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Impact of Policy on Children
August 14, 2020

Returning to School in the Era of COVID-19

Author Affiliations
  • 1Children’s National Hospital, Washington, DC
  • 2Department of Pediatrics, George Washington University, Washington, DC
  • 3Child Health Advocacy Institute, Division of General Pediatrics and Community Health, Children’s National Hospital, Washington, DC
  • 4HSC Health Care System, Washington, DC
JAMA Pediatr. 2020;174(11):1028-1029. doi:10.1001/jamapediatrics.2020.3874

What was once a routine ritual of returning to school in the fall is now fraught with uncertainty and challenges for families across the US, including the effect on family health, work productivity, and in-person academic, social, and emotional benefits to the child. In what has become a highly politicized arena, the study by Kroshus et al1 represents an important effort to survey parents directly about their concerns. Parents may be navigating multiple sources of information about coronavirus disease 2019 (COVID-19) to make the decision that is best for their family. This article finds that fears of COVID-19 or other associated diagnoses such as multisystem inflammatory syndrome in children, confidence in the school system, or ability to homeschool factor into decision-making to return to school.

It is important for school systems to address these concerns in outreach to families and for schools to have the resources they need to establish safe practices during the pandemic and gain the confidence of parents. Schools have traditionally been a trusted source of information for parents.2 Strategic public health messaging targeting the needs of families is not a new principle for school systems. For example, the role of school nurses has expanded over the years to include responsibilities such as disease surveillance, chronic disease management, emergency preparedness, behavioral health assessment, ongoing health education, extensive case management, and much more.3 School systems need to collaborate with other public health messengers in the community, such as departments of health, health care systems, or pediatricians, to assist families in weighing their options regarding a return to school during the COVID-19 pandemic.

The study by Kroshus et al1 also highlights the complex considerations that families face when considering educational options for their children and the educational inequities that are exacerbated by the pandemic. This study uses oversampling of Black and Hispanic participants, which is critical because the experience of virtual learning during the pandemic has varied widely and raises significant concerns for educational equity. The survey was administered in English only and therefore did not explore the needs of non–English-speaking families and students, for whom English as a Second Language services are vital for academic success. Research during the pandemic shows that Black, Latinx, and Native American students have less access to electronic devices, internet connectivity, and quality virtual learning programs.4 Owing to these inequities, Black and Latinx students may experience an additional 3 months of learning loss compared with other students.5 Black, Latinx, and Native American communities also experience a disproportionate burden of disease and death due to COVID-19 as a result of longstanding health and social inequities.6 In addition, this study highlights the effect of employment type, with “just 19% of those whose jobs were not flexible planned to probably or definitely keep their children home… Critically, schedule control tends to be more prevalent in senior white-collar jobs, meaning that less socioeconomically advantaged families likely will be less able to make the choice about in-person schooling that works best for their family.”1

Just as local communities have struggled to scale up health care responses including sufficient laboratory testing and personal protective equipment, communities are also struggling to identify the resources required to deliver quality educational experiences, either in-person or virtually, and to identify education solutions that serve children in their district equitably. Parental and school district considerations for education in the fall are heavily focused on safety, as they should be. The authors address the importance of safety in parental decision-making and found that “More educated parents in the sample had greater confidence in their child’s school, potentially related to more positive prior experiences with their child’s school meeting student needs in other contexts.”1 Parents with students in underfunded schools will be faced with concerns over whether a school has the resources to reopen safely. It is important to examine the educational options from an equity lens. For districts offering a choice between in-person learning and virtual learning, some families may not have the luxury of choosing a virtual option owing to a lack of employment flexibility and/or lack of access to electronic devices and internet connectivity. Additionally, they may depend on the resources and services provided in schools, such as nutrition, physical activity, and health services. While levels of community transmission of COVID-19 may necessitate virtual learning, it is important to identify and address the structural barriers that prevent students and families from accessing a virtual curriculum. While a virtual learning option may be safest with respect to COVID-19, it may be very inequitable with respect to access to education and quality of online instruction and may further strain families who depend on critical services provided through schools. As districts across the country consider in-person and virtual learning options, it is critical to apply an equity lens to assess the differential impacts of each option on their students and families.

Part of the lens of equity necessitates understanding the implications of closure for families with children with disabilities. In the US, 14% of all public school students receive special education.7 In addition, approximately 1% of children and adolescents have complex medical conditions.8 These populations are heavily reliant on schools for services to help them learn and develop in a healthy manner. Access to special education services is federally mandated under the Individuals With Disabilities Education Act. During the COVID-19 pandemic, children with disabilities have struggled to access services remotely. Special education teaching and rehabilitation services, such as physical, occupational, or speech services, normally provided during the school day have been difficult to provide in a virtual environment. Owing to safety concerns and inadequate staffing, pushing services into homes has not been a viable option for most children. This leaves families of children with disabilities in a challenging position when thinking about whether to return to school for in-person services. They face the same risk calculations as other families with the additional challenge of whether their child can effectively learn in a remote setting and whether their child’s disability puts them at higher risk for getting COVID-19 or complications from it. To help alleviate this, schools will need to contemplate additional safety measures to ensure students with disabilities and their families, as well as the teachers serving them, can feel able to safely consider returning to school in person. Schools will also need to contemplate alternative instructional strategies to allow improved access to virtual learning environments for students with disabilities and their families.

Kroshus et al1 highlight the complex web of factors that parents must consider this fall and elevate parental considerations amidst a political environment. While each family will have to make the decision that best suits their needs and considerations, this study sheds light on the critical role of schools in addressing equity and serving children holistically, partnering with health departments and health care systems to deliver public health messages to students and families, and playing a vital role in response to disasters.

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Article Information

Corresponding Author: Nathaniel S. Beers, MD, MPA, HSC Health Care System, 1731 Bunker Hill Rd NE, Washington, DC 20017 (nbeers@hschealth.org).

Published Online: August 14, 2020. doi:10.1001/jamapediatrics.2020.3874

Conflict of Interest Disclosures: None reported.

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