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Sept. 20, 2021

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If you have unvaccinated kids, act like ‘nobody in household’ is vaccinated, experts urge

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Coronavirus cases in Washington are nearing peaks not seen in six months — and for parents readying for a new school year, navigating the path back to classrooms is suddenly fraught with tough questions.

Will safety measures like masking and ventilation be enough to curb classroom outbreaks? How might the delta variant confound plans for in-person learning? And since masks are mandatory again, which ones are best for kids?

We turned to experts to weigh in on all the ways the delta variant is fueling uncertainty, how parents can talk with kids about this stage of the pandemic and what safety measures to expect when school doors open in a few weeks.

What do parents need to know about the delta variant?

Researchers now have good evidence that the delta variant is significantly more transmissible than prior variants. And even though vaccinated people seem to be protected from severe illness and death, research suggests they can still transmit the virus.

Kids have largely fared better than adults during the pandemic. They are far less likely to get sick, and it’s uncommon for them to be hospitalized or die from COVID-19; in Washington, children up to age 19 make up about 2% of all COVID-19-related hospitalizations, for instance.

But an Aug. 12 report from the American Academy of Pediatrics suggests the share of COVID-19 cases cropping up in children and teens is increasing nationwide. Over the course of the pandemic, kids made up about 14.4% of cases; in the week ending Aug. 12, they made up 18%. Because delta is more virulent, and overall cases are skyrocketing, the total number of infected kids — and the number winding up in the hospital — is increasing, too.

When parents of unvaccinated children are making decisions about going out into the community, they “need to behave as if nobody in the household is vaccinated,” said Elizabeth Meade, immediate past president of the Washington Chapter of the American Academy of Pediatrics. Meade said her family behaves as they did a year ago: They avoid crowds and everyone wears masks in public indoor spaces.

What safety measures are mandated this school year?

Everyone inside school buildings — vaccinated or not — is required to wear a mask. And as of this past week, all adults who work in schools are required to get fully vaccinated against COVID-19 by Oct. 18 or face the possibility of losing their job unless they qualify for a medical or religious exemption. School officials are encouraging eligible students — those 12 and older — to get vaccinated; some kids under 12 may be able to get a shot as soon as midwinter, though the exact timeline isn’t clear. Schools must also have a plan to isolate students and staff when COVID-19 symptoms crop up. For example, schools have to exclude those who are infected or in close contact with someone who’s infected. Similar to last school year, school officials have to report all cases and outbreaks to their local public health department. Some districts may also report case numbers and outbreaks on their websites, though they aren’t required to do so.

State officials are encouraging districts to use a layered approach to safety: The more safety measures they take up, the safer schools will be. But many of last school year’s strict requirements have been loosened or reduced to recommendations. In the latest back-to-school guidance, for instance, state education officials encourage, but don’t require, schools to maintain 3 feet of physical distance between students.

What should happen when someone has COVID-19 symptoms at school?

Per state requirements, schools must immediately isolate someone who is sick, send them home and refer them for testing. If a kid or staff member can’t leave campus immediately, schools are supposed to keep them in an area away from other people; schools can use outdoor spaces to isolate students, for example, so long as an adult is available to supervise.

If a student or staff member tests positive for the coronavirus, they can return to school after they meet three criteria: their symptoms have improved, it’s been at least 24 hours since they had a fever without taking fever medication, and 10 days have passed since the start of their symptoms or the date they tested positive.

Many of these safety measures were crafted before the rise of delta. Will they be enough to keep school outbreaks at bay?

A large body of evidence suggests schools are among the safest places for children — they’re highly controlled environments, and transmission rates are low when schools use the type of layered approach to safety Washington and many other states have adopted. As of this past week, the Centers for Disease Control and Prevention and the American Academy of Pediatrics still recommend that most children return to in-person learning.

That being said, “What we have to do is be willing to change our guidance as we get new information. And that is really, really difficult for people because we want to plan our lives,” said Meade.

Others are sounding an alarm now. An even more virulent variant — and relaxed safety measures — could be a dangerous cocktail as thousands of unvaccinated Washington kids head back to school, said Steve Lim, University of Washington professor of health metric sciences and senior director of science and engineering at the Institute of Health Metrics and Evaluation. “All of our evidence about effective mitigation in schools is largely based on those less-transmissible variants,” said Lim, who plans to home-school his unvaccinated kids this fall. “Delta, in my opinion, is dealing with a new disease.”

Lim is also worried that safety measures that largely defined last school year in Puget Sound area districts — smaller class sizes, no meals at school, hybrid scheduling that kept density inside schools low — are going away. “A lot of the justification to the approach in this new school year is, we didn’t see any widespread outbreaks in the Seattle area in the spring,” he said. “But of course in the spring we had far stricter measures in place.”

What type of masks are best for kids?

The best type of mask is the one your child will wear, Meade said. Just like for adults, a child’s mask should fit snugly over their nose and mouth, but be comfortable enough that they’re willing to keep it on.

Families who use cloth masks should wash them frequently, she said. And if cloth masks are used, they should be multilayered. N95s and KN95s do a better job, though, and parents should consider these more effective options if their child is willing to wear them — especially if their child is vulnerable to COVID-19 or other vulnerable people live at home.

What are some strategies for parents and caregivers who want to talk with their children about this phase of the pandemic?

Caregivers can share facts and reassure children that schools and health officials are monitoring the course of the pandemic closely — and making decisions that are in children’s best interest, said Lisa Barrois, a clinical psychologist at Seattle Children’s hospital.

Families can also remind their children of experiences where plans changed, or instances when they were able to adapt and still succeed.

As we head into another school year, caregivers should be on the lookout for signs of anxiety. Kids might share worried thoughts or appear withdrawn, Barrois said. But children sometimes express mental or emotional concerns by complaining about physical symptoms like headaches or stomachaches. Labeling those emotions or symptoms can help kids feel validated and understood, she said.

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