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US: Is it safe for children to come home once the school day is over?

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As schools in many parts of the U.S. reopen this week, the debate continues to swirl about whether it is safe to send our kids back for in-person education in our K-12 schools. While the danger of COVID-19 to children remains an unsettled issue, an equally important question risks being overlooked: Is it safe for children to come home once the school day is over?

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Many state and federal officials who favor schools reopening maintain that COVID-19 does not pose a serious threat to children, pointing to the relatively low number of severe illnesses and hospitalizations reported among those under 18. There's some reason to believe this is true: Apart from an uncommon inflammatory syndrome, children do appear to experience less severe cases of COVID-19.

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But it's not the whole story. While children may not often become gravely ill from COVID-19, they can catch and share the coronavirus with others - and this is the root of a clear danger with reopening schools.

Kids' ability to spread the disease was confirmed last week in new guidelines from the U.S. Centers for Disease Control and Prevention, which noted that cases among children are on the rise. Children "likely have the same or higher viral loads in the nasopharynx compared with adults and ... can spread the virus effectively in households and camp settings," the report said. We are already seeing this play out in states that have returned to in-person classes. More than 2,000 students, staff and teachers across five states have been quarantined after cases were identified in their schools, and several schools had to close just days after opening due to high numbers of positive tests.

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But what happens at school doesn't stay at school. Children who become infected by peers in the classroom are bringing the virus home, potentially exposing their siblings, parents, grandparents and caregivers. And for many of these family members, the risk of severe illness or even death from COVID-19 is significantly higher.

According to an analysis of census data by the Pew Research Group, 64 million Americans - roughly 20 percent of the U.S. population - live in multigenerational homes, with children, parents and grandparents all under one roof. The percentage is higher among Black and Latinx households, which have suffered disproportionately from COVID-19. In many other households, a grandparent or older relative may also provide after-school care while parents work.

It's these interactions that complicate the public health risks associated with reopening K-12 schools. Unlike college students, who mostly reside among peers on self-contained campuses, primary and secondary school children are interacting with intergenerational family members every night. Most families are not taking precautions such as social distancing or wearing face masks within the home, leaving open the opportunity for the virus to pass easily from an infected child to others in the household.

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Few school districts have the testing speed and capacity to catch infections as soon as they occur, especially among youth, who often show no symptoms of illness. It's not hard to imagine a situation where a six-year-old, having picked up the virus from a peer at school, nestles in with a beloved grandparent to read a bedtime story, unknowingly elevating the risk the grandparent becomes seriously ill.

At the same time, we should not write off the dangers to children themselves. While the CDC guidelines note that children remain underrepresented in the U.S. COVID-19 caseload - they account for just 7 percent of cases while comprising 22 percent of the overall population - cases among children rose steadily from March to July.

It is possible that lower incidence among children was a product of the measures most communities took in the spring to close schools and businesses. In fact, many states where schools are reopening are reporting more new daily cases now than they were in March when there was a wide consensus that keeping schools open presented too great a threat of community spread.

There is much we still do not know about the effects of this novel disease on children or the role children play in spreading the virus to others. Unfortunately, the pandemic requires that we learn as we go. The inauspicious first days of reopening K-12 schools should teach us a lesson. As much as we want our kids to be back in school, sending them to school should worry us - not only for their safety but also for what they are bringing home.

Dennis Clements is interim director of the Duke Global Health Institute at Duke University, where he is a professor of pediatrics, family medicine, and community health, and global health.

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