When schools reopen, will the epidemic get worse?

The scary statistic became public this week as South Florida schools wrestled with when to reopen: Nearly one-third of Florida children tested for COVID-19 turned out to have the virus, a far higher percentage than adults.

That staggering figure diminished Saturday, after the state health department reported a massive increase in testing of children that reduced their positivity rate to about 13{50531db320f8e8a316d79d6a285e47c71b6e4f6739df32858cb86474d7e720e9}, roughly in line with the rest of the population. However the numbers shift, the prevalence of the virus among children will be watched closely in the coming weeks, as parents, teachers and officials debate when children can return to the classroom.

Although children are far less likely to experience serious illness from the disease, their very lack of symptoms can make them more dangerous carriers. And no one expects 7-year-olds to scrupulously observe rules on hand-washing, mask-wearing or social distancing.

“Kids are less likely to cough into their elbow or cover their mouth or socially distance without a lot of guidance,” said Dr. Ronald Ford, chief medical officer of Joe DiMaggio Children’s Hospital in Hollywood. “They’re less likely to cooperate with everything we’re asking people to do limit the spread, so they pose a pretty significant risk for transmission of the disease.”

President Trump and Gov. Ron DeSantis are pressuring schools to reopen for in-person classes. With the epidemic showing no signs of ebbing in South Florida, parents worry about the risks to their children’s health and education. Teachers wonder how school days can be organized to keep everyone safe. And the significant percentage of children carrying the virus indicates the epidemic could still get worse.

“The most important thing for all of us to do to get our kids back to school is to get this outbreak under control,” said Dr. Sonja Rasmussen, professor of pediatrics and epidemiology at the University of Florida. “To do that, we really need to start wearing masks, we need to wash our hands, we need to watch our distance.”

Many unknowns remain about the new disease’s impact on kids, such as how likely they are to spread it compared to adults and why it leaves most unharmed and others severely ill. But for most children, experts say, school attendance in the era of coronavirus probably poses little risk.

“Going to school, especially for a healthy child, is very safe,” said Dr. Barry Gelman, chief medical officer of Holtz Children’s Hospital at Jackson Memorial Medical Center and associate professor of pediatric critical care at the University of Miami’s Miller School of Medicine. “In all the countries with the virus, when you look at the pediatric hospitals, the number of hospitalizations, the number of people with serious illnesses, the number of [child] deaths is exceedingly low. The same thing is true for the state of Florida.”

But Gelman said their ability to carry the virus means family members must take precautions. After school, kids should change clothes and wash hands. And parents should consider keeping children home if a family member is vulnerable.

“If grandma has breast cancer and is on chemotherapy, it may be very appropriate for that family to say we want keep our child home and do remote learning,” Gelman said. “If the parents in the household are healthy — and most parents are in their 20s, 30s, maybe 40s — the risk is not quite as low as the child. But if the child is healthy and the parents are healthy, then it should be safe, and the parents should not worry about their kids going to school.”

Nationwide, about 175,000 children aged 17 and under have contracted COVID-19, about 6{50531db320f8e8a316d79d6a285e47c71b6e4f6739df32858cb86474d7e720e9} of all confirmed cases in the United States, according to the Centers for Disease Control, the Associated Press said. There were 228 deaths, or about .2{50531db320f8e8a316d79d6a285e47c71b6e4f6739df32858cb86474d7e720e9} of the total of more than 138,000 deaths nationwide.

President Trump and Gov. DeSantis are pushing schools to re-open, with the President threatening to withhold funding from districts that fail to do so.

Florida Education Commissioner Richard Corcoran signed an order requiring school districts to offer in-person classes at the beginning of the year, but the order allowed school districts to wait until they considered it safe. The school districts of Broward, Miami-Dade and Palm Beach counties have all said they would delay a physical return to class until the COVID-19 situation improved in South Florida, the hardest-hit part of the state.

Super spreaders

Teachers, who will have to spend the most time with the children, have questioned whether it will be safe for schools to reopen.

Cheryl Argent, a teacher at Coral Park Elementary School in Coral Springs, said her preschoolers are “super spreaders.”

“They’re orally fixated even at that age,” she said. “They lick their fingers and suck their thumbs.”

Argent fears for children in all the grades. She wonders about the long-term implications on children, even ones who are asymptomatic.

“It’s the lives of our own children, our babies that we care so much about,” Argent said. “Is it worth it?”

The number of Florida children hospitalized for the disease since the epidemic began was 246, according to the state health department. Four have died. As with adults, the disease is most dangerous to children with underlying conditions such as obesity, severe asthma or lung problems. Of 48 children sent to intensive care units in the United States and Canada for the disease, 83{50531db320f8e8a316d79d6a285e47c71b6e4f6739df32858cb86474d7e720e9} had underlying medical problems, according to a study in JAMA Pediatrics.

At Jackson Memorial’s children’s hospital, an 11-year-old boy died of the disease who had suffered from kidney and lung disease, Gelber said.

An exception to the disease’s tendency to harm only children with underlying conditions is a devastating attack on the body called multisystem inflammatory syndrome, a life-threatening condition marked by swelling in the heart, blood vessels, kidneys and other organs.

This rare result of COVID-19 typically occurs in otherwise healthy children. A study in the New England Journal of Medicine found nearly three-fourths of victims of that syndrome had no other serious health problems.

“These kids are really, really sick,” Rasmussen said. “And these are kids that don’t seem to have illnesses beforehand.”

At Joe DiMaggio, several children have been treated for that syndrome and all came through treatment successfully, Dr. Ford said.

As school officials, parents and teachers discuss the risks of school attendance, doctors say they should keep in mind the health benefits. Kids gain from exercise, the stimulation of interacting with other children and, for many students, breakfast and lunch.

“Kids are doing a lot of things at school that are healthy that they’re not doing at home,” Gelber said. “They’re going outside for recess. They’re using all sorts of supplies in arts and going to music, and they’re not having that experience when they’re sitting at home. So the learning is better, the socialization is better, and all of that contributes to the development of a child. It’s extremely important.”

Shifting numbers

The debate over reopening schools acquired new intensity last week after the state reported that about 31{50531db320f8e8a316d79d6a285e47c71b6e4f6739df32858cb86474d7e720e9} — 16,797 of 54,022 children tested — turned out to be positive for the virus, based on testing from the beginning of the crisis through July 9.

The state on Saturday issued a new report showing that the total number of children tested more than tripled in the past week — bringing the child positivity rate down to 13.4{50531db320f8e8a316d79d6a285e47c71b6e4f6739df32858cb86474d7e720e9}. According to those numbers, 23,170 of 173,520 children tested were infected. The largest number of cases was in Miami-Dade County, with 4,227, followed by Broward with 3,226 and Hillsborough with 1,902. Palm Beach County has 1,751.

Rasmussen, of UF, questioned whether the initial high percentage of positive tests indicated more children than adults were getting the disease. She said more adults are routinely tested and children tend to be tested only when they show symptoms, which could skew their positivity rate upward.

“We’re all getting tested to go back to work,” she said. “I don’t think anybody’s going to stick that long swab into a baby unless they really think the baby has it.”

Dr. Ford, of Joe DiMaggio, said he wouldn’t be surprised to see the positivity rate for children increase, based on his recent experience. At a testing site at C.B. Smith Park in Hollywood, he said, the positivity rate for children has been steadily rising, with the cumulative rate — meaning the total result of testing since the beginning — rising from about 10{50531db320f8e8a316d79d6a285e47c71b6e4f6739df32858cb86474d7e720e9} in April to 18.4{50531db320f8e8a316d79d6a285e47c71b6e4f6739df32858cb86474d7e720e9} last week.

Staff writer Ramishah Maruf contributed to this report.

David Fleshler can be reached at [email protected] or 954-356-4535.


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