Pediatric Annals

Editorial Free

Can Students Safely Return to School in the Age of COVID-19?

Joseph R. Hageman, MD

New data, information, opinions, and surveys are being published daily about whether it is safe for children to return to school for in-person instruction this fall. Based on my summation of all the reports I have read and researched over the last few weeks, in-person instruction should resume if it is done safely.

The Centers for Disease Control and Prevention (CDC),1 Dr. Anthony Fauci,2 the Director of the National Institute of Allergy and Infectious Diseases, and others have all provided guidelines and recommendations for returning to school safely. Here is a summary of strategies to help mitigate the spread of coronavirus 2019 (COVID-19) in school settings:1,3–9

  1. Monitor the COVID-19 transmission rates in communities and within school districts (hot spots are more of a concern for in-person schooling)

  2. Require universal cloth face coverings for children age 2 years and older

  3. Social distancing (6 feet of separation): attention to limits on class size and interactions with other children and teachers

  4. Cohort classes, teachers, and support staff

  5. Hand hygiene: washing hands with soap and water for 20 seconds or using hand sanitizer with 60% ethanol. Avoid touching face, nose, and eyes. Coughing and sneezing should be averted into sleeves

  6. Disinfect classroom and other areas of the school at least daily and more often if possible

  7. Meals should be packaged and delivered to each classroom

  8. Classrooms should be well ventilated. Heating and air conditioning systems should be inspected for optimal functioning, filters should be within service life, and MERV-13 (minimal efficiency reporting value) efficiency filtration should be used

  9. School buses must be set up with attention to social distancing

  10. Limit sharing of common items without disinfecting between uses

  11. Offer alternate days of classes

  12. Offer a combination of in-person and virtual class experiences (D. Kamat, MD, PhD, UT Health San Antonio, email communication, July 26, 2020)

  13. Symptom screening for children, parents, teachers, and administrators (students and teachers should stay home if they are sick)

Implementing these strategies successfully is certainly complicated. As both the CDC1 and American Academy of Pediatrics (AAP)7 state that groups making the decisions should be multidisciplinary, they need to review community transmission rates daily, and they need to be flexible in planning and decision-making.

The main priority for any school is to maximize efforts to keep everyone as safe as possible from the potential of acquiring COVID-19. According to the article “A Regimen for Reentry,” the most important strategies for reentry involve five pillars: hygiene, distancing, screening, masks, and culture.5

What Do the Parents of These Children Think?

In one national survey of families with children age 5 to 17 years, a total of 31% of parents indicated they would “probably” or “definitely” keep their child home this fall, whereas 49% indicated they would “probably” or “definitely” send their child to school.9 Factors associated with keeping their child at home were lower income, being unemployed, and having a flexible job. Planning to keep their child at home was also associated with fear of COVID-19, fear of multisystem inflammatory syndrome, confidence in schools, and challenges of home-schooling. Race and ethnicity were not associated with plans to keep children at home this fall.9

Another national survey by Patrick et al.10 addressed the concerns for the well-being of children and their parents during this pandemic. Since March 2020, a total of 27% of parents reported worsening mental health for themselves, and 14% reported worsening behavioral health for their children.10 There was also an increase in food insecurity from 6% to 8%, a decrease in employer sponsored health insurance coverage for children from 63% to 60%, and 24% reported a loss of childcare.10

All of this information is relevant for children and families, because most people rely on a regular source of income so they can provide for their families. Some families, specifically those with lower incomes, also depend on meals, sometimes breakfast and lunch, to be provided at school.

Parents, teachers, administrators, and pediatric providers should all consider as much information as possible when making a decision about in-person learning this fall.


  1. Centers for Disease Control and Prevention. FAQ for school administrators on reopening schools. Accessed August 18, 2020.
  2. Edgers G. Q&A with Dr. Fauci: ‘We will get out of this and we will return to normal. Don't despair.’The Washington Post. Accessed August 26, 2020.
  3. Jenco M. AAP guidance on school reopening addresses physical and mental health, instructional time. Accessed August 18, 2020.
  4. Cooper DM, Guay-Woodford L, Blazar BR, et al. Reopening schools safely: the case for collaboration construction disruption of pre-coronavirus 2019 expectations, and creative solutions. J Pediatr. 2020;223:183–185. doi:10.1016/jpeds.2020.05.002 [CrossRef]
  5. Gawande A. Amid the coronavirus crisis, a regimen for reentry. The New Yorker. May13, 2020. Accessed August 18, 2020.
  6. American Academy of Child & Adolescent PsychiatryAmerican Academy of Child and Adolescent Psychiatry (AACAP). American Psychiatric Association (APA) detail steps necessary for safely reopening schools this fall. Accessed August 18, 2020.
  7. American Academy of Pediatrics. COVID-19 planning considerations: guidance for school re-entry. Accessed August 18, 2020.
  8. Sharfstein JM, Morphew CM. The urgency and challenge of opening K-12 schools in the fall of 2020. JAMA. 2020;324(2):133–134. doi:10.1001/jama.2020.10175 [CrossRef]
  9. Kroshus E, Hawrilenko M, Tandon PS, Christakis DA. Plans of US parents regarding school attendance for their children in the fall of 2020 [published online ahead of print August 14, 2020]. JAMA Pediatr. 2020. doi:10.1001/jamapediatrics.2020.3864 [CrossRef]
  10. Patrick SW, Henkaus LE, Zickafoose JS, et al. Well-being of parents and children during the COVID-19 pandemic: a national survey [published online ahead of print July 24, 2020]. Pediatrics. 2020. doi:10.1542/peds.2020-016824 [CrossRef].

Joseph R. Hageman, MD

Pediatric Annals Editor-in-Chief Joseph R. Hageman, MD, is the Director of Quality Improvement, Section of Neonatology, Comer Children's Hospital; a Senior Clinician Educator, The University of Chicago Pritzker School of Medicine; and an Emeritus Attending Pediatrician, NorthShore University HealthSystem.

Address correspondence to Joseph R. Hageman, MD, via email:

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