September 2, 2020

The end of the summer of 2020 brings us to a back to school season like no other in living memory. What has been an age-old ritual, filled with excitement and anticipation in normal times, has become a much more complicated and anxiety filled prospect in the age of COVID.

Expert groups such as the National Academies of Sciences, Engineering, and Medicine, as well as the American Academy of Pediatrics (AAP), have published statements supporting a return to in-person learning for elementary and secondary school attendees, and a number of groups, including the CDC and AAP, have published guidance around how to do this safely. The underlying reasoning is that in-person learning is critical for children, especially younger children, to optimally learn, and that schools also provide so much more than academics – social and emotional development, peer connections and interactions, and for many children, schools are a primary source of nutrition, activity, and other important aspects of healthy growth and development. As physicians, we often see kids only once or a handful of times each year, but their schools and teachers see them five days per week through most of the year, and are therefore well positioned to know these kids well and be alert to changes in mood, attitude, and even spots signs of neglect and abuse. In addition, it may be difficult to adapt curriculum for kids receiving special educational instruction to fit a remote learning model.

This must be balanced with both the real and perceived risks of contracting COVID-19 when kids return to an in-person setting, which for many of these kids may be the first time they’ve been around large groups of people since they left school in March. Here in New Hampshire, we have been fortunate to have flattened the curve of COVID-19 infections and currently have a relatively low level of transmission and daily new cases in the state. Both NH DHHS and the NH Department of Education have released guidance for safe in-person school re-openings.

In a state like New Hampshire, where school districts have a significant amount of local control, it has been interesting to see the different approaches of various districts across the state. Some of the larger districts such as Manchester (grades 2-12), Concord, Exeter and others have decided to start the year fully remote. Other districts are going with a hybrid approach, with part of the learning in-person and part remote, and still others have decided to start the year with full time in-person instruction. The other variable here is that families have a choice, so regardless of what approach their district is taking, some families have weighed the risks and benefits and determined that they will have their kids learning remotely, at least to start the year.

It is important to also note that some families do not have the choice to have their kids attend school remotely, for various reasons such as limited or no internet connectivity, inability to have a parent at home with younger children due to work and an inability to afford child care, and other limitations that tend to adversely affect more Black and Brown families in the Granite State as well as across the country.  Educational inequities, which were already present before the pandemic, like many other inequities are being amplified due to COVID.

Given the known benefits and relatively low risk currently, it seems reasonable for a return to in-person learning as we head into the fall. The logistics are incredibly complex, and vary from district to district, but the guidance of all groups for safely resuming in person education centers on sound public health principles – consistent use of masks, physical distancing at ideally six or more feet, and frequent handwashing/sanitizing – which apply to our kids as they enter schools but also to all of us as we try to keep COVID at bay and strive to promote a safe and equitable learning environment for all of our kids across the Granite State.

In health,

John Klunk, MD
NHMS President

Please send comments or questions to john.klunk@nhms.org.