This month South Carolina students get back into classrooms after the pandemic disrupted nearly one and a half school years. But with COVID-19 cases rising and vaccination efforts slowing, this school year is likely to be anything but normal.

Dr. Laura Valleni, an associate medical director with BlueCross BlueShield of South Carolina, who is an epidemiologist, pediatrician and neonatologist, answers some common questions parents may have as their children return to classrooms.

What should parents be thinking about when it comes to students going back to in-person classes this fall?

The American Academy of Pediatrics* (AAP) strongly advocates that school plans start with the goal of keeping students safe and physically present in school together with their friends and teachers. It is critical to use science and data to guide our decisions about the pandemic and school plans. Parents should look to the Centers for Disease Control and Prevention* (CDC) and AAP recommendations.

Parents should know these guidelines are meant to reduce risk but cannot completely eliminate it. In other words, these recommendations are aimed at lowering the risk of exposure to COVID-19. 

To protect against COVID-19, both the CDC and the AAP recommend COVID-19 vaccination for everyone 12 years of age and older. The CDC and AAP also recommend that everyone age 2 years and older, including those vaccinated, wear a mask in indoor public spaces. While rare, current data suggests fully vaccinated individuals can have breakthrough infections and spread the virus. This is of particular concern with the new COVID-19 variants currently in our community. Masks remain an important tool in protecting against COVID-19 and preventing spread to others. This is to protect everyone but especially those who cannot get the COVID-19 vaccine, such as children under 12 and those with serious chronic illnesses.

In addition to getting vaccinated and wearing masks, the CDC and AAP also recommend we all continue to practice good hygiene by washing our hands and keeping our distance where possible.

At the beginning of the pandemic, we had very little knowledge about COVID-19, how best to protect ourselves and our community, and how to treat the illness. Now we have multiple vaccines and much more data about what works. Numerous studies have demonstrated that with masking, vaccinations and good hand hygiene, we can get children back to in-person learning. This is important for their education and their physical, developmental, emotional and mental health.

Why is it important for children to be in school this year?

This pandemic has disrupted children’s lives in an unprecedented manner. Some kids are more resilient than others, but all had their lives turned upside down nearly overnight. They have had to deal with isolation, loss and a new normal. The pandemic has taken a heart-wrenching toll on many. For children, it’s not just their education that suffered. Children’s mental health, emotional health and physical health have suffered as well. The pandemic has highlighted and worsened many preexisting disparities. Inequities have resulted in greater morbidity, mortality, challenges and stressors for many children, families and communities. Taking the right precautions and steps to get our children back to school safely for learning, school services, and overall social and psychological well-being is critical.

Why is it important for children to have socialization now?

There are factors unique to the pandemic, such as widespread grief and loss. The reasons for grief and loss vary and may be due to the loss of a family member, friend or loved one. It can also stem from the loss of daily life as we knew it. All of a sudden, everything was shut down and kids were sent home. They had to stay home and away from any social gatherings. Kids have had a lot of uncertainty and disruption. They have endured epic changes in their lives and mixed messages as to what they are supposed to be doing. The pandemic has gone on for a long time, increasing the risk of child and adolescent mental health issues, including depression, emotional distress and behavioral problems. The pandemic has interrupted school support services. School specialists can help identify and address these issues best when children are on campus for classes. Children need to be engaged with other children.

Is this true for children of all ages?

Yes. Infants need close interaction with other people, especially with those caring for them. Young children need socialization for their development. During middle school, children become more independent and learn how to interact with others. This is very important for their development. We know that suicide is the second leading cause of death among youth, adolescents and young adults ages 10 to 24. The full effect of the interruption of child and adolescent socialization remains to be seen. Schools have mechanisms to help and to provide services for these children. Being isolated can increase depression, isolation, loneliness and the potential for suicide. Children and adolescents need to be among their peers.

What do we know about children and the COVID-19 vaccine?

There have been large, randomized, controlled studies of the vaccine and children. Researchers are studying younger age groups, but the CDC has not yet recommended vaccines for children under 12. As of now, children 12 and older are eligible, and the CDC and AAP recommend they receive the COVID-19 vaccine. The vaccine that is currently approved for children ages 12 to 18 is the Pfizer vaccine. It has been shown to be safe and effective for individuals as young as 12 years of age. It is a two-dose vaccine, with doses taken 21 days apart. 

The CDC continues to monitor the safety of the COVID-19 vaccines for any reported health problems after vaccination. Parents should talk with their pediatrician or family doctor about vaccine recommendations.

Are there children who are more at risk?

Children with underlying medical conditions are at increased risk for severe illness compared to children without underlying medical conditions. While the data is still limited on children with chronic conditions, current evidence suggests that children who are medically
complex, such as those with significant genetic abnormalities, neurologic or metabolic conditions, or congenital heart disease, are at increased risk for severe illness from COVID-19. Similar to adults, children with obesity, diabetes, asthma, chronic lung disease, sickle cell disease or immunosuppression are also at increased risk of severe illness from COVID-19.

One way to protect the health of these children is to ensure that everyone who can be vaccinated is vaccinated.

Are there other vaccines children can get this fall?

We know many kids are behind on their regular immunization schedule and regular well-child visits because of the pandemic. It is important that parents bring their children in to catch up on and continue well-child visits. This is important for preventing illness, raising awareness of health and safety, tracking growth and development, and discussing any concerns. Children may need pre-participation physical exams for sports, and they should get caught up on immunizations they may have missed during the pandemic.

The CDC also recommends that all children and adults get vaccinated against influenza this fall because, like COVID-19, influenza can cause severe illness and death, particularly in vulnerable populations. (For more information about the flu and the flu shot, read the blog on our website.) We don’t want another outbreak of a vaccine-preventable disease.

Is there anything else parents should know?

There are huge disparities regarding who feels comfortable sending children back to school and in the levels of fears and concerns. Families who have experienced severe COVID-19 disease, are likely to be more concerned about jumping back into school and community events. Continued education about prevention based on science and data is important. Due to ongoing studies, we are learning more every day. What is being recommended today may change as we learn more and will depend on which variants of COVID-19 are infecting our communities. Currently, we are seeing COVID-19 variants that have a higher risk of transmission and severity of illness. Parents should stay engaged and up to date on what is going on by following the CDC’s information and talking with their health care provider.

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