Back-to-School Risk Mitigation: What the Experts Recommend

Christopher J. Chiu, MD; Justin L. Berk, MD, MPH, MBA


September 04, 2020

This transcript has been edited for clarity.

Christopher J. Chiu, MD: Welcome. We are The Cribsiders, the pediatric medicine podcast where we interview leading experts to bring you clinical pearls and practice-changing knowledge, and answer key questions about current topics in pediatrics. I'm Christopher Chiu and I'm here with my colleague, Justin Berk.

Justin L. Berk, MD, MPH, MBA: Today we are recapping an episode we recorded with Dr Joshua Sharfstein. Dr Sharfstein is a national public health expert. He is the author of Public Health Crisis Survival Guide, a book we all need. He is now host of a podcast sponsored by the American Public Health Association, Public Health On Call. He is a former secretary of the Maryland Department of Health and the former deputy commissioner of the US Food and Drug Administration.

Today we are talking about going back to school — kindergarten through 12th grade school reopenings. This requires assessing both the risks and the benefits of going back to school.

There are definitely obvious benefits. Schools support the intellectual and social development of children. They need friends. The free and reduced meal programs at a lot of schools feed kids. Unfortunately, schools are also a great way to help keep kids safe. I say "unfortunate" because 1 in 5 reports of abuse come from schools and teachers. Without schools, we worry about an increase of incidents in child abuse.

Chiu: But remember, there aren't just benefits. There are obviously risks. And these are the issues that everyone's talking about and worried about. We have to talk about risk mitigation and risk reduction. Not risk avoidance because that's really, frankly, impossible to do.

Risk mitigation requires us to look at what risks we have. What we do know is that risk may be associated with age. Children younger than 10 years of age may have a lower risk for transmissibility, may be more likely to be asymptomatic. But as children become older, their ability to possibly transmit the virus may be much higher.

Burke: We talked about a few different risk-mitigation strategies. One is the idea of having pods or classrooms that are kept in groups. If anyone were to get sick, it would be very easy to do contact tracing and quarantine specific groups to help reduce transmission. We've seen some of these strategies put into place in other countries. Germany, Norway, Denmark, and Israel have all had school reopenings with some success. Most started with conservative measures that proved to be successful.

Dr Sharfstein pointed out that Israel was an example where some of the risk-mitigation strategies were relaxed. Ultimately, that required closing schools because of an outbreak. We've already seen some states reopen and have to close.

One of the things I took away from the discussion with Dr Sharfstein is that the biggest risk factor is the community rates. If we want kids to be able to go back to school safely, we must reduce the spread and transmission in the community.

Chiu: One important thing that I also got out of our discussion was the fact that not going back to school really exacerbates our health disparities. Children in underserved communities are at higher risk for these exacerbations. These are children who have poor WiFi or inconsistent Internet access. We have to keep those things in mind. It's our children, the next generation, who we are sacrificing if they don't go back to school.

Burke: The other important population that we talked about is teachers. We have to protect the teachers and we have to make sure that they feel safe going back. No school system can send teachers back without the appropriate protective gear. This is the same crisis we saw early on with healthcare workers.

Dr Sharfstein discussed recent events in the Baltimore City school system. Just last winter, they had an issue with schools losing their heat, requiring teachers to fight and advocate to get heaters back into the classroom. The response may have been slower than they anticipated. We may have lost a lot of credibility with teachers. It wouldn't be unfounded for teachers to be skeptical when school systems say everything's in place and ready to ensure a safe return.

Chiu: I hope everyone checks out our full episode with Dr Joshua Sharfstein. You can also send us an email. Thanks so much for listening.

Chris Chiu, MD, is assistant professor at The Ohio State University, where he is also the physician lead at OSU's Outpatient Care East Clinic and serves as the assistant clinical director for the internal medicine residency. He is an Air Force veteran and a self-proclaimed gadget geek. Follow him on Twitter

Justin Berk, MD, MPH, MBA, is assistant professor of medicine and pediatrics at the Warren Alpert School of Medicine at Brown University. He is a clinical educator active in ambulatory and inpatient care and pediatrics. He enjoys coffee, thinking about hiking, and being a generalist. Follow him on Twitter

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