Brian Lee, pediatric infectious diseases specialist, University of California San Francisco

By SUNITA SOHRABJI/EMS Contributing Editor

Children can and should safely return to schools even before they are vaccinated, according to University of California San Francisco pediatric infectious diseases specialist Brian Lee.

“I am a parent. I worry about my kids getting sick from COVID when they go back to school. I share your anxieties,” said Lee, at an April 22 town hall meeting organized by UCSF’s Asian Health Institute. Lee practices at UCSF Benioff Children’s Hospitals in San Francisco, where he was born, and in Oakland, where he grew up. Lee is also a Clinical Professor of Pediatrics at UCSF’s School of Medicine.

The Pfizer vaccine for COVID is currently available for children over the age of 16, and the company has submitted data for administering to children 12-15. Lee anticipates young teens will be eligible for the Pfizer vaccine this summer.

Moderna and Johnson and Johnson are studying their vaccines for delivery to children ages 6 months to 17 years. By this fall, as children return to classrooms, most should be eligible for the vaccine, anticipated the physician.

But children can return to in-person learning even before they are vaccinated, said Lee, citing the viewpoint of the American Association of Pediatrics, which noted that the pandemic has taken a toll on children’s physical and mental well-beings. There is a low risk of transmission at schools even in communities with high levels of transmission, he said.

In San Francisco, for example, 20,000 people, including children, teachers and staff, attend public schools, but only 5 children have become infected at school, said Lee.

Protective measures do not eliminate the risk of infection, but greatly reduce it, said the physician. Children over the age of two must wear well-fitted masks, which cover their nose, mouth, and chin, and should carry an extra one in case of tears or breakage. Children who have temperatures higher than 100.4 degrees Fahrenheit should stay home.

In the classroom, children should be seated at least three feet apart. Cohorting — assigning groups of students to remain with each other throughout the day — should be implemented, and teachers can be rotated, rather than students, to avoid crowding in hallways.

Outdoor areas can be employed for in-person learning, particularly in good weather, said Lee. Indoors, ventilation can be increased in classrooms by opening doors and windows.

Cleaning with soap and water is important, but disinfecting daily is unnecessary, said Lee.

Kids do very well with COVID, even when they get infected, and they are normally asymptomatic, or have only mild symptoms, said Lee.

Less than two percent of people under the age of 18 have been hospitalized with COVID, and only .03 percent have died, according to data from the Centers for Disease Control. Of those who have been hospitalized, more than 40 percent have an underlying illness — such as obesity, chronic lung disorder or a neurological order — which makes them more vulnerable to getting ill from an infection.

The symptoms of a COVID infection in children include fever, coughs, headaches, muscle aches, and sore throats. Less common are diarrhea, nausea, vomiting, abdominal pain, and a loss of taste or smell.

One area of concern is Multi-system Inflammatory Syndrome in Children — known as MIS-C — an extremely rare, but very severe inflammatory condition associated with COVID which infects multiple organs, especially the heart. MIS-C is most prevalent in children aged 8-9 and typically shows up two-four weeks after a child has been infected with COVID.

Children do not play a major role in transmitting COVID, said Lee, stating the point of view of the American Academy of Pediatrics.

But the disease has taken a toll on children’s mental and physical well-beings, said Lee. 36 percent of girls and 19 percent of boys have experienced anxiety during the past 15 months, as schools reconfigured into online learning. 31 percent of girls and 18 percent of boys have experienced depression. Both sexes are experiencing greater levels of withdrawal from friends and family, and are exhibiting increasingly hostile behavior, said Lee, citing CDC data.

“I’ve seen this with my own children: they are spending a lot of time in their rooms, looking at their I-pads, not going outside to get fresh air and exercise. Nagging does not help,” said Lee, noting that two-thirds of children in virtual classes had decreased physical activity, and more than a third had worsening mental health.

Moreover, there has been a 24 percent increase in children going to the emergency room with mental health emergencies, and a 31 percent increase for teens.

“The benefits of in-person learning — academic improvement, better physical and mental health outcomes — far outweigh the risks,” said Lee.