UCSF health professionals call for February 1st school reopening

By Dr. Jeanne Noble and other UCSF department leaders

By Dr. Jeanne Noble and other UCSF department leaders

Long term school closures have a detrimental, measurable impact on children and adolescents. While school closure is challenging for all families, households which include essential workers and those with limited financial means are disproportionately impacted. Children with special needs, in particular, are uniquely negatively impacted because they depend on in-person learning for educational, rehabilitative, social, and behavioral resources that cannot be adequately supported in distance learning, resulting in additional stress on these families. School closures have widened the achievement gap. Educational inequities have the potential to translate into a lifelong barrier and a staggering number of life years lost (JAMA Netw Open. 2020;3). In California, many private schools reopened during the Fall, while the majority of public schools have been closed since March. The essential societal role of public education is reflected in Article IX of California’s constitution, which mandates unfettered access to education for all children to ensure that a child’s ability to participate in public education is not dependent on the financial means of their family.

Because literacy and health literacy influence health status, prolonged school closure is contributing to social isolation among children and adolescents. It is taking a heavy toll on their mental health and well-being. The Emergency Department at Benioff Children’s Hospital-Oakland reported a temporal increase in the proportion of all children and youth (10 to 17 years) who reported suicidal ideation, from 6% in March 2020 to 16% in September 2020. Similarly, the CDC reported that compared to 2019, the proportion of pediatric emergency visits due to mental health issues in 2020 increased by 24% among children ages 5 to 11 and by 31% for children ages 12 to 17. Apart from social isolation, an increase in high-risk behaviors among youth could be related to a lack of parental or adult supervision. The cumulative long-term impact of trauma related to social isolation, educational distress, family stress, and other stressors may culminate in post-traumatic stress disorder, depression, anxiety, and other behavioral disorders. It is reasonable to expect that children who live in poverty are even more likely to experience these adverse outcomes.

There is also a real concern for significant but unknown drops in student attendance, especially in disadvantaged communities with less access to computers and the internet for online learning. School districts around the country are reporting higher rates of students failing classes, a phenomenon which has been disproportionately seen among low-income Latinx and African American children.

Since March 2020, we have learned that young children are not the primary drivers of COVID-19 transmission. We have also learned that children are generally not at risk of severe health consequences from COVID-19. Indeed, in the entire state of California there have been only 5 COVID-related deaths among persons younger than age 18. For comparison, there were 15 deaths due to influenza in this same age group during the 2018-19 flu season. Fortunately, there is accumulating evidence from the Bay Area and other states that schools can safely reopen. In Marin county, for example, more than 450,000 “student days” (i.e., tens of thousands of students on school campuses for over 3 months) have been associated with just six cases of school-based transmission. That is, there have been only 6 additional COVID cases resulting from 40,000 students and 5,000 teachers interacting on campus since September. There is similarly reassuring data from the state of New York where COVID prevalence is no higher among high school students and teachers who returned to campus compared with community matched prevalence rates.

Teachers and other school staff are key players in this process and should be viewed as essential workers. Their health and safety are paramount. Fortunately, we now have robust data demonstrating that schools may be safely re-opened and school-based transmission remains very infrequent when universal masking and social distancing rules are carefully followed. We support the availability and use of universally accepted PPE including surgical masks and face shields for all school staff. We also support their prioritization for vaccine administration along with appropriate testing and COVID-related time-off alongside other essential workers, though school opening can and should proceed prior to vaccination availability or completion.

Following the lead of many European and Asian countries, we believe that California schools should be the first sector of our economy to reopen and the very last to close. Given the significant negative health and educational consequences of school closures for children and their families, coupled with robust data supporting reopening with appropriate mitigation strategies, we strongly support efforts to reopen California schools as soon as possible. Prioritizing reopening must include adequate resources to support the most important mitigation strategies: universal masking and social distancing. As pediatricians, internists, infectious disease specialists, epidemiologists, emergency physicians, and other healthcare professionals, we believe these strategies need immediate support and implementation, so that all schools can reopen for in-person learning by February 1st or as soon as permitted by the state.

Jeanne Noble, MD, MA

Associate Professor of Emergency Medicine

Director of COVID Response, UCSF Emergency Department

Elena Fuentes-Afflick, MD, MPH

Chief of Pediatrics, Zuckerberg San Francisco General Hospital

Vice Dean for Academic Affairs

University of California, San Francisco

Jackie Grupp-Phelan MD MPH

Chief Pediatric Emergency Medicine

UCSF Benioff Children’s Hospital

Vice Chair Department of Emergency Medicine

James E. Crawford-Jakubiak, MD

Professor of Pediatrics

Medical Director, Center for Child Protection

UCSF Benioff Children’s Hospital Oakland

Judith Walsh MD, MPH

Professor of Medicine and

Epidemiology and Biostatistics

Division of General Internal Medicine

Associate Medical Director

Women’s Health Primary Care Clinic

University of California, San Francisco

Elizabeth Rogers, MD

Associate Professor of Pediatrics

Associate Vice Chair for Faculty Development

Chief Experience Officer, Department of Pediatrics

Director, Intensive Care Nursery ROOTS Small Baby Program

Margaret McNamara, MD

UCSF Professor of Pediatrics

Director, Pediatric Residency Program

Mitul Kapadia, MD MSc

Associate Professor of Pediatrics and Orthopedics

Director of Pediatric Rehabilitation, UCSF Benioff Children’s Hospital San Francisco

Maria Raven, MD

Vice Chair and Chief of Emergency Medicine

UCSF Medical Center

Christopher B. Colwell, M.D.

Chief of Emergency Medicine

Zuckerberg San Francisco General Hospital and Trauma Center

Professor and Vice Chair, Department of Emergency Medicine

UCSF School of Medicine

Sarah Doernberg, MD, MAS

Associate Professor of Clinical Medicine

Division of Infectious Diseases

University of California, San Francisco

Margaret E. Feeney MD, MSc

Edward B. Shaw Chair and Professor of Pediatrics

Division of Pediatric Infectious Diseases

University of California, San Francisco

J. Matthew Aldrich, MD

Executive Medical Director, Critical Care Medicine

Clinical Professor

Anesthesia and Perioperative Care

University of California—San Francisco

Judith Klein, MD

Assistant Professor of Emergency Medicine

UCSF-ZSFG Department of Emergency Medicine

Shannon Lundy, PhD

Associate Clinical Professor, Department of Pediatrics

Director of Psychology Services, Division of Developmental Medicine

UCSF Benioff Children’s Hospital

Amy Beck, MD, MPH

Associate Professor of Clinical Pediatrics

University of California San Francisco/Zuckerberg San Francisco General Hospital

Melanie Callen, MEd

Assistant Clinical Instructor Pediatrics

Child Development & Educational Specialist

University of California, San Francisco/Zuckerberg San Francisco General Hospital

Alejandra Rincon, PhD

Associate Adjunct Professor Family and Community Medicine

Curriculum Lead Latinx Center of Excellence (LCOE)

University of California, San Francisco

Darrow D. DeLuca, MD

Pediatric Hospitalist

UCSF Benioff Children’s Hospital, Oakland

Maya Vijayaraghavan, MD, MAS

Assistant Professor of Medicine

Division of General Internal Medicine

University of California, San Francisco

Roxanna A. Irani, MD, PhD

Ambulatory Executive Medical Director for Women’s Health

Assistant Professor

Division of Maternal-Fetal Medicine

Department of Obstetrics, Gynecology & Reproductive Sciences

University of California San Francisco

Kimberly Newell Green, MD

Assistant Clinical Professor, UCSF

Past President San Francisco Marin Medical Society

Shannon Udovic-Constant, MD

UCSF Associate Clinical Professor

Chair, California Medical Association Board of Trustees

Nora Pfaff, MD

Assistant Clinical Professor of Pediatrics

Division of Hospital Medicine

University of California, San Francisco

Jahan Fahimi, MD, MPH

Medical Director, UCSF Emergency Department

Associate Professor of Emergency Medicine

Abbey Alkon, RN, PNP, PhD

Professor, UCSF School of Nursing

Director, California Childcare Health Program

Celeste Allen, MD

Director, Pediatric Residency Program

Attending Physician, Primary Care and Adolescent Health

Assistant Clinical Professor, UCSF

Lydia Tinajero-Deck, MD

Attending physician

Primary Care Department

UCSF Benioff Children’s Hospital Oakland

Rebecca L McEntee, MD

UCSF Department of Family and Community Medicine

Pooja Mittal, MD

Adjunct associate professor

UCSF-ZSFG Family and Community Medicine

Andrea Marmor, MD, MSEd

Professor of Pediatrics

Medical Director, Pediatric Asthma/Allergy Clinic

Zuckerberg San Francisco General Hospital

University of California, San Francisco

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