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How might COVID-19 spread in schools?

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SciLine interviewed: Dr. Tina Tan, a professor of pediatrics at the Northwestern University Feinberg School of Medicine, an attending physician specializing in pediatric infectious diseases at the Ann & Robert H. Lurie Children’s Hospital of Chicago, and a member of the board of directors of the Infectious Diseases Society of America.

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What do scientists know about children’s likelihood of catching COVID-19? What about transmitting it to others? 


[00:00:29] 

TINA TAN: So we know that persons of any age can contract COVID-19. It just so happens that what studies are showing us is that the majority of children and infants, actually, either have very mild symptoms or are asymptomatic, meaning that they have no symptoms at all. When you look at the viral loads that infants and children have, it appears that the amount of virus that’s in their nose is the same as what you would see in an adult. So we know that individuals, even though they may have only mild symptoms or no symptoms, can still transmit COVID-19. Now, what we know is that children under 10 years of age appear to be less affective transmitters of the virus than children over 10 years of age. But they still can transmit the virus.  

And it’s really not clear why the younger children are not as effective transmitters. There have been some hypotheses that have been put out there, including the fact that there are other viruses in their nasal cavity that, basically, compete with COVID-19 so that COVID-19 has to work a little bit harder in order to, basically, cause an infection in these children. It’s also been hypothesized that they don’t have as many angiotensin-converting enzyme receptor 2 molecules that are there. So that – this is a receptor that COVID needs to bind to the respiratory tract. And, basically, there are fewer of these receptors in younger children. But by the time someone reaches 10 years of age, they actually have about the same number of receptors as what’s seen in an adult. And we know that the transmission characteristics and individuals getting sick actually increases at – around that time period so that kids 10 years of age and older can actually transmit the same way that adults transmit.  


Do COVID-19 symptoms manifest differently among young people than among adults? 


[00:03:01] 

TINA TAN: When a younger person or when an infant or child gets infected with COVID and actually has symptoms, the symptoms are almost exactly the same as what you see in the adult population. However, there are certain symptoms in infants and children that are more common. And these include fever, cough, runny nose, vomiting, diarrhea and, sometimes, abdominal pain. But when – you know, so they really don’t get or can’t tell you that they have loss of taste and smell. Other things – they can’t, sometimes, express the fact that they do have a headache or a sore throat. But when the symptoms are there, they’re pretty much the same as what you might see in an adult.  


Can parents do anything to protect their children from catching COVID-19 in schools and/or prevent them from spreading it to others? 


[00:03:56] 

TINA TAN: The basic mitigation protocols that should be in place in a school setting include universal mask-wearing among students, among teachers and among staff members. And this is all day long except for when you eat. You should be wearing a mask in the classroom. You should practice social or physical distancing so that you stay six feet apart from other individuals. And you should practice good hand hygiene. And this should be – you know, you should, basically, either wash your hands or use hand sanitizer frequently throughout the day, especially before you eat and before you go to the bathroom and then after you eat and after you go to the bathroom. But those three things are major ways that you can prevent your child from becoming ill if they go to in-person school.  


Which COVID-19 mitigation protocols used in schools are supported by scientific evidence? 


[00:05:02] 

TINA TAN: So almost all the protocols that have been put out in terms of protecting students and teachers put out by the CDC or the American Academy of Pediatrics or the Infectious Disease Society of America are all scientifically based. So we know that universal mask-wearing, physical social distancing, frequent disinfecting of your hands, frequent disinfecting of frequently touch surfaces – all these are based in science. So there is nothing out there that comes from the national organizations that are not based in – on science.  


Are there any mitigation protocols that schools are using that are not supported by science? 


[00:05:55] 

TINA TAN: I’m really not hearing about things that are in place that are not supported by science. What concerns me more is that people are not adhering to these mitigation protocols. So when you look at schools that have reopened for in-person learning and have to close a week or several days after they reopened, when you go back and you see why there was an outbreak of COVID in those schools, most of the time it’s because the mask and the physical distancing protocols were not adhered to. So we know that schools here in the United States that have opened and closed, it’s primarily because masks were not mandated, especially for students. They were mandated for teachers, but not for students. And there was no physical distancing that was mandated. And even abroad – so in Berlin, basically, there were a number of schools that were open and then closed within a week of opening, primarily because masks were not mandated in the classroom for the students. They were mandated when the students walk in the hallways or went to recess or went to the cafeteria. But in the classroom setting, they were not mandated. And, you know, there’s a lot of science out there now that really shows that wearing of masks and social distancing really are quite effective in preventing the transmission and spread of COVID-19.  


As a clinician and a scientist, what else do you think people should know about preventing COVID-19 spread in schools? 


[00:07:41] 

TINA TAN: There are actually two really important things that people need to understand, and that is one, that universal masking and physical social distancing actually are very, very effective ways of preventing the transmission and the spread of COVID-19, whether you’re in a preschool, a school – elementary school, a high school or a college.  

The other thing which is incredibly important is that immunizations be up to date for all students and staff that are going back to in-person learning. One of the unintended consequences of this pandemic has been a significant decline in immunization rates for routine immunizations that are given to children as well as to adults. So it’s incredibly important that people be up to date on their immunizations, especially if they’re going back to in-person learning.  

The other thing that’s really important is that everyone 6 months of age and older should be getting an influenza vaccine this year. That is one way to protect yourself as well as other members of your family against getting influenza disease. And we know that this is expected to be – there is expected to be a resurgence of COVID during the fall. And so the symptoms that you see with flu and the symptoms that you see with COVID are very similar. And sometimes it’s going to be very difficult to tell the difference between whether someone has COVID or whether someone has flu or whether they have both. So in order to protect yourself from getting influenza, it is going to be really important that everyone get their influenza vaccine this season. 


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Dr. Tina Tan

Northwestern University Feinberg School of Medicine; Ann & Robert H. Lurie Children's Hospital of Chicago

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