Falling Back Into School

We are in August and it’s time to plan “back to school” for parents and students. It seems the summer flew by although it had its own challenges of limiting vacations, avoiding COVID-19 hotspots and almost cutting out social interactions unless they are on zoom!  Schools, teachers and parents have been hopeful to return to in person teaching. They have been working on setting up hand wash stations, small group classes, outdoor education, and other methods to socially distance while being on campus. It’s not even a possibility for some jurisdictions and a challenge for most public schools. With California’s COVID 19 database potentially being inaccurate – now schools have lost hope for at least another month before a waiver can even be considered for on-campus education. There are other states where schools are opening in person.

From a clinical perspective, SARS-Cov-2 testing in children is an absolute must to guide us and prevent spreading of infection. COVID-19 Associated Hospitalization Surveillance Network (COVID-NET), a population based surveillance system collects data on lab confirmed COVID-19 associated hospitalizations in 14 states found a cumulate rate of COVID 19 associated hospitalizations among children under 18 years is 8 per 100,000 population from March 21 – July 25, to be low compared to adults (164.5) with one in three hospitalized children admitted to the ICU (with 6% requiring mechanical ventilation and 1 died) per the CDC weekly MMWR. This is a low number and mortality is 0-0.8% of all deaths and 0-0.03% of child deaths. Highest rates are in children under 2 years of age. Weekly rates steadily increase in children (from 0.1 to 0.4 per 100,000, with a weekly high of 0.7 per 100,000). Hispanic or Latino and non-Hispanic Black children having higher cumulative rates of COVID 19 hospitalizations (16.4 and 10.5 per 100,000 respectively). Since July 9 and August 6, there was a 90% increase of COVID-19 cases in four weeks. Imagine what it would be when schools open in person; 70% of cases are in the southern and Western states.

I would also like to take this opportunity to brief you on multisystem inflammatory syndrome in children (MIS-C) which is a rare but severe condition seen 2-4 weeks after a patient has onset of COVID-19; 570 kids reported to have MIS-C have been reported to the CDC with median age being eight and two-thirds of the children had no underlying health conditions except for those that were obese. The infection is seen in children and adolescents and can have cardiac involvement, gastrointestinal symptoms, elevated markers of inflammation with positive SARS-CoV-2 testing by RT-PCR or serology. Clinicians may have difficulty in differentiating from other severe infection or inflammatory conditions. Awareness of MIS-C will allow for clinicians to recognize, diagnose and treat promptly.

Efforts at prevention in settings where children congregate such as childcare centers and schools is key. Recommendations include wearing cotton masks for kids 2 years and up in all settings including home especially if there is someone vulnerable living in the household. It is also good practice for the kids to wear masks at home to create a habit if returning to school or going outside the house. Kids should be tested for SARS COVID-19 if they have any symptoms such as diarrhea, rash, sore throat and other symptoms that may be different from adults. 

American Academy of Pediatrics recommends children should be tested if they have been around someone with a confirmed case of COVID-19 or if they are scheduled for an elective surgery. A major limiting factor is rapid and cheap testing necessary to keep in person learning going and limiting risk to others. Health and human services have a state testing plan and information can be found on their website if you are interested. 

As we approach the end of the summer, we may or may not want to recall how tough it was managing children when we were thrown into home-schooling last spring. There was a disproportionate burden on mothers or a primary caregiver to take care of the home and decreasing interaction with others. Those parents that work and have kids at home all of a sudden had to manage work, kids and other responsibilities. Finding what is a good fit for your family and the right amount of structure to give kid’s security during this time requires some planning and implementation. Sometimes it’s a matter of trial and error! 

Despite the challenges of this situation and unfortunate events due to COVID-19. Our daily life must be approached positively to keep our spirits up. In my situation, working in long term care and hospice gave me flexibility to make my own schedule most of the time. Many of us being in healthcare still have jobs and therefore an income; a reason to be thankful!  It is, however, difficult to multitask especially working at home or if you have a younger child or one that has more special needs. Over the years, I have learned multitasking isn’t very productive although our culture in America is to applaud the person who manages to carry so much on their plate. It’s one of the issues that afflicts us and takes us away from mindfulness. This is why it’s so important to look at the  positive aspects of our current situation – learning that we can do a lot from home rather than the office, more time as a family,  finding creative ways to get work and chores done, and the positive aspect of less time spent traveling (whether from work or on a trip), etc. Taking time to be in nature and outdoors even if it’s just in the backyard is very therapeutic. There are a lot of self-care methods and one may not fit all. But, taking a few moments to take deep breaths throughout the day, playing with your children, reflection in the morning or night with journaling, meditation, prayer, or a walk can give great benefits to health. Getting physical activity or exercise several times a day – taking breaks from the desk or clinical work are well known. Socializing in a safe manner at this time can feed the soul, also. We will definitely become more resilient after this pandemic is over! At the same time, it’s important to seek help from mental health colleagues for anyone who is suffering from anxiety, depression or worsening of their baseline psychiatric diagnoses. I encourage you to spend a few moments for yourself and away from your to-do list and reap the benefits of self-awareness. 

We will continue getting more data on children as we move into the fall and hope the people of our state see the importance of a caring community. Hopefully COVID-19 cases will go down and we get some space to move around. Otherwise, we may be going into more restrictive movement to decrease our overall numbers. Until then, stay safe and good luck with homeschooling -- don’t forget to put your oxygen mask on first!


  • CDC MMWR https://www.cdc.gov/mmwr/index.html
    • COVID-19–Associated Multisystem Inflammatory Syndrome in Children — United States, March–July 2020
      • Weekly / August 14, 2020 / 69(32);1074–1080
    • Hospitalization Rates and Characteristics of Children Aged
      • Weekly / August 14, 2020 / 69(32);1081–1088
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