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COVID Learning: Bay Area Doctors Sign Letter Calling For California Schools To Reopen Feb. 1

SAN FRANCISCO (KPIX) -- A group of Bay Area doctors are calling for California schools to reopen as soon as possible.

"We have a proposal put through for a March 1 opening, and we have Gavin Newsom advocating for kindergarten through sixth grade to go back to school in February," says UCSF Dr. Jeanne Noble. "Frankly, those both fall short."

Noble is a Professor of Emergency Medicine, and just one of the thirty UCSF health care professionals - from infectious disease experts to adolescent health specialists - calling for a reopening of California schools as soon as February 1. They say 10 months of lost learning and the mounting social isolation caused by the closures outweighs the risk posed by reopening.

"They are suffering," Noble says. "There are a lot of real measurable detrimental impacts from school closure that, in general, have not received nearly the amount of attention as the COVID numbers have."

That argument runs squarely into the position of teachers' unions.

"I know that this is not good for any child, but I also know that it is far worse for a child to lose a parent or lose a grandparent that takes care of them," East Oakland Pride Elementary teacher Adi Hoag said at a protest last week.

Teachers have asked for mass vaccination and a host of other precautionary steps before returning to classrooms.

"Two points there," Noble explains. "One, we support early vaccination for teachers. Two, we don't think vaccination is a requirement for them to enter the classroom. The reason is that schools can be operated safely and we have a lot of data on that."

READ: Bay Area Health Professionals Call for February 1 School Reopening

Long term school closures have a detrimental, measurable impact on children and adolescents. While school closure is challenging for all families, households which include essential workers and those with limited financial means are disproportionately impacted. Children with special needs, in particular, are uniquely negatively impacted because they depend on in-person learning for educational, rehabilitative, social, and behavioral resources that cannot be adequately supported in distance learning, resulting in additional stress on these families. School closures have widened the achievement gap. Educational inequities have the potential to translate into a lifelong barrier and a staggering number of life years lost (JAMA Netw Open. 2020;3). In California, many private schools reopened during the Fall, while the majority of public schools have been closed since March. The essential societal role of public education is reflected in Article IX of California's constitution, which mandates unfettered access to education for all children to ensure that a child's ability to participate in public education is not dependent on the financial means of their family.

Because literacy and health literacy influence health status, prolonged school closure is contributing to social isolation among children and adolescents. It is taking a heavy toll on their mental health and well-being . The Emergency Department at Benioff Children's Hospital-Oakland reported a temporal increase in the proportion of all children and youth (10 to 17 years) who reported suicidal ideation, from 6% in March 2020 to 16% in September 2020. Similarly, the CDC reported that compared to 2019, the proportion of pediatric emergency visits due to mental health issues in 2020 increased by 24% among children ages 5 to 11 and by 31% for children ages 12 to 17. Apart from social isolation, an increase in high-risk behaviors among youth could be related to a lack of parental or adult supervision. The cumulative long-term impact of trauma related to social isolation, educational distress, family stress, and other stressors may culminate in post-traumatic stress disorder, depression, anxiety, and other behavioral disorders. It is reasonable to expect that children who live in poverty are even more likely to experience these adverse outcomes.

There is also a real concern for significant but unknown drops in student attendance, especially in disadvantaged communities with less access to computers and the internet for online learning. School districts around the country are reporting higher rates of students failing classes, a phenomenon which has been disproportionately seen among low-income Latinx and African American children.

Since March 2020, we have learned that young children are not the primary drivers of COVID-19 transmission. We have also learned that children are generally not at risk of severe health consequences from COVID-19. Indeed, in the entire state of California there have been only 5 COVID-related deaths among persons younger than age 18. For

comparison, there were 15 deaths due to influenza in this same age group during the 2018-19 flu season. Fortunately, there is accumulating evidence from the Bay Area and other states that schools can safely reopen. In Marin county, for example, more than 450,000 "student days" (i.e., tens of thousands of students on school campuses for over 3 months) have been associated with just six cases of school-based transmission. That is, there have been only 6 additional COVID cases resulting from 40,000 students and 5,000 teachers interacting on campus since September. There is similarly reassuring data from the state of New York where COVID prevalence is no higher among high school students and teachers who returned to campus compared with community matched prevalence rates.

Teachers and other school staff are key players in this process and should be viewed as essential workers. Their health and safety are paramount. Fortunately, we now have robust data demonstrating that schools may be safely re-opened and school-based transmission remains very infrequent when universal masking and social distancing rules are carefully followed. We support the availability and use of universally accepted PPE including surgical masks and face shields for all school staff. We also support their prioritization for vaccine administration along with appropriate testing and COVID-related time-off alongside other essential workers, though school opening can and should proceed prior to vaccination availability or completion.

Following the lead of many European and Asian countries, we believe that California schools should be the first sector of our economy to reopen and the very last to close. Given the significant negative health and educational consequences of school closures for children and their families, coupled with robust data supporting reopening with appropriate mitigation strategies, we strongly support efforts to reopen California schools as soon as possible. Prioritizing reopening must include adequate resources to support the most important mitigation strategies: universal masking and social distancing. As pediatricians, internists, infectious disease specialists, epidemiologists, emergency physicians, and other healthcare professionals, we believe these strategies need immediate support and implementation, so that all schools can reopen for in-person learning by February 1st or as soon as permitted by the state.

Jeanne Noble, MD, MA
Associate Professor of Emergency Medicine
Director of COVID Response, UCSF Emergency Department

Elena Fuentes-Afflick, MD, MPH
Chief of Pediatrics, Zuckerberg San Francisco General Hospital
Vice Dean for Academic Affairs
University of California, San Francisco

Jackie Grupp-Phelan MD MPH
Chief Pediatric Emergency Medicine
UCSF Benioff Children's Hospital
Vice Chair Department of Emergency Medicine

James E. Crawford-Jakubiak, MD
Professor of Pediatrics
Medical Director, Center for Child Protection
UCSF Benioff Children's Hospital Oakland

Judith Walsh MD, MPH
Professor of Medicine and
Epidemiology and Biostatistics
Division of General Internal Medicine
Associate Medical Director
Women's Health Primary Care Clinic
University of California, San Francisco

Elizabeth Rogers, MD
Associate Professor of Pediatrics
Associate Vice Chair for Faculty Development
Chief Experience Officer, Department of Pediatrics
Director, Intensive Care Nursery ROOTS Small Baby Program

Margaret McNamara, MD
UCSF Professor of Pediatrics
Director, Pediatric Residency Program

Mitul Kapadia, MD MSc
Associate Professor of Pediatrics and Orthopedics
Director of Pediatric Rehabilitation, UCSF Benioff Children's Hospital San Francisco

Maria Raven, MD
Vice Chair and Chief of Emergency Medicine
UCSF Medical Center

Christopher B. Colwell, M.D.
Chief of Emergency Medicine
Zuckerberg San Francisco General Hospital and Trauma Center
Professor and Vice Chair, Department of Emergency Medicine
UCSF School of Medicine

Sarah Doernberg, MD, MAS
Associate Professor of Clinical Medicine
Division of Infectious Diseases
University of California, San Francisco

Margaret E. Feeney MD, MSc
Edward B. Shaw Chair and Professor of Pediatrics
Division of Pediatric Infectious Diseases
University of California, San Francisco

J. Matthew Aldrich, MD
Executive Medical Director, Critical Care Medicine
Clinical Professor
Anesthesia and Perioperative Care
University of California—San Francisco

Judith Klein, MD
Assistant Professor of Emergency Medicine
UCSF-ZSFG Department of Emergency Medicine

Shannon Lundy, PhD
Associate Clinical Professor, Department of Pediatrics
Director of Psychology Services, Division of Developmental Medicine
UCSF Benioff Children's Hospital

Amy Beck, MD, MPH
Associate Professor of Clinical Pediatrics
University of California San Francisco/Zuckerberg San Francisco General Hospital

Melanie Callen, MEd
Assistant Clinical Instructor Pediatrics
Child Development & Educational Specialist
University of California, San Francisco/Zuckerberg San Francisco General Hospital

Alejandra Rincon, PhD
Associate Adjunct Professor Family and Community Medicine
Curriculum Lead Latinx Center of Excellence (LCOE)
University of California, San Francisco

Darrow D. DeLuca, MD
Pediatric Hospitalist
UCSF Benioff Children's Hospital, Oakland

Maya Vijayaraghavan, MD, MAS Assistant Professor of Medicine
Division of General Internal Medicine
University of California, San Francisco

Roxanna A. Irani, MD, PhD
Ambulatory Executive Medical Director for Women's Health
Assistant Professor
Division of Maternal-Fetal Medicine
Department of Obstetrics, Gynecology & Reproductive Sciences
University of California San Francisco

Kimberly Newell Green, MD
Assistant Clinical Professor, UCSF
Past President San Francisco Marin Medical Society

Shannon Udovic-Constant, MD
UCSF Associate Clinical Professor
Chair, California Medical Association Board of Trustees

Nora Pfaff, MD
Assistant Clinical Professor of Pediatrics
Division of Hospital Medicine
University of California, San Francisco

Jahan Fahimi, MD, MPH
Medical Director, UCSF Emergency Department
Associate Professor of Emergency Medicine

Abbey Alkon, RN, PNP, PhD
Professor, UCSF School of Nursing
Director, California Childcare Health Program

Celeste Allen, MD
Director, Pediatric Residency Program
Attending Physician, Primary Care and Adolescent Health
Assistant Clinical Professor, UCSF

Lydia Tinajero-Deck, MD
Attending physician
Primary Care Department
UCSF Benioff Children's Hospital Oakland

Rebecca L McEntee, MD
UCSF Department of Family and Community Medicine

Pooja Mittal, MD
Adjunct associate professor
UCSF-ZSFG Family and Community Medicine

Andrea Marmor, MD, MSEd
Professor of Pediatrics
Medical Director, Pediatric Asthma/Allergy Clinic
Zuckerberg San Francisco General Hospital
University of California, San Francisco

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