September 20, 2020

Pediatricians foresee an “intermittent” school year due to quarantines for COVID positives


“As a pediatrician, I’m not worried; as an epidemiologist, a little bit; and as a parent, a lot.” Thus summarizes his impressions, in a somewhat ironic tone, the coordinator of the working group of the Spanish Pediatric Association (AEP) for the reopening of schooling, Quique Bassat. This Friday, September 4, is the date set for the opening of educational centers after six months of closure to prevent the spread of COVID-19. Navarros (2nd cycle of Early Childhood, Primary and Special Education) and Madrid (between 0 and 3 years old) will be the first to rejoin the classroom en masse, although in some private centers in the country they have already done so. Meanwhile, the Canary Islands, Asturias and Murcia have decided to delay the reopening.

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Although the Government insists that it is working in a “safe and very controlled school environment”, in the words of the Minister of Education, Isabel Celáa, the figures of daily infections worry both parents and teachers. This Wednesday Health has registered 8,581 new cases of coronavirus. Of the total in Spain, the community with the most cases is still Madrid, with 2,401 and 1,362 between yesterday and today. In total, since March, 479,554 test-confirmed people have been infected. After Madrid, Catalonia is the second region with the most new diagnoses: it totals 1,563 (87 in the last 24 hours), followed by Andalusia (884 and 272), Euskadi (535 and 524) and the Valencian Community (455 and 179).

That is why there are parents who are thinking of delaying their children’s attendance, even in cases where schooling is compulsory, between six and 16 years. “With children there are two approaches: the individual risk of each schoolchild of suffering from severe COVID, which exists although it is very small, and what can happen in each family if the child becomes ill and there are elderly or at risk people. More are combined social factors than medical “, explains the pediatrician at the Infanta Sofía Hospital in Madrid Alfredo Tagarro, principal investigator of the National Registry of Pediatric Patients affected by COVID-19 (EPICO-AEP).

The second is the case of María, who is in the third trimester of pregnancy, and who has decided not to take her five-year-old daughter to school at the moment. “During pregnancy the gynecologist has been telling me to treat everyone as if it were a possible contagion, keeping distance and wearing a mask. We have a higher risk of being hospitalized for COVID,” he explains.

Regarding the fear for the children themselves, the Spanish Association of Pediatrics only recommends that they stay at home in cases of high risk profile (certain heart diseases, cancers, diseases with chronic immunosuppressive treatment …). “Children who probably would not go to class in non-COVID conditions, in which the risk is above the benefits,” says Bassat. The AEP has updated its tips for a safe return to the classroom. Children with chronic conditions such as asthma, fibromyalgia or ADHD, for which they have been published specific recommendationsThey should also follow the advice of their pediatrician about their particular case.

Leave from work due to positive PCR that will be extended to contacts

Epidemiologists point out that what happens during the course will also depend a lot on the incidence of the virus in the different territories, and on the degree of community transmission – or not. That is why communities such as Asturias or the Canary Islands have raised delays in the beginning to closely monitor the evolution of the epidemic.



What the pediatricians consulted are clear about is that this course can be defined as “intermittent”, since every time a child tests positive for coronavirus it will force the isolation of the entire class at home for fourteen days, to which we should add another ten additional days of isolation of the parents that accompany them in the case of those with positive PCR. “This is going to happen several times throughout the course, in each class,” Tagarro intuits. Bassat agrees with him, who foresees that there will be cases that will go unnoticed as there is a high percentage of asymptomatic among minors. “Unless they do active screening of the whole class, which is not the plan, there will be infections that are not detected,” he assumes.

On how parents can combine these circumstances with work, the law provides for the possibility of having a sick leave in case of positive CRP from close contact, that is, if the child has actually contracted the coronavirus. Those who must accompany the rest of their colleagues during the quarantine (14 days) can now take advantage of the “Take care of me” program of reduced working hours (unpaid). But the Government, through the mouth of its second vice president, Pablo Iglesias, has announced that he is already working so that temporary disability is “imminently” extended to fathers and mothers that they must take care of their children during a quarantine or that they must stay at home when they detect suspicious symptoms in children such as fever. The losses related to COVID-19 have a payment by the State of 75% of the regulatory base.

The coordinator of the AEP also emphasizes that this course will be marked by the “continuous uncertainty of possible cases”. In autumn, classes have on average two or three sick children a day, with all kinds of ailments, especially respiratory. “This year the slightest mucus is going to be almost synonymous with illness. Under normal conditions, those children would have gone to class, but in this climate of continuous anxiety about the coronavirus, we hope that no sick child will go to school.”

On whether the children, after six months of isolation, will have an immune system less prepared to assume the multiple infections that swarm in the classes during the course, he believes that indeed “from the point of view of immunity against repeated diseases we have suffered a pothole in recent months in which we have not been exposed “, but Bassat also understands that there will be less transmission of circulating viruses thanks to hygiene and prevention measures. “In places where the cold has already arrived, as in Latin America, there has been a huge decrease in the incidence of flu and other respiratory viruses in children, precisely because there are masks and other barrier measures.”

The same risk of transmission as in the environment

But despite the safety measures that have been imposed in educational centers by agreement between the Government and the autonomous communities, such as masks, temperature controls and a health protocol if there is a positive, no one expects that there will be fewer infections than in their environment, always taking into account that the level of transmission among children is “much lower than among the general population”, as highlighted this Monday by the director of the Center for the Coordination of Health Alerts and Emergencies (CCAES), Fernando Simón.

“What the school is not going to do is reduce transmission in the population you are in. That would be a miracle. You are bringing together a lot of people and logically, no matter how well you do it, it is difficult for local transmission not to translate. in the environment of the school. What would be a drama is that it multiplies it. There it would be a disaster, and it would be evident that they must be closed “, says Bassat.

In any case, it coincides with the diagnosis that if the appropriate measures are applied in schools, the risk of transmission is “acceptable and low”. “Almost all the evidence suggests that if things are done well inside the school, schools are not super contagious events. There are exceptions, but in general it is when you have done very badly, like when they opened in Israel without any kind of prevention measures, arguing that the children did not transmit the virus, and they had to close them because they had outbreaks everywhere. ”

As the UOC Professor of Psychology José Ramón Ubieto assures, “it will be inevitable to live in fear this course, the strategy is not to eliminate it but to try to limit it to familiarize ourselves and learn to live with something that is still strange like this coronavirus”.

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