Ben Hoffman and Alex Foster
Hoffman, MD, is a professor of pediatrics at OHSU. Foster, MD, MPH is the director of the MD/MPH program at the OHSU-PSU School of Public Health and assistant professor of pediatrics.
COVID-19 has blown up what we took for granted as normal. Everything that was part of our routine has had to change, and change is never easy.
As pediatricians, we have dedicated ourselves to ensuring the health and well-being of children and adolescents. One immutable truth about kids is that they are incredibly resilient by nature. They possess immense capacity to adapt. Another is that kids need to learn, to have experiences that allows their brains to develop and grow in the right way. We know what it takes to build kids right, and that includes in-person school.
School attendance is much more than just classroom learning for many kids. School is where crucial therapies happen for kids with special needs, where hungry kids get food, where sedentary kids get exercise, where kids get support and nurturing from caring, committed adults and where kids learn the social and emotional skills that will prepare them to be competent adults. While it is possible for a resilient kid to adapt to learning remotely, many children may not. And even if they can, remote learning cannot serve the needs of the most vulnerable children.
The issue of whether to return to in-person school has become a massive, intensely charged debate. Thankfully, last month, Gov. Kate Brown moved the discussion forward by easing restrictions on schools and identifying teachers and school personnel as priority recipients of COVID vaccines. This was the right decision for kids, and we must continue to prioritize them. Kids do not have power like other stakeholders and consequently, their voice can be lost or even unheard.
As pediatricians we hear them, because we know them. We know the child who can only participate in remote classes from the parking lot of the school, because their home does not have high speed internet. We know the child living with autism and ADHD who simply cannot engage with a computer screen. We know the child who is not getting needed mental health services and has attempted suicide.
Communities of color have been hit disproportionately hard by COVID, at least in part because they make up a larger portion of our front line and essential workforce. They have been impacted to a greater degree by school closure, and we run a significant risk of widening racial disparities in educational outcomes as schools stay closed. As we move forward, we must recognize the disproportionate impact COVID-19 and remote learning have had on our communities farthest from opportunity and ensure that we take a trauma-informed approach to safely getting kids back into the classroom.
Returning Oregon’s kids to in-person school can be done in a way that minimizes the risks to them and to school staff. A growing body of scientific evidence, including data from New York state and Mississippi, strongly suggests that schools are not COVID super-spreaders. Rather, gathering with people outside of their household, close contact with COVID positive people, and not using masks in school remain risk factors. The New York state data shows that infection rates of school staff were a function of infection rates in the broader community and that kids and teachers attending in-person school were not increasing community rates.
We have learned much about how to protect kids and school staff using multiple layers of protection. Teachers and staff must continue to be prioritized for receiving vaccine. Masks, physical distancing, and robust cleaning protocols must be instituted. Protocols for ensuring that any student or staff with COVID symptoms or exposure can be identified and quarantined will be essential.
We cannot just open schools tomorrow and pick up where we left off like nothing happened. We can, however, follow the governor’s lead by putting the best interests of kids first. That conversation must acknowledge that what we are doing is not working for many of Oregon’s kids and establish the urgency to change.
A successful blueprint must prioritize the highest need children and teens, those most impacted and most vulnerable. It must be grounded in principles of equity and anti-racism and be built upon trust and honesty. It must include voices of educators, parents, and community leaders, whose voices must be heard and honored. It must address fear and bias in an authentic way and incorporate all we have learned in the last year much of it the hard way.
The COVID pandemic has required us all to change so many things. The change to remote learning was tremendously difficult and changing back may be even harder. But kids need to be in school. We need to start with those kids who have lost the most and are most at risk. We need to put kids front and center and ensure we can protect school staff as well as students and families. It’s not about us, or the economy. It’s about kids and about their future which is ultimately all of our futures.
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