When schools reopened in the immediate aftermath of the pandemic, school officials warned parents to keep their kids home if they showed even the slightest sign of illness. Now, as we head into the third school year with COVID, the messaging has changed.
“My advice on keeping children home from school now is similar to what was in place pre-pandemic,” Dr. Smita Malhotra, chief medical officer for the Los Angeles Unified School District, wrote in an update to parents and caregivers.
Parents are now being told to send their children to school if they are unwell, but keep them home if they have more serious symptoms.
“It is not practical for working parents to keep children home from school for every runny nose, nor is it in the best interest of children to continue to miss school after pandemic school closures,” Malhotra wrote. “If your child has a mild runny nose or cold symptoms that are not bothering them, and they test negative for COVID-19, send them to school. Your child can wear a mask at school when they have these mild symptoms.”
If your child has a mild runny nose or cold symptoms that are not bothering them, and they test negative for COVID-19, send them to school.
— Dr. Smita Malhotra, chief medical officer, Los Angeles Unified School District
This guidance is significantly different than in past years when parents were told that any illness meant keeping kids at home.
“I completely agree with LAUSD’s message,” said Dr. Anuradha Seshadri, internal medicine and pediatrician at UCLA Health Century City. “It has been shown to improve their psyche and emotional well-being by seeing their friends at school, interacting, coming back and being a part of extracurricular activities, getting that exercise that they need, and just social stimulation is very, very important for one's health.”
We’re in a quieter phase of the pandemic, she says, and between the availability of vaccinations, home testing and telehealth visits, Seshadri is comfortable with the district’s recommendations for most kids.
At-home COVID testing is a must
She does have some concerns about the policy and how it could hurt the health of an immunosuppressed child.
“If a child is at higher risk for possibly being hospitalized, whether (because) they are immunosuppressed, if they're on cancer medications, or they have sickle cell, or they're diabetic, or extremely obese, then they need to be a little bit more cautious.”
Seshadri said children shouldn’t be treated in isolation. Time and again, grandchildren with a mild COVID case infect grandparents or other immunosuppressed adults.
“When the kids get sick, it's not just the kids getting sick,” she said. “They come back and spread it to family members.”
At-home testing, she says, is key.
“Even with mild symptoms, I think it would benefit not only the child, but other people to just rule out COVID with the antigen test, Seshadri said. “Parents and families need to maintain good hygienic measures at school and preventative measures so that if there is a chance that you had COVID, I would say implement the testing measures that we have.”
What do multiple COVID infections do to kids?
Last August and September, TK-12 schools in L.A. County reported more than 1,100 COVID clusters — or groups of three or more potentially connected cases over an eight-week period, according to data from Public Health.
Children are the least vaccinated age group in L.A. County. Just 2.5% of children six months to 4-years-old are up to date on their COVID shots, followed by 7% of 5 to 11-year-olds and 11% of 12 to 17-year-olds.
Studies have shown that repeat COVID infections in adults can spell trouble. A 2022 study found multiple cases of COVID in adults can increase risk in many areas, including potential cardiac, pulmonary or neurological problems.
Dr. Seshadri said we don’t know how multiple COVID infections could affect children or their developing organ systems, including brain development.
“We’re still in the learning phase right now,” she said.
Can children get the newly formulated COVID shot this fall?
The CDC expects the updated vaccine rollout to begin the third or fourth week of September, meaning pharmacies will likely start offering them in October, but who will be eligible for the shot is still up in the air.
The Food and Drug Administration is waiting on safety data from pharmaceutical companies Pfizer and Moderna for their respective updated COVID shots. Once the FDA has approved the shot, the CDC’s Advisory Committee on Immunization Practices will likely call a special meeting to review the data and make recommendations on the dosage size and which age group will be able to get the shots.
There are COVID vaccines available right now. Children six months and older can get the bivalent vaccine, which Seshadri recommends.
“We saw a big uptick in child vaccinations in June, parents were interested in getting them vaccinated before traveling,” she said.
How much COVID is there?
Getting accurate data on COVID cases is harder now. The weekly data from L.A. County Public Health measure the number of patients in the hospital with COVID, including emergency room visits and COVID-positive ICU patients.
It does indicate an upward trend since the start of July.
L.A. County also does wastewater detection, which is an indicator of how much COVID is circulating in the community, which is also rising.
Should we treat COVID the same way we treat the flu?
COVID isn’t seasonal in the same way as other viruses like the flu and RSV. Symptoms for flu and COVID are very similar, making it hard to differentiate as a physician without a lab test.
LAUSD recommends that children should not go to school if they have these symptoms:
- Fever (100.4 F and above)
- Vomiting or diarrhea
- Severe pain
- Difficulty breathing
Take them to their pediatrician, who can do one nasal swab that tests for the big three viruses — COVID, flu and RSV.
Health experts look to the Southern Hemisphere to help predict our coming flu season, and it’s been a busy one in Australia. They’ve had a lot of influenza A and B, which tend to target children, putting pressure on pediatric services. About 80% of hospital admissions have been in children, and Australian health authorities have been urging young people to get the flu vaccine after two deaths of school-aged children.
“We're already seeing some flu cases here itself, so we're prepping for the flu and RSV season,” Dr. Seshadri said.
L.A.’s status as a tourist destination as well as its dense population makes it important for children to get their immunizations and booster doses, she said.
“Los Angeles is special in the sense that it is a very big tourist area. Even if you're not traveling, or the schools don't recommend it, it’s still a good idea to get vaccinated. We get a lot of tourists here that bring in viruses and other communicable diseases. In daycares and schools, there's a lot of prolonged close contact and protecting your children is protecting your family,” she said.
