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Healthy Balance

Back-to-School for High-Risk Kids: COVID Delta Edition

Conor in mask on first day of school

With vaccines against COVID-19 widely available, Julia Martin was hopeful her second grader wouldn’t need to wear a mask at school this year. But then came the delta variant.

Like most parents, the coronavirus pandemic has made Julia both wary and excited about Conor going back to school. But she has an added worry: Conor had a liver transplant. Every day, he takes medication to suppress his immune system. This medication keeps his body from rejecting a donor liver he received at UVA Children’s. But it also means his immune system can’t fight off infection as well.

Filled with kids too young to get vaccinated, Conor's second-grade classroom could be a danger zone for him. “I didn’t think I’d be doing this again,” Julia says. Before school started, she stocked up on masks. She's hoping they'll keep her child safe. But are masks enough?

Mask Up Indoors or Consider Virtual School

Monica Lawrence, MD, has been fielding lots of school-related questions from worried parents. As a UVA Children’s immunologist, she specializes in caring for children with a primary immune deficiency.

Her advice for parents? “Have your child stay virtual if your child’s school is not doing distancing, keeping kids in small groups, and encouraging indoor masking,” Lawrence says. "Now is not the time to be risking it."

Lawrence has expert advice for every parent with a child in school – and especially those with a child at a higher risk for developing a severe case of COVID. This includes children with obesity, cancer, a congenital heart defect, or like Conor, an organ transplant.

Why Worry?

You might understand the fears of a mother with an immunocompromised child. But even if your kid isn't high risk, you should keep them safe from COVID.

Lawrence explains that, to her, “The scary thing is a lot of kids are getting hospitalized, and they don’t have any risk factors. So this is advice I’m giving to parents of immune-compromised kids but also to parents of a non-immune-compromised kid. Some kids are getting very, very sick and have zero risk factors, so the best protection is not to get COVID.”

2 in 100 Children with COVID Hospitalized

Her advice comes on the heels of disturbing trends: The number of children getting COVID has been increasing exponentially over the summer. Lawrence is especially concerned about data that shows 2 out of 100 children who get COVID end up hospitalized. (This is based on early August statistics covering 23 states.)

“If we fill the hospitals with COVID patients, how are we going to handle the car accidents, or the flu and RSV illnesses, which typically come in the fall?” Lawrence says. “I know there is a lot of fatigue among parents and kids about dealing with this pandemic. But there’s also fatigue on hospital workers and respiratory therapists. Some of them are leaving their jobs and cutting back on hours, creating shortages nationwide.”

Seven Things Parents Need to Do to Protect Their Child

  1. Get vaccinated. “The single most important thing you can do for your and your family’s health is to get a vaccine when you’re eligible,” Lawrence says. (For now, this means those ages 12 and older.) And for those who have a moderate to severe immune deficiency, “I’m telling them to prioritize a COVID booster,” she adds.
  2. Mask indoors. “Think long and hard about keeping a child in a school that has a mask-optional policy when indoors,” Lawrence says. She applauds Virginia for requiring all students, teachers, and staff in K-12 schools to wear masks indoors this fall. Even children ages 2 to 5 are tolerating masks better than people predicted, she notes.
  3. Wash up. Encourage frequent hand washing and sanitizing.
  4. Take good tests. Take advantage of PCR COVID testing. It detects COVID better than at-home test kits, which can give a false result.
  5. Take sick days. Keep your child home if they develop a fever, cough, or other sign of illness.
  6. Plan. Have a plan in case a COVID outbreak leads to at-home schooling.
  7. Skip indoor sports. “They're high risk and you can’t maintain distancing,” Lawrence says. While she felt comfortable having her 5- and 8-year-old children play outdoor soccer over the summer, she’s not sending them back to gymnastics this year.

What Your Child’s School Needs to Do

Lawrence says schools should:

Special Precautions for a Child with Cancer

Michael E. Engel, MD, PhD, leads the pediatric cancer division at UVA Children’s. He explains, "Immune system recovery after cancer chemotherapy can take many months or even longer in some situations. So families should continue to be vigilant with regard to masking in indoor spaces, hand washing, and distancing.”

For kids receiving immune-suppressive therapy, COVID symptoms can show up as a fever only. “Families should always contact their oncologist if their child develops a fever or has any other symptoms or signs that concern them. It is never wrong to call, day or night,” Engel stresses.

Every child who is receiving chemotherapy (and every member of their family who is eligible) should receive the COVID vaccine. Engel notes, “For kids with cancer, the response to the vaccine might not be as robust and the symptoms of infection can be more subtle than in kids with normal immune systems. This could have significant consequences, such as missed recognition of illness, impaired clearance of virus, and increased transmissibility to others.”

Some children with cancer, he cautions, are allergic to polyethylene glycol. This is found in some COVID vaccine formulations. “So it’s important for these families to contact their doctors to make sure they get the right vaccine formulation for them.”

Who Needs a COVID Vaccine Booster?

A third shot is available at UVA for people who are significantly immunocompromised. "This is not a huge group of patients, but an important one because they are at greater risk for breakthrough cases, and we think a third dose will be effective to keep them healthy," says Patrick Jackson, MD, an infectious disease expert. A booster is available for those who:

Discuss with your primary care doctor or specialist whether you would benefit from a third vaccine. Learn more about boosters.

Cancer & Coronavirus

Want more answers on how the COVID pandemic is affecting families facing cancer?

Keeping Conor Safe

Last year, Conor was able to attend school in-person all year long. He goes to a small Pennsylvania private school, which took lots of steps to keep him and other students safe from COVID. They updated air-filter systems. They replaced water fountains with water-bottle filling stations. During lunch, he and his classmates stayed at their desks. Conor’s mask only came off during outside recess. Conor sat in the back corner of the room.

Julia credits Conor’s school directors, teachers, and fellow students for having awareness about his added vulnerability if he gets COVID.

“Probably, one of the most important things is open communication with the teachers,” Julia says. “It’s so important that the teachers are aware of what COVID means for an immune-compromised child and what impact that has on them if they become ill. I know our teachers are very thoughtful about that … Conor is going to have one-on-one learning for some of his classes. So academically and medically, that will be really good for him. And thankfully, we have that opportunity.”

Wearing a mask is hard for Conor, his mom shares. His glasses often fog up. He gets distracted a lot because he has to pull up his mask. She worries that constant mask-wearing might make school even harder for Conor, who also has dyslexia. (This learning disorder affects how language is processed and makes reading and writing more challenging.)

Make Mask Wearing More Fun

To make wearing a mask less of a burden on her son, Julia bought fun face coverings. Last year, she bought masks with pictures of sharks, fish, monkeys, and basketballs. This year, she ordered a large box of masks with colorful stars. She aims to use these to keep her preschool daughter covered, too.

Heading into the 2021-22 school year with the delta variant spreading brings challenges. But Julia remains hopeful: “It has to be better than it was last year for everyone. I’m just grateful they can go to school in person. I think it’s so important.”

Lawrence shares the same hopes that her kindergartener can stay in school and her 4th grader won’t have to return to online learning.

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