Back to school - how not to get COVID from your child...
July 22, 2020 12:31 PM   Subscribe

Our Canadian province has revealed that kids are going back to full-time, in-classroom school in the fall. Details are scarce but it seems there will be no small cohorting. Masks will not be mandatory. Meanwhile our local cases are on the rise again. What are the things I can do so that my ultimate nightmare does not come true - that the two kids and two adults in the house get COVID all at the same time? My child will be a 5th grader. In a class of probably 28. We also have a toddler.

If anyone has been through this, please help. If you have ideas, please help. I don't have any plans to home school my daughter. I love her dearly but she doesn't respect my teacherly authority. She also has learning challenges. It's too stressful for us. And I want/need to keep bringing in income by working. So I don't need advice there.

So far everything has been ok with me working at home, my husband working outdoors, my 9-year-old at home with me and my toddler in a small dayhome. So that's the current situation.

What I do need is advice and a plan for how to implement practices and organize the house so that if my fifth grader *does* get COVID at school, we don't all get it. I need risk mitigation strategies. Sorry is this is scattered, I'm just a teeny bit panicky here. I'm a fixer who doesn't know how to fix this. So ideas and questions below:

- We are lucky to have a 2 storey, 4-bedroom house, 2-bathroom with a habitable but gross basement.
- It will get cold starting end of October. Windows won't be open much in the house from that point on and there won't be a whole lot of playing outside.
- In my city we can get tested for free as often as we want, although I'm expecting demand to cripple that system in the fall

Ideas and questions:
- morning and evening temp checks for everyone
- wash hands frequently ( I could set a timer for every hour)
- hand sanitizer and signs inside the front door reminding us to proceed immediately to the washroom to wash hands
- label things so there is no accidental sharing of anything that goes in mouths (toothbrushes, water glasses etc.)
- no eating children's leftovers after meals
- no accidentally kissing child on mouth - are cheek kisses ok??
- no sleeping with kids if at all possible
- Everyone gets their own hand towel for bathroom and kitchen? Or just use paper towels?

- Should I expect 5th grader kitcat to wear a mask at school all day? Will she even comply (she's going through puberty, she's not super acquiescent by nature either)? Won't it give her a headache? Should I have her wear a face shield? They won't be able to distance well with 30 kids in her class.
- What else can I do? What am I not thinking of? Would it be ridiculous for us to all wear masks if we're watching tv on the couch?
- What can I buy to go into a "in case we all get COVID" medical kit?

I hope I don't sound crazy. I just can't fathom a situation where we all get sick. What if my husband and I both got so sick we couldn't take care of the kids? What if we were both hospitalized? Permanently disabled? The best thing I can do to manage my anxiety is to have a good plan in place. Thank you.
posted by kitcat to Health & Fitness (13 answers total) 5 users marked this as a favorite
Ideas and questions:
- morning and evening temp checks for everyone - unlikely to help. Transmission happens before symptoms.
- wash hands frequently ( I could set a timer for every hour) unlikely to help. Transmission is mostly airborne.
- hand sanitizer and signs inside the front door reminding us to proceed immediately to the washroom to wash hands unlikely to help. Transmission is mostly airborne.
- label things so there is no accidental sharing of anything that goes in mouths (toothbrushes, water glasses etc.) Unlikely to help. Transmission is mostly airborne.
- no eating children's leftovers after meals Unlikely to help. Food is particularly unlikely to transmit the virus.
- no accidentally kissing child on mouth - are cheek kisses ok?? Unlikely to help, but probably justified. Cheeks of course are okay. Transmission is mostly airborne.
- no sleeping with kids if at all possible Sure
- Everyone gets their own hand towel for bathroom and kitchen? Or just use paper towels? Unlikely to help. Transmission is mostly airborne.

I would look at air purifiers, masks in the house, etc. Best case everyone wears a n95 mask, but make sure you research how to properly seal it. It's hard enough that many doctors struggle with it.

But also, I wouldn't worry too much until there's reports of it being spread at your school.
posted by bbqturtle at 12:53 PM on July 22, 2020 [5 favorites]

I think it is interesting that often when one parents gets COVID, the other one will but the children won't. So, just having it doesn't mean everyone gets it. Also, kids tend to be less likely to get it and less likely to transmit than adults. (Doesn't mean it won't happen, just less likely)

I think morning and evening temperature checks are a good idea. You want to know if someone is sick asap so you can escalate the protection for others. The higher the viral load, the easier it is pass along to someone else and the more someone is exposed to another person, the greater the chances if getting it. So, you want to spring into a higher level of action as soon as you have a sign that it might be necessary.

Airborne transmission includes water droplets. So sharing spit is going to be a problem (separate toothbrushes, drinking glasses, no wet kisses) I would also insist on a good hand washing whenever someone returns to the house as well as before meal and after the bathroom (which probably gets you to every 2 hours anyway)

If she does get sick, plan on how to minimize contact between her and rest of the family. Have her stay in her own room and be the only to use "her" bathroom. This is the time to wear masks at home. It may be too late but it worth doing what you can.
posted by metahawk at 1:12 PM on July 22, 2020 [2 favorites]

HEPA filters for every room at home is about all you can do, short of isolating your child from the rest of you. I wish there were other options, but none of them seem to be practical.
posted by mcgsa at 1:41 PM on July 22, 2020

I’d have her wear a mask to school. My sense is that kids will do a lot better with this than we are expecting and in some ways may take to it more easily than adults.

What has helped me get to that opinion is that I now know of several families who’ve had their kids in care/school and they’ve all reported that all-day mask wearing has been a pretty easy transition. These are kids ages 2 to 11 so a pretty wide range.

You may want to start buying different styles of masks now so that you can find the one that is most comfortable for her. Then buy a bunch of them because she’ll want a fresh one every day, plus many will inevitably get lost.
posted by scantee at 2:04 PM on July 22, 2020 [1 favorite]

Unfortunately, kids "between the ages of 10 and 19 can spread the virus at least as well as adults do," a big study this week seemed to indicate, and we've known for a while about asymptomatic transmission; the study found people are more likely to contract COVID-19 at home. I think you should focus on sourcing masks that are comfortable for the whole family.

If your child does get sick from attending school, I think you'd want to give her sole use of one of the bathrooms -- if it's attached to your bedroom, as part of an owner's suite, that might be ideal for "isolating" her (you'd still check on your daughter regularly, while masked and gloved -- she just wouldn't be wandering the house increasing the odds of infecting the rest of the family). Otherwise, trying to disinfect after each pit stop will wear you down. I hope someone can link a single-purchase, fully-stocked kit for this situation, but remember to stock Pedialyte (liquid, and ice) and some non-perishable (ready to eat/easy to prepare) foods, too. A couple of months ago I saw recommendations to keep a pulse oximeter in the house, if possible.
posted by Iris Gambol at 2:06 PM on July 22, 2020 [6 favorites]

For what you should have in the house in case you do get sick, I think painkillers, soup, drinks you like, easy to make food. If it happens, let your local network know that you're self-isolating or sick, check in with someone regularly, and accept help that's offered as long as it doesn't break quarantine.
posted by plonkee at 2:15 PM on July 22, 2020 [1 favorite]

Once school starts again, I think you should all be masking at home. I know that sounds crazy. However, that’s what I’m seeing recommended by one of the epidemiologists I follow on Twitter (Abraar Karan of Harvard, now working on COVID response at Mass adept of Public Health).
posted by eirias at 2:46 PM on July 22, 2020 [4 favorites]

What some of my friends are doing is delaying their children’s return to school by between 2 and 4 weeks assuming that either A) the whole thing will be a disaster and called off or B) people will have a sense of what works and what doesn’t by then.

It’s a little selfish to let other people be the guinea pigs, but speaking as a high-risk candidate I’m glad they’re doing what they can to stop the spreading.
posted by Tell Me No Lies at 3:03 PM on July 22, 2020 [7 favorites]

Best answer: First thing to do is look at your province and local COVID-19 stats. If they are low and decreasing, or even low and pretty steady then I personally would be a lot happier with sending elementary-age kids back to school--and maybe even middle & high-school students.

(And that is speaking as someone how just went ballistic on my own local school district about their plan. But that is in an area where we have just surpassed the previous high number of cases and the curve is rising fast. And the district's entire plan amounted to "everyone wear masks and proceed as normal.")

My suggestions:

#1. I would definitely reach out to the school officials and put some pressure on them to do better. Science summary of lessons learned from schools around the world here. Simple things they could do:

- Require masks for everyone, all the time. This is a very common requirement now in schools around the world. It's so simple, inexpensive, and makes a big difference. Even if not all the time, maybe all the time except sitting at your own desk in class. Or for all teachers all the time, even if not all students.

- Phase in re-opening, with Elementaries first, then Middle, then High Schools, and/or half students on alternating days. If testing shows Phase I leads to no additional outbreaks after say 4 weeks, then ramp it up gradually. We've seen so many regions of the world botch up reopening by moving too fast. Take it step by step.

- Regular testing of students and staff. Like daily or at least 2X per week. They can either do random testing or "pooled" testing, where (say) 100 samples are all put together and tested. It's a simple and inexpensive way of telling if there are *any* cases at a school--which is what they need to know. We absolutely should not be reopening large group spaces of any kind without regular testing.

- Symptom check for all students daily. More than half of the infectious period is before symptoms show, but almost half is afterwards. It's well worth catching that 40% or whatever it is.

- Plans to keep students in set cohorts all day long and not mix them with hundreds to thousands of other students. Kids stay in one place and different teachers, lunch, etc come to them. Recess with only that class.

- Improved ventilation and (especially) greatly increased percentage of fresh air in the ventilation system. A HEPA air filter in every classroom isn't a bad idea, either.

#2. At home, you have good suggestions above. I won't reiterate in detail, but HEPA filters and improved ventilation with greater percentage of fresh air intake are most important. This could be as simple as cracking a window or two (selected ones, just a little, even in winter). Symptom checks daily, including temperature but also all others. Discovery of symptoms as soon as possible and prompt action will reduce family exposure a lot, though not entirely. I would personally step up handwashing just because it helps with so many things, and also a tiny little bit with COVID. And most important I would strongly consider having kid wear a mask to school.

- This needn't be permanent. How about doing it for the first 4 weeks and if that goes well with no great increase in CV-19 in your area then you relax it.

- Or as one step down from full-time mask, wear the mask from home to classroom and whenever outside the class. But student can take it off in own classroom while at own desk. This minimizes exposure while also being far more manageable.

#3. Elementary students do have by far lower transmission rates than other age groups, and also less serious cases when they do get it. So even Paranoid Flug thinks the balance tilts towards opening elementary-age schools, with reasonable precautions, when your area has a low and stable number of cases.

#4. To reduce your anxiety (or perhaps not!) about sending kid to school, and/or to help light a fire under your local school officials, it can be enlightening to use province-level or local COVID rates to figure out how likely it is you may have someone in the school or in a given classroom who is COVID positive.

Calculation looks like this (using Province of Ontario stats--adjust as necessary for your own province or local region):

- Current data for Ontario: 38,107 Total cases; 33,812 Resolved; 2,755 dead

- So that leaves 1540 currently active cases (38107 - 33812 - 2755 = 1540)

- Ontario population is 15.6 million.

- That means one case per for every 9460 people (15.6 million / 1540)

- In an Elementary school with 500 people, on average there will be 0.05 cases. Or to put it another way, there will be on average, about a COVID-19 case in about 1 of every 19 Elementary schools. (Calculation is 15.6 million / 1540 * 500 = 0.053)

- About one of every 315 classrooms (30 students) will have an active COVID case. (Calculation: 15.6 million / 1540 * 30 = 0.0032 or roughly 1/315)

Now that is according to the count of tested-positive cases. The bad news is, from everything we know there are 10-20 actual COVID-19 cases out there for every one positive test result. Good news, partially counteracting that: kids 10 and under are about 40% less likely to get or transmit the disease.

Taking those two factors into account in the most optimistic possible way (actual cases 10X tested cases, 40% reduction in transmission by age 10 & under) we get 1 of 53 classrooms in Ontario has an active infection, and 1 of 3 elementary schools.

By the way, taking this to Middle & High Schools gives a slightly different result. Students in these age groups are actually 40% **more** likely to spread COVID. Also the schools are bigger. In an average Ontario high school with 1500 students and average class size of 30, you've got an active infection in one of every 23 classrooms and 2.2 infected people in each high school, on average at any given time.

If it makes you feel better, the calculation for my own local school district looks multiple times worse than this. We're guaranteed to have nearly 500 active COVID-19 cases among our District's students and staff right now. 71 active cases in the High School. One infected person in every classroom of 20. In short, you have to do your planning around the fact that every school and every classroom will have one or more active COVID-19 carriers on any given day. Keep in mind that many infectious people never show symptoms and for those that do, more than half of their infectious period happens before they show any symptoms.

That was a lengthy arithmetic exercise, but in my mind it makes thinking about the problem much more concrete.

It is one thing think, well there might be COVID cases out there, but not in our area or at our school, most likely. What should I do about this vague and unlikely threat?

Versus: There are going to be, on average, two active COVID cases (or 71, as the case may be) in my school every week this year.

What exactly am I going to do to ensure this actual threat does not spread to the other students, staff, and families at home?
posted by flug at 3:38 PM on July 22, 2020 [26 favorites]

Response by poster: Everyone has great answers.

Wow flug. All that work. Flagged as fantastic! I'll be thinking of you when school starts. 2 active cases in your school *every week*? How will the classes not just be shutting down constantly? Wow.
posted by kitcat at 3:46 PM on July 22, 2020 [1 favorite]

I am in the same province, and I'm also stressed out and concerned about elementary age kids returning to school. We are working on making mask wearing a comfortable and routine part of the day. The whole family is trying different styles and materials so that if we need to, we can be ok with wearing them even at home. At least it's something we can do to feel a little bit in control.
If the number of active cases keeps rising the way it currently is, I can't help but wonder if schools will be closed again before the end of October. Which doesn't help you with regard to your daughter's learning but does help with infection anxiety at least?
posted by bluebelle at 7:38 PM on July 22, 2020 [1 favorite]

#3. Elementary students do have by far lower transmission rates than other age groups, and also less serious cases when they do get it. So even Paranoid Flug thinks the balance tilts towards opening elementary-age schools, with reasonable precautions, when your area has a low and stable number of cases.

Despite an overall fantastic comment, I would like to point out that this particular study isn't very strong evidence to support that conclusion, for two reasons:

1) While the age 0-9 group had a lower transmission rate than the overall average across all age groups (5.3% vs. 11.8% for household contacts), the # of cases and contacts traced for that age group were far, far lower than all other age groups (due to schools etc being closed) - it's the average from literally 29 infected young kids, some of whom were infants who likely weren't wandering around socializing.

By comparison, some of the adult age groups included more than 10,000 contacts traced from more than 1,000 infected people. This means that the differences observed in the tiny sample size for age 0-9 may be simple variability rather than the true average in the real world. You can see this reflected in the 95% confidence interval for age 0-9 (in essence, the range that we're 95% sure the "real" transmission rate falls within), which ranges from 1.3 to 13.7%.

Also, in the same study, ages 10-19 - which would include a few elementary students - had a far higher transmission rate, 18.6%, with a 95% CI of 14-24%. It seems unlikely that a nine year old has an usually low chance of transmitting the virus while a ten year old has an unusually high chance. I would guess much of this difference from the overall average is just noise (in both directions, but particularly in the younger group due to the much lower sample size), but even if a true difference does exist, it's hard to say at what age(s) the risk shifts, when all the kids are lumped into just 2 age groups.

2) This study was done in South Korea at peak lockdown, when schools were closed, and it's easy to imagine how transmission in a Canadian school might be very different from transmission in a country where mask-wearing is common, at a time when everyone was being super-cautious and the few contacts are likely from playing outdoors together in very small groups.

I am not sure if there are other studies out there to support an evidence-based conclusion about whether transmission rates are different for kids, but did want to point out these limitations of that particular study.
posted by randomnity at 8:09 PM on July 22, 2020 [5 favorites]

I think flug has it right here. Watch out for local transmission rates, advise your children to take sensible precautions regarding social distancing, check what your school is doing and engage with them on things that cause you concern.

Unless you're extremely clinically vulnerable, masking everyone at home seems excessive. Take reasonable common sense precautions and get tested if you have any symptoms. There are potential negative mental health and wellbeing consequences from excessive social distancing and PPE usage in the family home that you should be considering as well as the risk of catching COVID19.

On one specific thing you've mentioned, there is good evidence that washing hands within a minute of touching a potentially contaminated surface is more effective than scheduled hand washing. So make sure that hand washing is encouraged and easily done rather than setting timers.
posted by knapah at 2:18 AM on July 23, 2020 [1 favorite]

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