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Dr. Bryan Johnston, a family physician working on the North Side of Milwaukee, returns again to offer advice for students and families for the approaching, unprecedented school year.
The pandemic doesn’t care about the school year
The COVID-19 pandemic shows no signs of abatement as the school year approaches. Left with imperfect options and impossible decisions, what can we as families and communities do?
I’ve had many conversations with patients and colleagues about how to approach starting the school year in a pandemic. Inspired by these conversations, here is what I would like my patients to know.
What do we know about the benefits of in-person schooling?
Data from spring school closures shows that students lost out on learning when schools went remote. This gap was most apparent for students of low socioeconomic status, Latinx and Black students, students with disabilities and younger students. It is estimated that the “achievement gap” widened with schools going remote in the spring.
Learning is far from all that is missed. School is an important aspect of childhood nutrition in our society, furnishing millions of needed calories daily and taking financial burden off of families. Social development is hard to replicate remotely, especially for younger students.
The increased family burdens, normally shouldered by in-person school, also include the following: increased childcare burden, more intensive need for homework and other learning assistance, technical support and lack of healthy breathing room within the family unit.
As a grim reflection of this increased burden, abuse rates have risen with more concentrated time at home.
What about the risks?
A major risk is spreading infection, of course — to and from children, families, other contacts and the community at large.
Perhaps because children generally do not get as sick as adults, there is some sense that children are immune to COVID-19. This unfortunately does not appear true.
In the last two weeks of July, nearly 100,000 American children tested positive for COVID-19. While it is true that a young child becoming very ill or dying from COVID-19 is rare, around 600 children have been reported to develop a severe inflammatory syndrome.
We also are learning that when infected, children have similar viral loads to adults, indicating they are quite capable of infecting others. Whenever schools go in-person, we can expect increased transmission within schools and the community.
Milwaukee Public Schools will be starting remotely with a staged reopening approach based on infection control metrics.
Adopting a harm reduction mindset
In the setting of unavoidable risk, a harm reduction mindset can be helpful. As a family physician, I often use a harm reduction approach in working with my patients on their health goals.
A harm reduction approach to managing diabetes mellitus says, “We acknowledge that you may occasionally decide to have a slice of cake. Let’s make plans to minimize the harm from this.”
A harm reduction approach to negotiating a pandemic says, “What are the risks of an activity or exposure, and how can we minimize them? What are the benefits and how can we maximize them? Am I comfortable that the benefits outweigh the risks?”
Harm reduction in action
The approaching school year demands many new decisions from families. Some districts are asking parents to choose whether and when their child will attend in person, whether to participate in sports teams and after-school or weekend programs.
This is in addition to the many family-level decisions and approaches to home learning, homework, out-of-school contact with classmates and other family members—especially those in high-risk groups—and many other areas.
As the pandemic looms over our decisions in the coming months or years, one constant to bank on is that families will be confronted over and over with new decisions.
When approaching a new and complex COVID-19-related opportunity or decision, I find it helpful to write things down.
Here is a method I’ve used with my own family that might help illustrate what I mean:
- Start by listing risks and benefits.
- Write down aspects of risk that especially concern you, areas where the benefits are especially strong, and opportunities to reduce risk of harm for your family.
- Keep in mind which types of activities are especially risky. I like this chart from the Texas Medical Association to ground my thinking about risk.
- If you are considering a recurrent interaction between your household and others, such as places of worship, schools, sports teams, places of work or other organizations or households, write down the different places that may be interacting. Think about the intersections between those places, how risk might be especially concerning and ways it may be reduced.
- Consider: Do I feel comfortable with my plan? Do the benefits outweigh the risk? Discuss this with your family, including children if feasible.
Here is an example of what I came up with for my family as we consider returning my daughter to daycare (pardon the poor handwriting):
At the end of this exercise, I see some opportunities to reduce risk, and some areas of potential harm to others that I hadn’t been thinking about. Overall, I feel more empowered as a parent to approach this decision and find myself feeling more comfortable with her return.
National failure to control the pandemic, and in some cases prioritization of the right to disregard public health guidance, has placed impossible decisions in front of the families in our community. As we move together through this murky period of risk, let us work to prioritize reducing harm incurred by our families and young people.
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