The US grapples with a rise in infections and a shortage of covid-19 tests 1:54
(CNN) -
Millions of children in the United States will return to classrooms in the coming days, just after new pediatric hospitalizations for COVID-19 hit an all-time high.
And that leaves many parents wondering what is safe as the omicron variant travels the country.
"We fear things will get a lot worse from the end of the year and after school meetings," said Dr. Stanley Spinner, medical director of Pediatrics and Urgent Care at Texas Children's in Houston.
Some cities and school districts are taking aggressive new measures.
Several Atlanta-area school districts delayed face-to-face classes and will begin 2022 with remote learning.
In Washington, all public school students and staff must show proof of a negative COVID-19 test before returning from winter break.
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In New York City, public school students who test positive will receive a week of home testing to find out when it is safest to return to school.
But do vaccinated students still need to wear masks?
What should families do if they can't get tested for covid-19?
Should activities like choir and basketball practice be put aside until the omicron surge passes?
Here's how several pediatricians and health experts answered some of the most critical questions from parents:
Should children go back to classrooms at this time?
Health experts are divided.
In very high transmission areas, it might be too early to resume in-person learning, said pediatrician Dr. Peter Hotez.
"I wouldn't do it now," said Hotez, dean of the National School of Tropical Medicine at Baylor School of Medicine.
"There is an impressive level of transmission in the Northeast, in New York City and Washington. In trying to open schools at this point, it's hard to imagine how well things will go."
How is omicron different from other variants?
This is what we know 2:50
But the US Department of Education urged school districts to take safety precautions and ensure that classrooms are open for in-person learning.
"It is very important that all schools work to remain open to in-person learning five days a week, especially in light of the omicron variant," according to a new resource guide aimed at school leaders and obtained by CNN.
Pediatrician Dr. Paul Offit said it is important for children to be able to stay in classrooms, and not just for their academic health.
"There are many benefits to learning on the spot. Kids need the socialization that comes with being in school," said Offit, director of the Center for Vaccine Education at Children's Hospital in Philadelphia.
He commented that many children also depend on school meals.
And in some cases, the signs of child abuse are only noticed at school.
Still, many students returned to classrooms Monday, just two days after the New Year's Eve celebrations, said Dr. Lawrence Kleinman, vice chair of the Department of Pediatrics at Rutgers University.
And because covid-19 testing may not detect new cases until a few days after infection, some schools or parents may choose to delay the return by a few days to allow more time for testing, Kleinman said.
Should children be tested before going back to school?
Katie Lucey administers a COVID-19 test to her son Maguire on December 16 in New York.
Credit: AP Photo / Ted Shaffrey
"Getting children back to school has to be the priority, but doing it safely has to be paramount," said epidemiologist Dr. Abdul El-Sayed.
"So I think that requiring a negative test before going back to the classroom is a prudent approach here."
However, many families cannot find rapid tests or cannot afford them.
And a federal program to make millions of tests available for free has yet to begin.
Offit said he doesn't think children should necessarily get tested before going back to school, unless they have recently had contact with someone who has COVID-19 or if they have symptoms.
"If you're otherwise healthy, you don't really need to be tested," he said.
But if a child has symptoms "and if you can't assess them, assume it's covid-19," Offit noted.
"And then follow all the guidelines, that is, quarantine until you are asymptomatic and mask for five days after that."
Can parents feel safer if their children are vaccinated?
"Definitely," said pediatrician Dr. James Campbell.
"Your sigh of relief should be knowing ... that even if a child does contract a breakthrough infection, they are likely to only develop cold symptoms."
While the omicron variant is more contagious than any previous variant, children who are vaccinated have a great advantage.
"In the past, they didn't have access to a vaccine or they weren't vaccinated, they would have had a higher risk of potentially being hospitalized," said Campbell, a professor of pediatrics and a specialist in pediatric infectious diseases at the University of Maryland.
"But now that risk has decreased because of having been vaccinated, even with this new variant."
Covid-19 rapid test prices rise 0:52
Why vaccinate children if the omicron variant could be milder?
Early studies suggest that omicron causes less severe disease than the delta variant.
But because omicron is so much more contagious than delta, doctors say the gross number of children hospitalized in the coming months could be higher.
In fact, new hospitalizations for covid-19 among children reached a record during the holidays.
During the week ending Dec. 28, an average of 378 children were admitted to hospitals every day with COVID-19, according to CDC data.
That's a 66% increase from the previous week.
It also beat the previous record, set during the rise of the delta variant.
And nearly all children currently hospitalized for COVID-19 are not vaccinated, said the president of the American Academy of Pediatrics.
"What we're hearing from hospitals, really across the country, and this is very consistent, is that the vast majority of children who come in are not vaccinated," Dr. Lee Savio Beers told CNN on Thursday.
"Not being vaccinated significantly increases the risk of hospitalization."
For children who are not yet fully vaccinated, doctors say other safety measures become even more important.
In some cases, children who start out with mild or no symptoms of Covid-19 end up hospitalized weeks or months later with a condition called MIS-C, multi-system inflammatory syndrome in children.
MIS-C is "a rare but serious condition associated with COVID-19 in which different parts of the body become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs." according to the US Centers for Disease Control and Prevention.
Covid-19 seems to affect some children 4:08
And long-term complications of Covid-19 can be significant for children, even some who initially had mild or no symptoms, the American Academy of Pediatrics noted.
Offit said children and everyone in their household should get vaccinated as soon as they are eligible.
During a recent weeklong rotation at his hospital, "we admitted a lot of children. None of them had been vaccinated," Offit said.
"They were not vaccinated. Their parents were not vaccinated. Their siblings were not vaccinated," he said.
Should fully vaccinated children wear masks to school?
All pediatricians interviewed for this article said yes.
"We have layers of protection. And getting vaccinated is perhaps the most important of those layers," Kleinman said.
"But it is not completely sufficient because it is imperfect. They are all imperfect layers," he said.
"This is a model of Swiss cheese ... each (layer) has holes, just like Swiss cheese."
So while the vaccination layer has the smallest holes, other layers, such as masking and spacing, are also important, Kleinman noted.
Also, it is not yet clear how much vaccinated children can pass the omicron variant on to others, such as younger siblings who are too young to be vaccinated, Kleinman said.
While some vaccinated children may be disappointed to hear that they still have to wear a mask at school, "simple explanations work quite well for them," Campbell said.
"And that is, the virus has gotten smarter. And it is infecting people better. Your vaccine will definitely protect," he said.
"But it can still infect you, which means you can still catch a cold, you can still have a fever. You can still feel a little sick."
Covid-19 tests at Chicago Public Schools students' homes accumulate in a FedEx mailbox on Tuesday.
There's also a broader reason why students should avoid getting infected, even if they don't get sick, Campbell said.
Reducing infections is essential to help prevent new variants that could further prolong this pandemic.
"If the virus is defeated to the point where there is very little circulation, less circulation, then less replication," Campbell explained.
"The lower the replication of the virus, the less chance it has of mutating."
What kind of masks should kids wear right now?
Much has changed since the last school year.
The once dominant alpha variant has been replaced by the more contagious delta variant, which has been overtaken by the even more contagious omicron variant.
That means basic cloth masks with gaps around the edges will no longer stop you, said Mercedes Carnethon, vice president of preventive medicine at Northwestern University Feinberg School of Medicine.
He also advised against masks that have valves or vents.
"They are quite effective in spreading covid," he said.
Instead, three-layer surgical masks with an adjustable nasal wire and KN95 masks are much more useful, Carnethon said.
"That's really what you need to keep the air from escaping," he said.
More than ever, a good fit is important, Carnethon said.
One way to test fit is to have a child put on a mask and then goggles or sunglasses.
If you can feel the air leaking or fogging up your glasses, this is not a good option.
Are children the new victims of the pandemic?
3:08
Should activities like choir and basketball be put aside for now?
"I think it's a very difficult question," Kleinman said.
Ideally, students in activities that involve heavy breathing should be vaccinated, along with coaches, principals and any other nearby adults, he said.
"Testing is the other thing that is friendly to all of these activities," added Kleinman.
The answer should also depend on how rampant COVID-19 is spreading in a community, Campbell said.
"They may just have to say, 'Well, we're going to have to suspend (certain activities) for some time,'" he said.
"But I think just stopping all after-school activities is probably wrong at this point."
Children who are frustrated by current COVID-19 safety precautions should take comfort in knowing that they may not last much longer, Offit said.
Like several other health experts, Offit commented that he expects the current increase in covid-19 cases to start to decline in the coming months.
"So hang on for six weeks if you can," he said.
And by then, more children are likely to be vaccinated as well.
CNN's Liz Stark, Jen Christensen, and Sarah Fortinsky contributed to this report.