What to know about COVID-19 as kids go back to school

Michael J. Fields, MD

Pediatric Pulmonology

Families are getting ready to begin their third school year affected by the pandemic. Because the situation has been changing rapidly, pediatric pulmonologist Michael J. Fields, MD, PhD, offered a quick guide for parents.

Does mask-wearing protect unvaccinated children from COVID-19?

According to the American Academy of Pediatrics (AAP), Centers for Disease Control and Prevention (CDC), and SC Department of Health and Environmental Control (DHEC), the use of masks among children aged two and older has been shown to be a safe and effective layer of protection against COVID-19. For unvaccinated children, masks are generally not needed outdoors, unless you are in a confined and crowded space (such as a football game). Indoors, masks are recommended to be worn.

Where should my child wear a mask?

The AAP, CDC, and DHEC recently released guidance for the upcoming school year, and they emphasized clearly that the goal is to prioritize in-person learning using all tools available to reduce the risk of spreading COVID-19. 

Mask usage in schools is recommended for everyone over the age of two years, regardless of vaccination status. For both vaccinated and unvaccinated children, it is recommended to wear a facemask in all indoor settings when social distancing cannot be maintained or if in a public setting with others whose vaccination status is unknown.

Who else should wear a mask?

The delta variant has been shown to be able to infect fully vaccinated people and, even if they have no symptoms, they can then spread it to others. Therefore, if you live with someone who is unvaccinated or at high risk for suffering severe effects of COVID-19, you should be practicing measures to reduce the risk of disease transmission. These steps include:

• Hand hygiene
• Social distancing
• Wearing a mask 

Everyone must assess their own level of risk and decide for themselves. For example, it is recommended you wear a mask in public indoor places (even after you are vaccinated) if you:

• Are a parent of young children
• Live with an elderly person
• Live with someone at high risk for suffering severe COVID-19 disease

This problem is not simple, and one answer or rule doesn’t fit every situation. In addition, as the situation has changed, the recommendations change. Priorities, such as going to work and school, dictate certain choices, while other activities are more flexible. You can leave your children at home with another adult when you go to the grocery store to reduce their exposure. You can get takeout from restaurants to reduce your exposure.

Just as we wear additional layers of clothing when the weather gets cold, we need to consider adding layers of protection when we engage in riskier behaviors. For example, if you are fully vaccinated, you do not need to wear a mask when walking your dog in your neighborhood. However, if you are attending a football game with thousands of other people in close quarters, mask usage is a recommended extra step to take in a situation with increased risk.

Are there reasons a child can’t wear a mask?

There are very few reasons. If a child is younger than two years old, then mask usage isn’t recommended. If a child has emotional, behavioral or developmental difficulties that are exacerbated by mask usage, then they should not wear a mask. Otherwise, mask usage is safe and strongly recommended for everyone.

What kind of mask is best for children?

The best mask for your child is the one they will keep in place. Features to look for include:

• At least two layers of washable, breathable fabric
• A design that completely covers the nose and mouth
• A design that fits snugly against the sides of their face without any gaps
• A nose wire that prevents air from leaking out of the top of the mask 

Features to avoid are masks with exhalation valves and those made of material that make it hard to breathe.

What else can a parent do to protect their children from getting COVID-19?

The most important step to protect your children is getting COVID-19 vaccinations for you and any other people 12 years and older living with your children. 

Other steps include:

• Having any child over the age of two years wear a mask in public settings  
• Limiting visits with unvaccinated individuals (for children under the age of two)
• Washing hands frequently
• Cleaning high touch surfaces in the home frequently

When out of your home, maintaining social distancing (at least 6 feet, but 3 feet at a minimum) and avoiding touching items should be combined with frequent hand hygiene to protect yourself and your family.

Do children get sick with COVID-19?

Yes. Most cases are mild or show no symptoms, but there have been severe cases and deaths in children. 

Children under the age of one year or with certain underlying medical conditions are at risk for having more severe COVID-19 disease. These medical conditions include:

• Obesity
• Diabetes
• Asthma
• Chronic lung disease
• Genetic/neurologic/metabolic conditions
• Sickle cell disease
• Heart disease since birth
• Immunosuppression
• Medical complexity

Typical symptoms of COVID-19 include:

• Fever
• Cough
• Nasal congestion
• Sore throat
• Loss of taste or smell

Other symptoms that have been observed include:

• Shortness of breath
• Fatigue
• Headaches
• Nausea and vomiting

Monitoring your children for changes in their status is appropriate and if there are concerns, contact your child’s pediatrician or bring them to the emergency department.

If you, your child, or anyone in your home is sick with COVID-19 symptoms, you should remain home and keep children home from school or daycare until directed to return by your pediatrician. It is also a good idea to keep track of who has been in close contact with your child in case your child becomes sick, you can then notify others. This will break the chain of transmission.

What is MIS-C (Multisystem Inflammatory Syndrome in Children)?

MIS-C is a condition that causes inflammation in different parts of the body, including the heart, lungs, kidneys, brain, skin, eyes and gastrointestinal organs. It usually occurs 2–3 weeks after a COVID-19 exposure or illness. Many of the children with MIS-C did NOT have any symptoms of an active COVID-19 infection. 

Symptoms of MIS-C include fever and ANY of the following symptoms:

• Abdominal pain
• Bloodshot eyes
• Chest tightness
• Diarrhea
• Fatigue
• Headache
• Low blood pressure
• Neck pain
• Rash
• Vomiting 

All children have different symptoms. Blood tests and imaging studies are used in the diagnosis of MIS-C and patients are treated with multiple medications, frequently requiring care in the intensive care unit. If your child has MIS-C symptoms, contact your pediatrician or bring your child to the emergency department.

Who can receive a COVID-19 vaccine and where can I get one?

All individuals 12 years and up are eligible for a vaccine. Vaccinations are free and available through the health department, local hospitals and many commercial pharmacies.

Can children under 12 receive a vaccine?

At this time, no children under 12 years old can receive a COVID-19 vaccine. The trials are underway, and we are expecting vaccine to be available to children 6–11 years old later this year.  Trials are also underway for children between 6 months and 5 years of age, but we do not expect vaccine for this age group for several more months.