just young students. According to a recent analysis, nearly a quarter of teachers working in the U.S. school system are at greater risk of serious illness from Covid-19, whether due to age or existing conditions. I was particularly struck by the stories of troubled teachers across the country who said they were writing their wills in anticipation of returning to school.
My family also took a closer look at the overall level of virus spread in our area. Within the Fulton County School system, where we live, the guidelines for schools to turn into full-time, face-to-face guidelines require that the level of new issues per 100,000 people be less than 100 for the last 14 days . The current Fulton County rate? 316.2. Atlanta Public Schools has decided to go comprehensive for the first nine weeks. Moreover, our county, which includes part of Atlanta, does not even meet the federal government’s criteria for returning to school. According to the gateway criteria from the Coronavirus Task Force, we would have to go through two phases, each requiring a 14-day downward trajectory of documented cases and the ability to treat all patients without crisis care. We just are not there yet.
Coronavirus positivity rate: What the term means
Finally, the seven-day positivity rate in Georgia (ending August 10) is 11.3%, based on data from the Covid Tracking Project, which means that we are still not doing enough testing in our area. Recently, the General Surgeon said he would like to see positivity rates at less than 10% in communities before schools consider reopening. We are close, but it is still disturbing to put students back in an environment with that viral spread of community. It is worth noting that when we started withdrawing children from school around mid-March, there were less than 5,000 known cases of people known to have been infected in the United States and the confirmed deaths were in double digits. Now, school districts are considering reopening as more than 5 million people have been infected and more than 164,000 people have died in the US, according to Johns Hopkins University.
Over the past few weeks, we have been given some clues as to what might happen when schools start reopening. An overnight summer camp in Northern Georgia infected nearly 260 participants, though the CDC noted that some might have contracted Covid-19 another way. A high school in Woodstock, Georgia, has been temporarily closed after at least 14 positive Covid-19 cases in the first week. Hundreds are quarantined in the county. Another school in Dallas, Georgia, opened and closed its doors after infecting six students and three faculties. Their plan is to reopen after disinfecting the school, though it is not clear how much change it will make, as there is no demand for a mask – and a single sneeze or cough can contaminate a classroom once again.

It’s a lot to consider, but in the minds of our family, the evidence is clear. After considering all the objective criteria and assessing the situation in our community, we made the decision to keep our girls out of school for the time being. This was not an easy decision, but one that we believe best respects science, reduces the risk of further spread, and follows the criteria of the task force. As a compromise, we will allow our children to have a physically distant meeting with their new teachers, so that they can meet them in person before they begin to interact with them on a screen. And, after two weeks, we will reevaluate. It will also be important for us to understand what the causes will be in our school, in terms of infections or newly diagnosed diseases, that will require a return to virtual learning. Full and honest transparency from everyone will be more necessary than ever.

None of this is easy, and some families may come to a different conclusion after looking at the same data. In the Covid-19 era, it seems we are all forced to become amateur epidemiologists, being also the best parents we can be.

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