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July 6, 2020

The American Academy of Pediatrics, AAP, has taken the stance that children should return to school this fall. We wholeheartedly agree for the children that we see in clinic and all of the 22 million young Americans that need nourishment of the mind and body. As stated in previous newsletters, COVID19 is a lose lose scenario. There is no winner in a pandemic. Thus, we have to make the best of this net negative experience. The CDC has pegged the infection fatality rate at 0.26% for all Americans and It is highly likely that COVID19 will be with us for years if not forever moving forward. The preponderance of belief is that this virus is a new norm for us as a society.

Recurrent lockdowns and restrictions are unlikely to stem the tide of infections as we have seen with the first reopening. As soon as humans begin interacting, the virus spreads again. Therefore, the main goal should be to prevent the medical system from getting overwhelmed. Over time, we will develop some immunity that reduces the risk of death coupled with a viable vaccine/medicine that changes the death risk overnight. Those are all ifs and buts and will be very valuable if they come to pass. What is real and present is that children need education, interaction and as normal a life as possible now.

My personal experience with the March through May 2020 spring school experience for my two teenagers was lackluster at best. The education was spotty and the demands were paltry. Essentially, my children started summer break in March.One cannot blame a teaching crew that did not sign up for distance learning and web based interaction that is fraught with distraction from the sibling, house pet or bird out the window in the midst of a pandemic. However, coupling the poor quality education with the lack of social learning and you have the beginnings of stunted development at all ages regardless of the why. Then we can sprinkle in the risk that many children do not have adequate computing capabilities at home and the process stumbles further down for those without. Children stuck in dysfunctional family dynamics that are exacerbated by social isolation and poverty are going to cause long lasting emotional traumas. Witness a recent study noting a 1493% increase in child abuse. (Sidpra et. al. 2020) Add the final layer of poverty induced nutritional deficiency that was previously provided for by the school system's free meal programs and we have disaster for the emerging next generations.

The AAP has the right of it when they focus their lens on the next generation. What is a society but an educational juggernaut and protector of the youngest and most vulnerable among us who may not have the means to do it themselves. Remembering that the COVID pandemic is a lose lose situation means that sacrifices will be made somewhere. Where that occurs is up to society at large. For me, it is simple. Children deserve to be protected and educated at all costs. How this plays out in the details is a best guess for all involved as there is no precedence for what is happening.

Well meaning individuals can compromise on a learning environment that reduces COVID risk while focusing on the children's needs. The AAP has done just this. If you read the position document, you see a quality effort aimed at a best case scenario. There is absolutely no way to eliminate risk in any direction. It is a pure balancing act. We do the best that we can in any situation presented.

Two aspects of this make me more comfortable with children being in school: 1) Children do not appear to be super, asymptomatic or even symptomatic, spreaders of virus as once believed. This is unlike influenza where children are the main spreaders of disease. SARS2 is mainly spread by adults. 2) All adults can make personal decisions as to whether to send their children to school or to return to work based on their family's personal risk.

As the school year approaches, prepare to compromise in your mind for the betterment of children.


Dr. M

Munro Archives of Disease in Childhood
AAP School Re-entry Document
Peter Attia Discussion
CDC Document
Viner Lancet
Yung Clinical Infectious Diseases
Lee Pediatrics
Sidpra Archives of Disease in Childhood