Ashwin Dharmadhikari is a board-certified pulmonary and critical care physician. Nirali Shah is board-certified in general internal medicine, general pediatrics and pediatric hematology oncology. Prabha Viswanathan is board-certified in general pediatrics and pediatric infectious diseases.
As physician-parents of elementary and middle school students, we know that in-person school has undisputed benefits. Last year, our children struggled when schools were shuttered. We, too, were challenged in juggling patient care and work demands with our kids at home and appreciate that virtual education or hybrid teaching does not work well for many families and teachers. As physicians, however, we are deeply concerned that the hard-line stance of opening in-person schooling “on-time” at any cost despite a coronavirus surge is shortsighted and dangerous, risking long-lasting harm to our most vulnerable students, teachers and their families.
With the current omicron variant, the sheer number of positive cases is staggering — placing an immeasurable toll on individuals and families. Hospitalizations overall, and particularly in children, are peaking, placing a significant strain on resources and access to care. For immunocompromised families and those with other medical vulnerabilities, covid-19, the disease caused by the coronavirus, could have catastrophic consequences, both direct and indirect (e.g., delays in treatment and diagnosis).
Furthermore, short- and long-term complications of covid-19, including those of long-covid or multisystem inflammatory syndrome in children (MIS-C) are not fully characterized and may differ across variants and populations. We also do not know the impact of these complications on children over their lifetimes. Though vaccinations reduce disease severity, decrease hospitalizations and diminish risk for severe complications, there is yet no vaccine for those under 5 years of age, and vaccine uptake is variable among 5- to 11-year-olds. Because the coronavirus disproportionality impacts racial and ethnic minority populations, considerations of promoting health equity are a priority. Lastly, considering the needs for those at-risk for severe covid is imperative but has been largely forgotten in re-opening planning. Risk-mitigation to prevent or delay the spread and protect our front-line teachers, staff and vulnerable populations remains essential.
Each variant of the SARS-CoV-2 virus has presented its own challenges, and sole reliance on mitigation strategies developed for prior variants may be inadequate. Pressing forward without meaningful acknowledgment of the omicron variant’s incredible infectivity impacts all facets of life. When our schools resumed after winter break, many students, teachers and staff could not attend because of coronavirus infections or exposures, bus staffing shortages and personal risk-factors, leading to substantial disruptions and a chaotic reentry, exacerbating individual struggles. Yet classes in many districts resumed in a business-as-usual fashion with only weak mitigations, as if no surge were occurring — a clear departure from other sectors of society that pivoted to remote or hybrid environments to maximize safety and accessibility.
As the coronavirus pandemic evolves and continues to change shape, we must adopt strategies that allow us to safely change with it. As with snow days — both necessary and unexpected — we advocate for implementing coronavirus-related “pauses” to allow schools time to assess and enact changes responsive to new variants. That time would facilitate ensuring robust testing, planning for staffing shortages with input from teachers and facilitating interactive virtual options for those in-need.
To be clear, we oppose extended closures. Rather, we advocate for adopting brief (less than one week) pauses to implement necessary risk-mitigation and education-promoting strategies to ensure that in-school environments are safely accessible for all students and staff and that options are made available for those in need. Forcing families into a “one-size-fits-all” approach to school, without adequate risk-mitigation or alternative options, compromises individual health considerations and is simply unacceptable.
Schools represent the heart of our community: safe and nurturing institutions where we come together to help young people learn, grow, dream and realize their full potential. We need to preserve this. When schools take a rigid stance despite a changing landscape, the community is forced to carry the heavy burden of the coronavirus alone. Shifting from an era of avoiding coronavirus at all costs to navigating life with coronavirus has caused physical, mental and emotional whiplash. Taking time to adjust and optimally promote health alongside durability and sustainability of meaningful education is critical.
With this surge and those forthcoming, we call on schools and our community to normalize coronavirus planning pauses in school as our new “snow days” to facilitate the most positive approach toward school and meet the needs of the entire community.