Palo Alto Foundation Medical Group clinicians are circulating a statement in support of school reopenings.
Their statement follows in full:
“The clinicians at the Palo Alto Foundation Medical Group are dedicated to our community, including the health and vitality of its children and adolescents. As medical professionals, science and education are core components of our livelihoods. Most public school districts have closed their elementary, middle and high schools to help combat the COVID-19 pandemic since March of last year. As we continue to care for the population of school-age children during this pandemic, we are intimately familiar with the consequences of school closure for our pediatric population. This ranges from academic underachievement and inconsistent engagement to significant physical and mental health changes. The benefit of school closure as a means to combat the pandemic must outweigh the adverse effects on our youth. We believe we have arrived at an inflection point: the benefit of school opening outweighs the benefit of school closure as long as reopening can occur in a way that keeps adult educators and students safe. As we continuously learn more about COVID-19, the science overall supports the reopening of schools when rigorous risk mitigation measures are in place. The undersigned clinicians of the Palo Alto Foundation Medical Group today call for the safe reopening of schools.
The negative effects of shelter in place, stay at home orders, and school closure have been real for children and adolescents. The youngest students from transitional kindergarten to first grade have missed the opportunity to learn social skills and build the critical foundations for reading. Reading at grade level by 3rd grade has important consequences for life outcomes and school closure puts children at risk for not achieving this important milestone. Older children are having increased difficulty with concentration and inattention leading to academic underachievement; this may impact their school performance for years to come. School closure affects children and adolescent’s nutrition. Children dependent on school-based meal programs are now experiencing malnutrition related to food insecurity. Other children are experiencing unhealthy elevations in their weight due to reduced opportunities for physical activity at home. We’ve seen grave mental health problems in our children and adolescents due to social isolation, including behavior problems, eating disorders, anxiety, and depression. Perhaps most alarming are the reports of increased suicides in the adolescent population and decreased child abuse reporting, perhaps due to the lack of identification and mandated reporting from schools. In so many ways, schools play an important and profound role in the lives of children and adolescents.
There is an important imperative for equity woven into this discussion. As schools remain closed, communities disproportionately burdened by chronic divestment, underemployment, and unemployment are disconnected from the vital resources schools often provide, like supplemental nutrition, space for recreation, and access to computers and internet. As such, the negative impacts of school closure have been disproportionately borne by low income children and children of color. Moreover, children of color are often segregated into underfunded schools which may now lack adequate resources to safely reopen, exposing populations already rendered vulnerable to additional risk. For parents and teachers in these areas that are interested in reopening, their institutions should be prioritized and provided the needed resources to reopen.
In the beginning of our pandemic, schools were closed with the assumption that children would be primary drivers of the pandemic; however, we now know this is not the case. Schools have successfully opened in other parts of the country and world without worsening the pandemic. A few local school districts and a larger number of private schools have opened. This has shown us that schools can indeed reopen safely given the appropriate resources, and even without vaccination, routine COVID-19 testing or extensive infrastructure changes. These schools have reopened with safety measures including the four pillars of: facial coverings, hand hygiene, physical distancing and limits on gathering (stable cohorts). Beyond this, and waiting to be implemented, most school districts have created robust and detailed plans on how to reopen safely.
We know that the educator community is deeply committed to its students and wants what is best for them. Indeed, we see the tremendous dedication and innovation of the educator community after they moved to distance learning and continue each day to educate students through this pandemic. The dedication of the educator community is strong and commands respect and admiration. It is our pledge to provide our full support to the education leadership and community as we work to transition to in-person learning. We, as medical experts, can facilitate translation of the changing science of COVID-19 and provide guidance on how to stay safe going forward so that the education community can make their own informed decisions.
Vaccination is currently underway in our nation. Locally, we are well on our way and the educator community will soon qualify for vaccination. Though vaccination may not be an evidence-based prerequisite for safe school reopening, we call on all medical institutions, including Palo Alto Medical Foundation to prioritize and facilitate COVID-19 vaccination to educators and bring them to the front of the line when the counties activate phase 1B.
School reopening is a highly complex process. Everyone involved wants to keep themselves and their loved ones safe from COVID-19 infection. As frontline workers caring directly for COVID-19 patients, our personal experience proves that risk mitigation strategies work to protect ourselves and our families. As many of us are also parents, we emphasize that many parents and families want to return to school as long as they believe it is safe. We believe that the option to remain in distance learning should be preserved for those families who choose it. We, as clinicians, can see the benefit of the safe return to schools for the physical and mental health of children. We partner with our public health officials who guide our community as to when it is safe to bring students back to school. The recipe for the safe return to school will require planning and bi-directional communication. It will require clear intention, courage, comfort with uncertainty, and a willingness to try by all stakeholders involved. As clinicians dedicated to the children of our community, let’s advocate for our children, adolescents and educational community and move forward together.
We, the undersigned clinicians at the Palo Alto Foundation Medical Group, call for the:
- Prompt safe reopening of school and in person learning as an option for families per public health guidelines
- Encourage vaccination prioritization of educators through continued discussions with county and state health officials
- Availability of medical professionals to support and advise education leadership
- Continued collaboration between the medical community, teacher/education community, parent community and Department of Public Health
- Transparent and open communication grounded in science that fosters collaboration, inclusion and equity for all stakeholders
Sincerely,
Undersigned Clinicians at the Palo Alto Foundation Medical Group
Kurt VandeVort, MD
Neel Patel, MD
Rhea Boyd, MD
Ross DeHovitz, MD
Stephanie Lai, MD
Stephanie Chiang, MD
Lauren Weger, MD
Antoinette Rose, MD
Margaux Gray, MD
Alger Chapman, MD
Mercedes Kwiatkowski, MD
Lloyd Brown, MD
Elizabeth Copeland, MD
Margaret Fry, MD
Rebecca Fazilat, MD
Aaron Nayfack, MD
Lori Kandel, MD
Nicole Ketterman, MD
Sarah Nguyen, MD
Douglas Kaye, MD
Raelene Walker, MD
Christina J. Lee, MD
Lucy C. Lee, MD
Robyn Preising, MD
Lydia Delaney-Sathy, MD
Michael Sathy, MD
Nancy Zises, MD
Nicole D. Marsico, MD
Patty Cheng-Wei Ku, MD
Amy Heneghan, MD
Robin Drucker, MD
Erica Goldman, MD
Erika Drazan, MD
Eric S. Perez, MD, FAAP
Maria Sepetka. MD
Wanny Tam, M.D., M.P.H.
Rebecca Benton, MD, MPH
Grace Guo, MD
Melanie Perera, CPNP
Katharine G Padrez, MD
Suszanne Bernat, MD
Iris Kaddis, MD
Mona Luke-Zeitoun, MD
Evie Huang, MD
Natalia Colocci, MD, PhD
Kathleen Babington, M.D.
Veena G. Jones, M.D.
Amy C. Lee, M.D., M.P.H.
Eugene Kim, MD
Tim Lee, MD
Molly King, MPH, PA-C
Crystal Smith-Spangler, MD, MS
Juliann L. Kim, M.D.
Wenhsin Shen, MD
Sarah Huyen-Tran Nguyen, MD, MPH
Kathryn Sutter, MD
Kathleen Forcier, MD
Shiv Jain, MD
Jennifer Tran, DO
Aimee Blaustein, MD
Judi Yamamoto, MD
Eric Matsumoto, MD
Orchid Ghaffari, MD
Irene Lin, MD
Jessica Wong, MD
Francis Lastufka, MD
Hannah Iwan, CFNP
Amanda Romero, CPNP
Carla Collins Gorum MD
Jennifer Louie, MD
Sarah Maufe, MD
Kathrin Sidell, MD, PhD
Aimee Leigh Harris, MD
Tina Leung, MD
Naveen Sultana Mahmood MD, MPH
References
Leeb RT, Bitsko RH, Radhakrishnan L, Martinez P, Njai R, Holland KM. Mental Health–Related Emergency Department Visits Among Children Aged <18 Years During the COVID-19 Pandemic — United States, January 1–October 17, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1675–1680. DOI: http://dx.doi.org/10.15585/mmwr.mm6945a3external icon
Lesnick, J., Goerge, R.M., & Smithgall, C. (2010). Reading on grade level in third grade: How is it related to high school performance and college enrollment? Chicago, IL: Chapin Hall at the University of Chicago.
Falk A, Benda A, Falk P, Steffen S, Wallace Z, Høeg TB. COVID-19 Cases and Transmission in 17 K–12 Schools — Wood County, Wisconsin, August 31–November 29, 2020. MMWR Morb Mortal Wkly Rep 2021;70:136–140. DOI: http://dx.doi.org/10.15585/mmwr.mm7004e3external icon
The Covid-19 pandemic worsened an already dire childhood obesity epidemic
By Dr. Edith Bracho-Sanchez and Dr. John Rausch, CNN Updated 6:28 AM ET, Fri January 8, 2021
Zimmerman KO, Akinboyo IC, Brookhart A, et al. Incidence and Secondary Transmission of SARS-Co-V-2 Infections in Schools. Pediatrics. 2021; doi: 10.1542/peds.2020-048090.
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https://www.smcoe.org/…/school-recovery-planning.html
https://www.berkeleyside.com/…/opinion-open-letter-to…
https://www.smcgov.org/…/county-moves-expand-covid-19…
https://www.gov.ca.gov/…/governor-newsom-unveils…/
https://aapca1.org/california-pediatricians-urge…/
Transmission of SARS-CoV-2 in K-12 schools | CDC
Zimmerman KO, Akinboyo IC, Brookhart A, et al. Incidence and secondary transmission of SARS-CoV-2 infections in schools. Pediatrics. 2021; doi: 10.1542/peds.2020-048090
Top image credit: Getty Images
