Southern California pediatricians call for L.A.-area schools to immediately reopen

Los Angeles County campuses that closed amid the COVID-19 pandemic should immediately reopen, according to a regional affiliate of the American Academy of Pediatrics, because the harms of keeping children out of school outweigh the risks of safely and carefully managed classrooms.

“A large majority of the 1.5 million students in L.A. County has not been physically in a classroom in nearly a year,” said the statement from Southern California Chapter 2 of the academy. “This sad consequence of the pandemic should be addressed immediately with the reopening of schools.”

The statement by the affiliate is at odds with California guidelines that allow for fully reopening schools only after coronavirus infection rates are lower than they are now in every Southern California county. The superintendent of the Los Angeles Unified school district said campuses will remain closed until community infection rates drop. He’s also calling for teachers to be vaccinated, echoing the position of the teachers union, which reacted strongly Tuesday to the pediatric group.

The group represents about 1,500 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists in Kern, Los Angeles, Riverside, San Bernardino, San Luis Obispo, Santa Barbara and Ventura counties.

With the right measures in place, campuses can operate with an acceptable degree of safety, Dr. Kenneth Zangwill, a pediatric infectious diseases specialist at Harbor-UCLA Medical Center, said in the statement.

“We know how to keep teachers, staff and children safe on school campuses,” Zangwill said. “Hundreds of schools and school districts have been able to do this in other parts of the country.”

The status of in-person classes varies greatly across the country, but experts have estimated that more than half of students have not returned to campus.

Because of the pandemic, L.A. County campuses for kindergarten through 12th grade are not allowed to reopen for their full enrollment, but there are exceptions. Schools can reopen or continue to operate under a specially approved waiver for transitional kindergarten through second grade.

Other counties authorized waivers through 6th grade, the highest level allowed by the state under that program.

California schools have also been able to provide in-person services and instruction for up to 25% of enrollment at a given time for students with special needs, such as those with disabilities, those learning English and the youngest pupils.

The level of these services has varied by school system. Los Angeles Unified, the nation’s second-largest school district, began providing some in-person, one-on-one services in October but suspended them in mid-December when coronavirus infection rates surged to their highest levels of the pandemic.

Although L.A. Unified remains closed for in-person services, some other districts have resumed special services, and a small number have reopened waiver-approved campuses.

L.A. Unified Supt. Austin Beutner said it is critical that health officials specifically target school employees for vaccination while campuses are closed, so that this impediment to reopening is removed.

“Vaccinating school staff will help get school classrooms opened sooner,” Beutner said, adding, “Soon is good; organized is better.

“It won’t be sufficient to vaccinate some school staff now and others far down the road,” he said. “The driver takes students to school, the principal unlocks the front door, the teacher leads in the classroom, the cafeteria worker prepares lunch, and the custodian keeps the school clean — they’re all connected at school.”

Structurally, he said, L.A. campuses have been prepped to operate safely. And his campuses are ready to serve as community immunization centers, he added.

Recently enacted state guidelines allow for in-person elementary-level classes when the seven-day average of daily cases falls to 25 or fewer per 100,000 residents. For secondary schools, the adjusted rate is 7 cases or fewer per 100,000 residents.

In its statement, the pediatricians group made no distinction regarding grade levels.

The latest adjusted case rate for L.A. County, released Tuesday, is 38.7 per 100,000 residents. Last week, the rate was about 48 cases per 100,000 — a rapid drop from the prior week, when the adjusted case rate was about three times the reopening standard.

The debate over school reopening has been a balancing act: the harms of the coronavirus versus the harms of closed campuses. As early as June, the Southern California pediatricians chapter emphasized the damage done by closed campuses. At that time, the group pointed to research suggesting that the risks of COVID-19 transmission among children are lower than for adults. The intervening months have added to the body of research demonstrating that schools can be operated safely, the group said Tuesday. It referenced a January report, using U.S. data, in the Journal of the American Medical Assn. and a December report based on 17 other countries.

“Schools are safe when adherence to mitigation practices are in place such as mask wearing, hand hygiene, social distancing, and limitation of potentially higher-risk extracurricular activities,” the group’s statement said. “A year into the pandemic, and after great effort and expense, schools know how to implement mitigation.”

In support of their call to action, the doctors cited a recent survey of more than 500 Los Angeles teachers who reported “low levels of student attendance and engagement” and said children are suffering emotional and mental impacts “related to social isolation, anxiety, lack of structure.”

“Suicidality among teenagers is now an active area of investigation,” the doctors said in the statement.

The union that represents L.A. teachers, librarians, nurses and counselors said the pediatricians highlighted research findings selectively, understating warnings that preventing transmission in schools requires reducing levels of infection in the surrounding community.

“Saying the temporary trauma from distance learning is greater than illness and death of family members conveniently minimizes the reality that COVID-19 disproportionately impacts” families of color in Los Angeles, said Cecily Myart-Cruz, president of United Teachers Los Angeles. “Although, thankfully, serious illness and death among children is rare, 78% of the children who have died in the U.S. are children of color.”

The union and school officials are currently negotiating what a return to campus would look like.

The case for reopening schools immediately is not as clear-cut as some want it to be, said Theresa Chapple-McGruder, an epidemiologist in the Washington, D.C., area who specializes in maternal and child health and has advised 27 school districts on their reopening plans.

“There are a lot of holes in the data,” Chapple-McGruder said. “We don’t have good rates of children being tested. And we know that children are more likely to be asymptomatic.”

She added that it’s important to remember that “children live within families,” and the disease spreads easily within households.

“We need to be limiting our exposure to the virus, either through schooling at home, working from home — any ways that we can try and manage to stay safe at home — is really the same message that needs to be out today as it was six months ago, when the virus was not at such high peaks as it is today,” she said. “We need to be focused on those same prevention strategies that we used then.”