(CNN) — Many children are going back to school at a time when the number of coronavirus cases is high in most of the United States. Parents and caregivers have many questions about the precautions they should take for their children. Do they need to go back to wearing masks? How often should your children be examined? Should extracurricular activities be suspended? What happens if your children contract covid-19? How long should they stay out of school? And should families vaccinate their children if they haven’t already?
To guide us through this back-to-school refresher, we spoke with Dr. Leana Wen, CNN Medical Analyst, ER Physician, and Professor of Health Policy and Management at George Washington University’s Milken Institute School of Public Health. She is also the author of “Lifelines: A Doctor’s Journey in the Fight for Public Health” and a mother of two young children who will soon be going back to school.
CNN: The question that many parents and caregivers are asking is that of masks. Will you send your kids to school wearing masks?
Dr. Leana Wen: No, although I respect other parents and caregivers who are making a different decision than we are based on how they see the risk of covid-19 versus the downside of masks for their children.
Masks, especially those that fit well and are of high quality, can reduce the transmission of the new coronavirus. The US Centers for Disease Control and Prevention (CDC) recommends the use of masks indoors based on the covid-19 community level. I think it’s reasonable for parents and caregivers to follow the CDC guidelines and decide that if the level of covid-19 is high in their area, they will ask their children to wear masks inside the school. The use of masks will reduce the risk of their children contracting the coronavirus and is still advisable for families where avoiding covid-19 is a top priority, such as those with immunocompromised members at home.
I also think it’s reasonable for parents and caregivers to do a different calculation of risk. Children are already at low risk of serious illness from COVID-19. Vaccination further reduces that risk. Furthermore, the currently circulating variants are so contagious that it is quite difficult to avoid infection. Some families may decide that they no longer prioritize preventing infection and therefore choose not to ask their children to wear a mask to school.
That’s what my family decided. Our views have changed a lot since the beginning of the pandemic, when the impact of covid-19 on children was unknown. At that time, we took very strict precautions, such as wearing a mask at all times indoors and only interacting with other people outdoors. For us, the turning point was after the omicron variant became dominant, because it became even more difficult to avoid covid-19 despite precautions. Vaccinating our children also gave us more confidence that we could substitute the use of masks for the protection that vaccination provides. We know that our children could continue to get COVID-19, but the risk of serious illness is very low.
There is also the issue of the perceived cost of wearing masks for our children. Our children’s school does not require the use of masks and, based on our conversations with other families, very few parents will choose to have their children wear them. My almost 5-year-old son, who is starting kindergarten, has speech delays that have improved since his school made wearing masks optional in the spring. My 2-year-old son, who has just started preschool, does not wear his mask consistently. For us, the benefit of requiring our children to wear a mask does not outweigh the inconvenience at the moment. That could change if a more dangerous variant emerges in the future.
CNN: Are there circumstances where you would advise parents and caregivers to require their children to wear a mask at school?
Wen: It all comes down to how much the family wants to avoid getting sick from covid-19. Let’s say there’s a medically vulnerable household member who could get very sick if they contracted covid-19. It would make sense for all family members to be more careful not to infect that person.
Families could also decide to wear a mask before visiting vulnerable loved ones. For example, if an immunocompromised grandparent is coming to stay for a week, children can wear a mask to school the week before and during that visit. In addition, I would advise that children get rapid tests just before grandpa’s arrival, and that everyone, including adults, avoid closed gatherings for the week before and during the visit.
CNN: Speaking of tests, how often should families test their children?
Wen: Some schools may have a regular testing cadence or random testing protocol to assess the level of COVID-19 in their student body. Others may simply ask that children be tested if they are symptomatic or have a known exposure. Once again, the extent to which families want to test their children will depend on the degree to which they want to avoid the coronavirus. Many families view covid-19 like any other viral illness, while some remain very cautious in trying to avoid it for a number of reasons, including the unknown future risk of long covid.
CNN: Should parents and caregivers curb their children’s after-school activities or play dates?
Wen: Any decision must weigh the desire to avoid COVID-19 against the downside of taking children away from activities they would like. Taking into account our family’s calculation of risks, I am not holding back my children’s activities. My son plays soccer, which is sometimes done indoors. My daughter is in a music class with a lot of singing, which takes place mostly indoors. We go out to play, both outdoors and indoors.
By the way, this does not mean that my family does not follow any precautions. My husband and I wear masks at airports and on trains. We don’t take our kids to the aquarium or the science center when it’s overcrowded, with tons of people jammed together. We are not trying to get sick from covid-19, but we are not going to change our lives as we have done during most of the pandemic to try to avoid it. And we fully understand that other parents decide to be more cautious and continue with activities mainly outdoors.
CNN: What happens if children get COVID-19, how long should they stay out of school? What if someone in your family gets covid?
Wen: The CDC guidelines They say that people who get COVID-19 should self-isolate for five days and then can return to public settings with a well-fitting mask for the next five days. People exposed to COVID-19, if up to date on their vaccinations, do not need to be quarantined and can return to public settings as long as they wear a mask for 10 days, get tested after five days, and remain asymptomatic. That’s what our family will do if we get infected again.
Some schools have different protocols than this, so be sure to check with your school to make sure you’re following their rules.
CNN: Should families vaccinate their children if they haven’t already?
Wen: Yes. A recent large scale study, just published in The New England Journal of Medicine, found that during a time of dominance of the omicron variant, two doses of the Pfizer/BioNTech vaccine reduced hospitalizations by 83% among children ages 5 to 11. Vaccination also reduced infection by 65%. This and multiple other studies demonstrate how vaccination is crucial in reducing the likelihood of serious infections and symptomatic illness in children.
Both of my children were vaccinated as soon as they met the requirements. (My kids are under 5; kids 5 and older can get boosters, though most haven’t.) For me, the calculation came down to this. He knew that even without vaccinations, the chance of serious illness was very low. But if I can further reduce the chance of something bad happening, I’d like to do it. And now, with vaccination, I am comfortable with my children returning to normal pre-pandemic activities, even during a wave of covid-19.