SCHOOL RISKS

ECU physician answers COVID-19 concerns of parents of immunocompromised school children

As children across North Carolina and nation prepare to return to school, the parents of children with underlying health conditions – such as cancer, blood disorders and asthma – are worried if in-person classroom instruction during the COVID-19 pandemic can be safe for their already at-risk children.

Dr. Beng Fuh, director of pediatric hematology and oncology at ECU’s Brody School of Medicine, recently addressed some frequently asked questions from parents of immunocompromised children in order to help allay their concerns and provide expert insight into the risks schoolchildren could face this school year.

“Given my years of experience of working with families who have children with severely compromised immune systems, it is amazing what these families – and especially these children, some of whom are very young – are able to learn and are able to do,” said Fuh, who is also the director of ECU’s Comprehensive Sickle Cell Center.

QUESTIONS AND ANSWERS

Editor’s Note: The understanding of COVID-19 is constantly evolving and the opinions provided in this interview may change as new discoveries are made in the future.

Are kids really less likely to contract COVID-19 or merely less likely to show symptoms and negative effects?

Let me first make it clear that children can contract COVID-19. Children can develop symptoms of COVID-19. And children can develop serious complications and some of them will die from COVID-19. With that being said, we know that children are less likely to develop severe complications from COVID-19 when compared to adults. And if you look at the number of cases – both in the United States and around the world – we know that the number of COVID-19 cases in children is lower than it is in adults when you compare to their share of the population. However, there is some concern that these lower numbers that we are seeing is because children frequently do not have symptoms. So, since most of the time only people with symptoms are being tested, we may only be picking up children with COVID-19 because they have symptoms. We will know in the months, and perhaps years, to come what the real question is when it comes to children and their risk of contracting COVID-19.

What else is known about COVID-19 and children?

We know that some symptoms are more common in children than in adults, for example, the complications of belly pain, diarrhea, loss of appetite and vomiting. In the last few months we have noticed a very unusual symptom in children that is known as a Multisystem Inflammatory Syndrome in Children (MIS-C). This involves an inflammation of the brain, bowels, heart, kidneys and lungs. These symptoms can last for months and we are not quite sure yet what the long-term implications of these symptoms will be.

What do we know about COVID-19 and children with a weak immune system?

Most of the children we serve in the Division of Hematology and Oncology are considered higher risk. This is based on their immune system being compromised. If you have child who has received any form of chemotherapy – or they are born with a problem with their white blood counts or problems with their spleen – that compromises the immune system and that puts them at a higher risk of contracting COVID-19 and if they do, they are at higher risk of having severe complications. Children with chronic diseases in the areas of the body that we mentioned are impacted by COVID-19 – such as children with Crohn’s disease, asthma, heart disease, kidney disease and rheumatoid arthritis – they are considered at higher risks of having complications from COVID-19.

How should I decide if my child should attend school this fall?

As you look at that very difficult decision, the first consideration is to talk directly with your school to see what they are putting in place to diffuse the risk of disease spread. If the school has procedures in place to limit contact between children as they get into school and as they are in class, that is a good sign that your child’s risks will be low.

The next consideration is your child. Is your child mature enough to be able to do the physical distancing? Will your child be able to wear a mask throughout the school day? Is your child able to follow instructions when they are given by the teachers? The third component is who else is in the household? Do you have vulnerable people in your household?

Lastly, what is your degree of comfort with the risk? Everybody has a different appetite for risk. What risks are you willing to take for your child? We know there is an increased risk with reopening schools. But we also know that education is important enough that everybody has to weigh this.

In North Carolina, Phase 2 was recently extended another five weeks. Should I change my decision about how my child should attend school this fall?

We have unfortunately had significant increases in COVID-19 cases in North Carolina in the past two months. I don’t think the extension of the Phase 2 was unexpected given the trajectory of cases. The key is what we discussed earlier – What has your school put in place? What is your home situation? What is your level of comfort with the risks?

Is the community spread of the virus high in Pitt County?

I wish I could tell you we were in a good place. Unfortunately, Pitt County – like the rest of North Carolina – has seen a rapid rise in the number if COVID-19 cases in the last two months.

Since the beginning of August, we have ranged between seven new cases a day to 42 cases a day in Pitt County. So, we have to assume that we are a hot spot and take the precautions, as needed. We are talking about school today, but a lot of spread does not happen in school. The children that we are seeing today with COVID-19 mostly do get it (outside of school).

What activities should my child avoid or limit if they attend school?

When we look at school, the key aspect of school for the fall semester is education. Unfortunately, we are going to see some of the extra-curricular activities are not as key. So, what are some of the things that should be avoided?  Contact sports, sharing objects with other students (school supplies, computers and other electronics), crowded school buses, congregating in the hallways and activities that mix students from different classes.

Based on my child’s treatment and recovery, is it safe for my child to go to school?

If your child has diagnosed with cancer and they completed their chemotherapy and/or radiation treatment and their blood counts have recovered – or if your child has sickle cell disease and are not currently in the hospital – then the precautions we discussed earlier are good and you should make your decision based on that. If the school has put the precautions in place and you feel comfortable, your child should be able to return to school if that is your choice.

What are my child’s chances of getting COVID-19 if someone in their class tests positive?

It depends on the circumstance of what the school does. We can certainly assume that as schools reopen there are going to be some children who are going to contract COVID-19 in the classroom just as they can contract it in any other circumstance, including at home. So yes, there is a risk that they may get it. But if there is physical distancing, they are wearing masks and they are avoiding the high-risk activities, I think they can go to school with a relatively low risk. But we can’t keep children 100-percent free of risk.

What should I do if I think my child may have COVID-19?

You should contact your primary care provider, and we will evaluate your symptoms and make a decision if your child needs to be tested. The most important thing is to inform the school and keep your child from school, because if you don’t you will put other children at risk. If your child is getting treatment or is at risk of complications from COVID-19, and have tested positive for COVID-19, we will likely watch them very closely at home. But if they get to a point where there is concerns of complications, we may have to bring your child into the hospital for further management. (The phone number for ECU’s Division of Hematology and Oncology is 252-744-4676.)

Is it safe to send my younger child back to daycare with school starting back?

That is a question that many parents have to grapple with, especially with going to work – you need daycare for your child. I will say for daycare, take some of the precautions we discussed regarding school. What has the daycare put in place to reduce the risk of contact between children and the risk of transmission of COVID-19? What are the mitigations in place if staff or one of the children catches COVID-19? After weighing all of that, if you are comfortable with the procedures they have in place, I think you can manage the risk of your child going to daycare.

Is it practical for my child to keep his/her mask on all day while at school? 

It is difficult, but it is possible. As someone who has been treating cancer for many years now, it is amazing what children are able to learn when both parents and teachers make it clear to them the importance of that measure. What we need to do as parents is start working with our children on what is important and why it is important. We know that masks, physical distancing and hand washing is the best way to reduce exposure to COVID-19.

I have elderly family members or others with compromised immune systems living in my household. Should I send my child to school?

You are right to be concerned about the risk. We know that older people are at a higher risk of serious complications from COVID-19 and that is something you should take into consideration as you decide if your child is going to return to in-person classes. The key is if your child follows the rules at school. If they’re able to do this and, as a household, you are able to keep up with the hand washing, continuing to practice physical distancing (when possible) and removing some of our habits – such as getting into each other’s food or hugging and kissing one another – then I think you can control the risk. But if you feel your child can’t follow the rules at school or you are not confident in the precautions that were put in place at the school, then you may want to consider keeping your child in virtual education for the sake of your family members.

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