Extensive research has established and confirmed the safety and value of reopening schools.
Emerging epidemiologic reports on COVID-19 in children show that they are less likely than adults to be infected and have severe illness. In a large study published in Pediatrics, the official peer-reviewed journal of the American Academy of Pediatrics, researchers conducted the first retrospective epidemiologic analysis of disease spread and severity in 2,143 confirmed or possible pediatric COVID-19 infections reported to the Chinese Center for Disease Control and Prevention. The study analyzed children hospitalized in Wuhan, China (children were defined as being less than 18 years old). “Only one child died, and most cases were mild, with much fewer severe and critical cases than adult patients,” the study reported. The findings suggest that compared with adult patients, clinical manifestations of children’s COVID-19 may be less severe. In fact, only one child died with cerebral palsy during the initial COVID-19 outbreak in Wuhan, China. Yan Cheng, a 16-year old boy, died because his father, and sole caregiver, contracted COVID-19 and was hospitalized, however, no one checked on his son who died due to neglect.
The New England Journal of Medicine, one of the most prestigious peer-reviewed medical journals, published an article outlining the dubious nature of children contracting and transmitting COVID-19 to adults. The study tested people living in Iceland who were at high risk for infection along with a population screening that utilized two strategies: 1) open invitation to 10,797 people, 2) random invitations sent to 2283 people. A total of 1221 of 9119 people who were recruited for targeted testing had positive results. 87 people in the open-invitation and 13 people in the random population screening tested positive for the virus. Children under 10 years of age were less likely to receive a positive result than were persons 1- years of age or older. Out of 564 children under the age of 10 years in the targeted group testing, 38 tested positive, in contrast to positive test results of 1183 of 8635 people who were 10 years of age or older. “In the population-screening group, the difference was even more marked: none of the 848 children under the age of 10 years tested positive…,” the article stated. Based on the study’s results, the article concluded that children are unrepresented among COVID-19 cases, especially amongst severe and fatal cases.
In late April 2020, scientists at France’s Institute Pasteur, an international research and education institute founded in 1887, with the support of the Hauts-de-France Regional Health Agency and the Amiens Education Authority, carried out an epidemiological survey on 1,340 people linked to primary schools in Crépy-en-Valois, in the Oise department. “Overall, the results of this study are comparable to those of studies carried out in other countries, which suggest that children aged between 6 and 11 are generally infected in a family environment rather than at school. The main new finding is that the infected children did not spread the virus to other children or teachers or other school staff,” commented Arnaud Fontanet, lead author of the study, Head of the Epidemiology of Emerging Diseases Unit at the Institute Pasteur and a Professor at the CNAM.
A report by McKinsey and Company, one of the largest management consultancies in the world, states that children have a much lower risk of contracting COVID-19. “The most critical question is whether reopening schools will lead to a resurgence of infection among students, staff, and the broader community. The evidence here is still nascent. Children’s risk of contracting COVID-19 appears to be lower than that of adults. In China and the United States, the countries with the largest number of confirmed COVID-19 cases, children represent 2 percent of cases. Emerging evidence also suggests that children are more likely to be asymptomatic, less likely to be hospitalized, and much less likely to die if they do develop COVID-19.” The Report also underscored the importance of in-person schooling. “Every year, students in the United States lose a month’s worth of learning over the summer, with the sharpest learning declines in math, seen especially in low-income students. One recent analysis project that students could return in the fall having progressed only 70 percent of a grade in reading and less than 50 percent of a grade in math during the 2019–20 school year. If closures extend beyond the fall, this shortfall could be even greater, with negative consequences for individual students and society. Beyond academics, schools provide important social support, especially to vulnerable students. Indeed, 19 percent of reports of child abuse or neglect in the United States come through education personnel, and school closures have resulted in a steep drop in such reports. This change suggests that school closures have shut down support sources for victims of abuse. Reports of domestic violence increased more than 30 percent in France, 50 percent in India, and 60 percent in Mexico. With such high stakes, systems that can consistently deliver remote student services—nutrition, safety, and mental-health support—can likely weather longer closures than those who cannot.”
The Journal of Pediatrics, the official peer-reviewed journal of the American Academy of Pediatrics, published a commentary that explores the scientific complexities of children transmitting COVID-19. The authors deduced that children infrequently transit COVID-19 to adults, basing their conclusions on a new study published in Pediatrics, “COVID-19 in Children and the Dynamics of Infection in Families,” and four other recent studies that examine COVID-19 transmission by and among children. Referencing cases in China, Japan, France, and Australia, the authors further elaborate that children are not “driving the pandemic.” For example, contact tracing of 40 children under 16 years of age with confirmed cases of SARS-CoV-2 at the Geneva University Hospital in Geneva, Switzerland from March 10 to April 10, were identified along with their infected household contacts. In only 3 of the cases did the child acquire symptoms onset preceding illness in their adult household contacts. In all other cases, the child acquired symptoms after or concurrent with their adult household contacts. This alludes to the notion that the child was not the primary source of the virus’s transmission, therefore more often obtaining COVID-19 from adults, rather than being the transmitters themselves. This study coincides with investigations performed in China, where 68 children confirmed with COVID-19 were admitted into Qingdao Women’s and Children’s Hospital from January 20 to February 27, 2020. 65 of these infected cases were household contacts of previously affected adults, which amounts to 95.59% of the total number of cases. An understanding of these studies demonstrates that the transmission of SARS-CoV-2 in schools is not as much of a profound predicament than originally considered. As the authors state, “Almost 6 months into the pandemic, accumulating evidence and collective experience argue that children, particularly school-aged children, are far less important drivers of SARS-CoV-2 transmission than adults.” School re-opening in the fall is imperative to the well-being and healthy development of children, the authors say. “Therefore, serious consideration should be paid toward strategies that allow schools to remain open, even during periods of COVID-19 spread. In doing so, we could minimize the potentially profound adverse social, developmental, and health costs that our children will continue to suffer until an effective treatment or vaccine can be developed and distributed or, failing that until we reach herd immunity,” the article concludes.
The American Academy of Pediatrics (“AAP”), an organization with approximately 67,000 pediatricians, has advocated in-person schooling and published its guidelines to ensure the overall health of children, staff, and communities. The guidelines stated, “Schools are probably not greatly amplifying the spread of coronavirus and children are less likely to become extremely sick from the virus than adults”. “The importance of in-person learning is well documented and there is already evidence of the negative impacts on children because of school closures in the spring of 2020. Lengthy-time away from school and the associated interruption of supportive services often result in social isolation, making it difficult for schools to identify and address important learning deficits as well as child and adolescent physical or sexual abuse, substance abuse, depression, and suicidal ideation.” They also emphasized that “schools are fundamental not only for the well-being of children but also provide them key social and emotional skills.” They also underscored the importance of schools in addressing racial and social equality. Dr. Sally Goza, the president of AAP, emphasized that remote learning hurts students with special needs. “Our children with autism, some of them are starting to show signs of regression by not being in school and having that social and emotional interaction,” she said.
The Lancet Global Healthmedical journal published an article in March 2020 that investigates inequalities in school closure response to COVID-19. Cross-examining the Ebola epidemic, the authors stated, “School closures impede learning and compound inequities, disproportionately affecting disadvantaged children. School closures during the 2014–16 Ebola epidemic increased dropouts, child labor, violence against children, teen pregnancies, and persisting socioeconomic and gender disparities.” In their call to action, the authors demand complete transparency in deciding whether or not schools should remain closed. “We call for transparent public discussion and research, incorporating the voices of children and their families on the feasibility, acceptability, and impact of closures to inform both our response now and future pandemic planning. We ask whether adequate evidence exists of transmission reduction due to school closures to outweigh the long-term risks of deepening social, economic, and health inequities for children. We must strike a balance, protecting those most at risk without sacrificing the next generation’s future.”
JAMA Pediatrics, a monthly peer-reviewed medical journal published by the American Medical Association, issued an article written by medical professionals that highlights the challenges low-income children face during COVID-19. “The rate of serious illness among young children from the novel coronavirus is very low. Yet to slow the spread of the virus, all states have closed schools, disrupting routines critical to learning, nutrition, and social development. Directly and indirectly, low-income children have been forced to subordinate their own well-being for the greater good.” The authors assess that compounding the loss of educational time is the challenge of accessing school resources. “While school districts are engaging in distance learning, reports indicate wide variability in access to quality educational instruction, digital technology, and internet access. Students in rural and urban school districts are faced with challenges accessing the internet. In some urban areas, as many as one-third of students are not participating in online classes.” The authors conclude by suggesting steps the government needs to take for the future success of low-income children in COVID-19.
British Medical Journal, one of the oldest general medical journals in the world, published an article in April 2020 emphasizing the need for children to return to school. The authors’ fundamental argument is that children are not COVID-19 super spreaders. This argument is supported by data from China, South Korea, and Ireland on children and COVID-19. “Some regions have implemented widespread community testing, such as South Korea and Iceland. Both countries found children were significantly underrepresented. In Iceland, this is true both in targeted testing of high-risk groups compared with adults (6.7% positive compared with 13.7%) and in (invited) population screening, there were no children under 10 found to be positive for SARS-CoV-2 compared with 0.8% of the general population.” Using their cumulated data, the authors deduce that “Governments worldwide should allow all children back to school.”
Eurosurvelliance, Europe’s journal on infectious disease surveillance, epidemiology, and control, published a study on the secondary transmission of COVID-19 from children attending school in Ireland. The study examined three pediatric cases and three adult cases of COVID-19 with a history of school attendance. The available epidemiological data for all cases indicated that they had not been infected with SARS-CoV-2 in the school setting. One pediatric case attended a primary school, while the other two cases attended secondary schools. One of the adult cases was a teacher, while the other adult cases conducted educational sessions in schools that were up to 2 hours in duration. A total of 1,155 contacts of these six cases were identified. They were exposed at school in the classroom, during sports lessons, music lessons and during choir practice for a religious ceremony, which involved a number of schools mixing in a church environment. Their findings show that among 1,001 child contacts of these six cases there were no confirmed cases of COVID-19. In the school setting, among 924 child contacts and 101 adult contacts identified, there were no confirmed cases of COVID-19. “The results moreover echo the experience of other countries, where children are not emerging as considerable drivers of transmission of COVID-19.”
The National Center for Immunization Research and Surveillance (NCIRS) investigated all COVID-19 cases in New South Wales, Australia schools in April 2020. The report shows that from March to mid-April 2020, 18 individuals (9 students and 9 staff) from 15 schools were confirmed as COVID-19 cases. A total of 735 students and 128 staff were close contacts of these initial 18 cases. Of these, no teacher or staff member contracted COVID-19 from any of the initial school cases. The report concluded that “Our investigation found no evidence of children infecting teachers…SARS-CoV-2 transmission in children in schools appears considerably less than seen for other respiratory viruses.”
The Public Health Agency of Sweden published a report comparing the effect of different approaches in regards to school closure in Sweden and Finland, as a response to the COVID-19 pandemic. Sweden is one of the very few countries that decided to keep daycare and primary schools open during the pandemic. In Finland, on the other hand, all schools were closed on March 18th until May 13th with the exception of children in grades 1-3, who had the possibility to participate in regular on-site teaching if their caretakers were working in areas that were considered critical for the society. Primary schools were reopened between May 14 and May 31. During this reopening period, there were 23 primary school exposures (index cases) in 21 primary schools. Of the index cases, 16 were pupils and seven adults. There were 392 pupils and 54 adults placed under quarantine and the last quarantine ended on June 12. Primary school closure and re-opening did not have any significant impact on the weekly number of laboratory-confirmed cases in primary school-aged children. Chief Physician at the Finnish Institute for Health and Welfare stated, “Coronavirus infections with serious symptoms are rare among children and young people in both Finland and Sweden. Neither country has reported a single coronavirus-related death in the under-20 age group. According to current information children also pass on the virus less frequently than adults.” The report concluded, “The negative effects of closing schools must be weighed against the possible positive indirect effects it might have on the mitigation of the COVID-19 pandemic.”
In February and March 2020, a study published by the Oxford University Press, in correlation with the Infectious Diseases Society of America (IDSA) and the HIV Medicine Association (HIVMA), within the newly issued volume of Clinical Infectious Diseases, depicted the low risk of transmission in school settings. The study was achieved in Singapore as part of the country’s public health strategy to undergo nationwide surveillance and contact tracing. The clinical and epidemiological data and the contacts of potential cases of SARS-CoV-2 within 3 separate educational settings were all obtained and analyzed. A 12-year-old student and a 5-year-old student were both diagnosed with COVID-19, and subsequently isolated, after acquiring symptoms for SARS-CoV-2. In both the secondary school and preschool #1, all close contacts were placed under quarantine 14 days from their last exposure, and subsequently examined and isolated if they experienced any respiratory symptoms or fevers. They were only discharged if they received at least 2 negative nasopharyngeal swabs taken on 2 individual days. Although schools were not closed during this period, they continued to take precautionary health measures. 8 students in secondary school and 34 students in preschool #1 became symptomatic, but all were tested negative for the virus. In preschool #2, the same measures were taken, except that schools were closed for 14 days following the detection of staff members with COVID-19, and a single NP swab for SARS-CoV-2 among asymptomatic children was also taken. Although 77 children became symptomatic, all were also tested as negative. Based on the study’s results, there was no evidence of disease transmission, which entails that children may be more resistant at a cellular level. “Based on these findings, more targeted control measures for preschool settings such as keeping symptomatic children away from schools, instead of blanket closures, could be considered.”
GMS Hygiene and Infection Control, an international journal that publishes information from the field of infection control and prevention, featured an article that discusses the inconsequential role children play in the spread of COVID-19. The mounting evidence provided in the study shows that among children, infection, and severity of COVID-19 infection are low and the majority of children and adolescents with the virus show either no symptoms or else only mild symptoms. Thus, the authors postulate that schools and daycare center closures are likely to have only a narrow impact on the further spread of infection and that with concomitant examinations, daycare centers, and elementary schools “promptly should be reopened.” “For children, this should be possible without excessive restrictions, such as clustering into very small groups, implementation of barrier precautions, maintaining appropriate distance from, or wearing masks.” Moreover, the authors assert that children and adolescents can be taught basic rules of hygiene such as handwashing and careful hygiene behavior when coming into contact with others during mealtimes and/or when using sanitary facilities.
The American Psychological Association (“APA”) is the largest scientific and professional organization of psychologists in the United States, with over 121,000 members, including scientists, educators, clinicians, consultants, and students. APA recently published a study on the effect of COVID-19 lockdown on parents. This study investigated the production of psychological distress and collateral concerns for parents in lockdown, due to unstable financial circumstances, school closures, and suspended educational services for children. Focusing on Italy as its case study, the writer’s stated, “Although there have been few cases of children infected with this novel strain of coronavirus, childcare is one of the most serious collateral concerns for Italian parents. COVID-19 may be producing a stressful environment for parents in several ways.” The authors go on to provide examples of ways in which parents experience psychological strain during COVID-19, “Parents may worry about the economic and physical health of their family; they may be concerned about their children’s social isolation from peers and teachers; they may be preoccupied with the management, duration, and outcomes of homeschooling; they may have doubts about their ability to provide information to their children about COVID-19 in a reassuring and age-appropriate manner; and they may mistrust the government’s intention to provide support for parents juggling childcare, home-based working, and/or summer holidays.” Moreover, the study suggests that through preliminary data collected, parents of children diagnosed with a mental or physical disease are experiencing higher levels of parental burnout and perceiving less social support, than other parents are. Thus, it is important to consider the ramifications of at-home learning.
The National Academies of Sciences Engineering and Medicine released an extensive report that concludes school districts should prioritize reopening schools full-time, especially for grades K-5 and students with special needs. “Keeping schools closed to in-person learning in Fall 2020 poses potential educational risks. Students of all ages benefit from in-person learning experiences in ways that cannot be fully replicated through distance learning,” the report states. Furthermore, “Opening school buildings to some extent in Fall 2020 may provide benefits from families beyond educating children and youth. Working caregivers would have affordable, reliable childcare for school-age children, and families would be better able to access services offered through the school, such as the provision of meals and other family supports.” The report also recommends schools and districts take certain precautions to protect staff and students such as providing surgical masks and handwashing stations or hand sanitizer for everyone entering the school building.
The Journal of Pediatrics and Child Care published an article in June 2020 prefacing the French Pediatric Society, and various Societies of pediatric specialties support on children returning to school. The authors concluded that there is no scientific evidence in the role children play in the transmission of COVID-19. “Children today are paying a heavy price for the initial assumption that they were the primary vector for the circulation of the COVID-19 virus, by analogy with other viruses. We now know that this is not the case and that almost all of the children who were infected with COVID-19 were in contact with adults. Finding your playmates should not be considered as exposing them to particular risks. It is urgent to recall that communities of children, nurseries or classes, continued to exist during confinement, especially for the children of nursing staff. No epidemic was noted in these groups of children, while viral circulation was high among adults.”
JAMA Pediatrics published another research letter approved by the Ethics Committee of Tongji Medical College and Huazhong University of Science and Technology. Using Hubei Province, China as its case study, this research investigated the mental health status of children in home confinement during COVID-19. Depression and anxiety symptoms were two of the driving health risks identified among students in Hubei Province, China. A total of 2330 students in grades 2 through 6 in 2 primary schools in Hubei province, of whom 845 were from Wuhan and 1485 were from Huangshi, were invited to complete a survey between February 28 and March 5, 2020. The information included sex, school grade, optimism about the epidemic, whether they worried about being infected by COVID-19, and depressive and anxiety symptoms measured by the Children’s Depression Inventory–Short Form (CDI-S) and the Screen for Child Anxiety Related Emotional Disorders, respectively. The study concluded: “22.6% of students reported having depressive symptoms, which is higher than other investigations in primary schools of China (17.2%). During the outbreak of COVID-19, the reduction of outdoor activities and social interaction may have been associated with an increase in children’s depressive symptoms. Our study found that 18.9% of students reported anxiety symptoms, which is higher than the prevalence in other surveys.”
The Official Journal of the American Academy of Pediatrics published an article written by pediatricians advocating for children during the COVID-19 school closures. The article underscored the imminent threat COVID-19 school closures pose to child health and well-being, particularly for children with disabilities and those living in poverty. Referencing students with disabilities, the authors stated that “Thirteen percent of public students have a disability requiring an individual education plan, with nearly two-fold higher rates in low-income communities. Of children with mental and behavioral health needs, 80% rely on school-based services. School closure means loss of critical resources for children with disabilities, including engagement with specialized educators and structured learning environments. Parents of children with high learning needs are unlikely to be equipped with resources to maintain remote learning. To offset worsening educational disparities in this population, we must prioritize strategies to safely resume in-person education for children with disabilities and advocate for resources to support expansion of assistive technologies for home (e.g., tools for visually or hearing impaired).” At-home learning for children from low-income families also proves to pose challenges. “Although remote learning presents a challenge for all families, those in poverty are at a greater disadvantage and thus at increased risk for widening educational disparities. One in seven children lacks home internet access, with a two-fold higher rate among low-income communities. Parents in poverty are facing their own pandemic-related stressors (e.g., unemployment, at-risk jobs) and may lack the time or resources to support remote learning.”
“Teachers are a young population in the United States. K-12 teachers, half of them are under 41, 82% are under 55, these are not high-risk age groups,”said Dr. Scott Atlas, former Stanford Neurology chief. In an interview, Dr. Atlas voiced his concern for school closure in the United States stating that closures have “nothing to do with the children’s risk.” “The harms to the children for closing schools, this is the biggest problem of all.” He goes on to discuss the imminent consequences of distance learning such as significant drops in math and reading ability. Referencing data from countries that have opened schools, Atlas stressed the fact that children do not significantly transmit the disease to adults. “You can’t insist that you believe in the science and then act contrary to science,” he concluded.
“What children lose by not being in school is enormous; school attendance is a life-defining experience that is critical for educational, social, and emotional development,” said Ruth Faden, founder of Johns Hopkins Berman Institute of Bioethics. Johns Hopkins University unveiled a re-opening policy tracker for K-12 schools that contains an interactive map and resource guides that compare and analyze reopening plans for schools nationwide. The policy tracker offers solutions for safe education during COVID-19 and includes examples of equity-oriented reopening policies, a biweekly e-newsletter, a COVID-19 school reopening checklist, and a guidance document titled “The Ethics of K-12 School Reopening” Identifying and Addressing the Values at Stake.”
The Indian Journal of Pediatricspublished a scientific letter that assesses the intricacies of transmission of COVID-19 in children. The authors affirmed that a notable feature of the COVID-19 pandemic is that children account for only less than 2% of total cases and most develop only mild illness. “Even when children with comorbidities are being reported at risk of severe disease, mortality was very rare. Many asymptomatic infections were noted. Most acquired infection from close contact with adults in family clusters. However, transmission from children to others was rare,” the letter stated. Pulling data from cases in China, Spain, and Sweden, the authors conclude that “it might be prudent to anticipate an optimistic scenario when schools open.”
The Lancet Child & Adolescent Health journal featured a story on the mental health effects of school closures during COVID-19 underscoring its dire effect on children with mental health needs. Referencing a survey taken by the mental health charity YoungMinds, the author brings attention to the crippling number of problems students with disabilities face with remote learning. “… 2111 participants up to age 25 years with a mental illness history in the UK, 83% said the pandemic had made their conditions worse. 26% said they were unable to access mental health support; peer support groups and face-to-face services have been canceled, and support by phone or online can be challenging for some people.” School closures inevitably lead to a lack of resources that children usually have in school. This point is further explained by the author, “School routines are important coping mechanisms for young people with mental health issues. When schools are closed, they lose an anchor in life and their symptoms could relapse.” The author concludes that there is an urgent need to monitor young people’s mental health status over the long term and to study how prolonged school closures affect the wellbeing of children and adolescents.
The Lancet Child & Adolescent Health journal published an article outlining child health issues exacerbated by the COVID-19 pandemic. “By mid-April, 86% of the world’s children – more than 1.4 billion in total – were out of school,” the author states. Subsequently, remote learning only benefited some students, while 60% of primary school-aged students worldwide and 86% in low-HDI countries were effectively out of education. Poverty and deprivation disproportionately affect children. “Education, especially in the early years, must be prioritized, given its clear benefits in child development and reducing social inequalities.” The author concludes that remote learning produces inequalities for learning and that schools should be reopened in order to foster equal opportunities for children.
Nature Medicine, a monthly peer-reviewed journal, published an article riddled with age-structured epidemic data from China, Italy, Japan, Singapore, Canada and South Korea that concludes individuals under 20 years of age are less susceptible than adults to become infected with COVID-19. Moreover, the authors found that interventions aimed at children might have a relatively small impact on reducing COVID-19 transmission. “Understanding the role of age in transmission and disease severity is critical for determining the likely impact of social-distancing interventions on SARS-CoV-2 transmission, especially those aimed at schools, and for estimating the expected global disease burden.” To explore the effects of school closure, the authors simulated three months of school closures with varying infectiousness of subclinical infections. Their study found that school closures in response to COVID-19 did not have a substantial effect on cases. “…There were more clinical cases per capita projected in cities with older populations, and more subclinical infections projected in cities with younger populations. Among the three cities analyzed here, school closures had the least impact in Bulawayo, which has both the youngest population and the fewest contacts in school relative to the other cities (19% of contacts for 0- to 14-year-olds occurring in school, compared with 39% in Birmingham and 48% in Milan).” Based on their simulation, the authors conclude, “In countries with younger population structures—such as many low-income countries—the expected per capita incidence of clinical cases would be lower than in countries with older population structures.”
On July 9, 2020, the CDC Director, Dr. Robert Redfield, made a statement proposing that he considers closing schools a more extensive health issue than reopening schools. He stated, “I’m of the point of view as a public health leader in this nation, that having the schools actually closed is a greater public health threat to the children than having the schools reopen. I think really people underestimate the public health consequences of having the schools closed on the kids. I’m confident we can open these schools safely, work in partnership with the local jurisdictions.” In addition, he addressed the fact that the virus does not detrimentally affect younger individuals, continuing, “I don’t think we should go overboard in trying to develop a system that doesn’t recognize the reality that this virus really is relatively benign to those of us that are under the age of 20.” He added that the CDC is ready to collaborate with each school or each school district to safely reopen schools.
The National Institute of Allergy and Infectious Diseases (“NIAID”) Director, Anthony S. Fauci, M.D., has said, describing the lack of any data to support excluding children from normal activities: “One interesting feature of this novel coronavirus pandemic is that very few children have become sick with COVID-19 compared to adults.”
CityNews, a news and current affairs program in Canada, makes reference to The Hospital for Sick Children, Canada’s most research-intensive hospital dedicated to improving children’s health, whose physicians and researchers recommend that children return to school in September. The seemingly minimal risks of infection and transmission of COVID-19 in children needs to be balanced with the risks of the deterioration of children’s physical and mental health brought by school closure. These risks include behaviors, such as depression, exposure to domestic violence, child abuse, neglect, and suicide. The President and CEO of SickKids, Dr. Roland Cohn, declares that there are methods to lessening the risks of transmission, even when continuing daily activities, such as schooling. He states, “Not opening schools in September would continue to have a negative impact on the mental, behavioral and developmental health of children. We hope these recommendations help provide a framework to keep everyone safe when school doors reopen.” To further the case of reopening schools, it should be noted that children make up less than 5-10 percent of the global quantity of COVID-19 cases, and in Canada, as of June 15, individuals up to 19 years of age make up only 7 percent of all cases. The associate pediatrician-in-chief at SickKids, Dr. Jeremy Friedman, says that there were only 30 positive cases out of the 5,000 symptomatic children that were tested for COVID-19 with a nasal swab. Among the 1,5000 asymptomatic children tested with the nasal swab, there were zero positive cases. Also, once schools reopen, there are actions they can undertake to mitigate risks. These include screening students for coronavirus symptoms before going to school, enacting a routine schedule for hand hygiene, and promoting more outdoor or physical education classes activities to eliminate the need for physical distancing. 
There are many other public health concerns such as increases in child abuse and neglect,, malnutrition,, mental health, as well as increases in alcohol and drug use,, associated with keeping kids out of school.,,