COVID-19, School & Teens
Many pandemic discussions have focused on whether virtual or in-person learning is better for younger children, but the choice is perhaps even more important for teenagers. Although we have limited data on pediatric COVID-19, some reports indicate that adolescent patients may be at higher risk of transmitting the disease, and have worse outcomes compared to elementary-school aged children. However, teenagers are also more capable of adhering to guidelines which will decrease their risk. So, which is a better choice?
For a more general in-depth discussion on school decisions during the COVID-19 pandemic, please see this article.
Brief Summary
As discussed in my previous article, the return-to-school decision must be based on multiple factors, including local infection rates, testing capacity and turn-around, individual/family risk factors and student needs. It also needs to be reassessed frequently.
Take your teenagers personality into account when you make the decision: How do they do with virtual learning? Do they have a specific need to be at school in person? Will they follow the distancing and masking guidelines?
Prioritize your teenager’s social life and check in with them frequently about how they are feeling, making sure they have ample support.
Children overwhelmingly have a good prognosis when infected with COVID-19.
Teenagers and chronically ill children have a higher rate of hospitalization and severe illness compared to toddlers and pre-adolescents.
Young children infected with COVID-19 can transmit to others, although this is comparatively infrequent. Teenagers, however, have a higher rate of transmission.
“Quaranteam” pods are increasingly popular and have distinct advantages.
Resilience and perspective are key. Children are far more adaptable than we believe.
This Is Really, Really Hard On Our Teenagers
Our teenagers have lost out on time with close friends, summer opportunities, and sporting events as a result of COVID-19. These are formative and memorable experiences and it is understandably disappointing to miss out on them. Any conversation about the upcoming school year requires acknowledgement of these losses, and a solid dose of empathy. It also requires an honest assessment of your teen’s optimal academic setting.
Compared to younger children, teenagers can succeed with virtual learning, both because they are more adept at using the technology and because more of their learning requires self-directed/individual study. However, without the benefit of ongoing in-person evaluation from their teachers, some teenagers may struggle to maintain focus and motivation. If your child struggled with the transition to virtual learning at the end of their last school year, you may be able to optimize their virtual learning environment in simple ways, such as setting up a home office or developing a structured routine. Your teenager likely has a good sense of what they need to thrive academically, and if you are still considering which option to choose in the fall, they will appreciate being involved in this tremendous decision.
Much of the non-academic work of adolescence involves developing social connections, empathy, and a sense of identity. Maintaining your teenager’s social life is (and should be) a priority, regardless of which learning route you choose. For teenagers who elect to stay home, I have real concerns about an increased perception of isolation.
You likely remember the changing emotions, mood swings, hormones, and angst of those teen years. Mental health concerns come up frequently during adolescent physicals; it is not unusual for our teen patients to hide much of their emotional turmoil from their parents, and choose to confide in friends and sometimes other adults in their lives (school counselors, coaches, etc). The loss of this extra monitoring from their communities may allow mood disorders to snowball out of control before we can help.
As a parent, you can help by checking in with your teenager frequently and ensuring that they maintain social connection as much as possible. Social media gets a bad rep culturally, and while it certainly has its dangers and should be monitored, it can also be mobilized effectively to help maintain social relationships in the era of COVID-19 (a topic for a future post!)
Lets Talk About Risk, Baby
You already know that the elderly adults with comorbidities are at highest risk for poor outcomes from COVID-19. Unfortunately, pediatric-specific information remains limited. A recent systematic review published by the Lancet found that the vast majority of children infected with COVID-19 have an excellent prognosis; approximately 3% required ICU admission, and almost all of these patients had serious underlying respiratory or cardiac disease, or other chronic health conditions leading to immunosuppression, such as leukemia. Fewer than 1% of these patients met CDC criteria for Multisystem Inflammatory Syndrome in Children (MIS-C). These data are for children of all ages, and are consistent with data from multiple other countries.
Teenagers Are Unique (In So Many Ways!)
Should teenagers be considered a separate group from pre-pubertal children? In short, yes. There are two considerations here: whether teens infect others around them, and how they fare if they contract COVID-19. In an ideal world, we would already have results from well-planned randomized controlled trials in every age group. But this is a novel virus, and we continue to learn more every week. For now, we must make decisions based on the information we have and be willing to pivot and change our approach as we learn more.
Unfortunately, most of the available literature does not stratify risk in children based on age. With that said, a recently released contact-tracing study from South Korea provides some limited aged-based data. This study identified the first member of a household to be infected, and then traced their contacts to see how effectively they transmitted COVID-19. While very few younger children are included overall, the results are interesting. When a child under the age of 10 years old was the index case, only about 5% of their close contacts subsequently tested positive. For children aged 10-19 years old, however, almost 20% of their contacts tested positive for COVID-19. Keep in mind, because children are more likely to have minimal or no symptoms, they are also less likely to be tested. In a community with high prevalence of COVID-19, it must be assumed that the rates amongst children of all ages will be higher as well. These minimally symptomatic, yet contagious students may well put their peers, family members, and teachers at higher risk.
On the second point: An upcoming article in Pediatrics* reviewed patient demographics, hospital course and severity at a hospital in NY and found that of the children who were sick enough with COVID-19 to be admitted to the pediatric unit, 48% were over 12 years old, and only 11% were aged 5-12 years. Interestingly, infants over 2 months old and immunocompromised children actually had a milder course compared to neonates, adolescents, or those with chronic illnesses. Again, there are several limitations to this study, including a small patient cohort, but these data are consistent with case reports and discussions amongst pediatricians across the country, all of which suggest that adolescents are more likely to be hospitalized/have a severe course of illness compared to the elementary-school aged cohort.
*Kainth MK, Goenka PK, Williamson KA, et al. Early experience of COVID-19 in a US children’s hospital. Pediatrics. 2020; doi: 10.1542/peds.2020-003186
Know Your Teen
Theoretically, adolescents should be able to appropriately follow social distancing guidelines more effectively than their younger counterparts, which would minimize their risk of spreading or catching COVID-19. If your teen strongly prefers going back to a regular or hybrid school program, and you are inclined to agree, please consider, realistically, how likely they and their peers are to wear masks and limit close contact with friends. Wearing a mask all day is uncomfortable, but not impossible. Practice wearing the mask for longer periods this summer. Recognize your own child’s susceptibility to peer pressure and have a frank discussion with them about the risks of COVID-19 to themselves and those around them. This is a great opportunity to encourage our teenagers to develop empathy and a community-centered perspective.
“Quaranteams”
Within the past few weeks, there has been a move towards trying to create “quaranteam” pods with tutors to allow for smaller-group learning. Not everyone will be fortunate enough to have the resources to choose this approach, nor is it the right choice for every student. In-person resources should be directed to those with the highest need. But if a proportion of the population elects to choose these pods, it may help everyone; by decreasing the population density within a class, it decreases the risk to the teachers and students who are present within the classroom. A pod can also provide the opportunity for adolescents to maintain some social connections while limiting risk to the broader family. In either case, I recommend finding opportunities where possible for your teenagers to stay active and socialize in lower risk settings, such as outdoors.
Final Thoughts
As a parent we often feel that every decision we make may have life-altering consequences for our children, and we fret about making The Right Decision. The truth is that most people, and especially children, are often more resilient than we believe. If we acknowledge how frustrating and disappointing these adjustments are, but approach this situation constructively, we hopefully teach our children an invaluable life skill: set-backs and change are an inevitable part of life, and are able to be overcome with some creativity and a positive attitude.
If you are considering putting together a quaranteam pod, check back in a few days for an upcoming post on risk assessments and rules you should consider implementing for your team members.