Students attend their first day of school at Menchaca Early Childhood Center.
Students attend their first day of school at Menchaca Early Childhood Center in August 2018. Credit: Scott Ball / San Antonio Report

I have been watching the mayor’s news conferences on a regular basis since the Memorial Day surge in coronavirus cases. With the subject of reopening schools now a leading topic of discussion for many San Antonians, it only makes sense to include the voices of pediatricians at these conferences. Pediatricians deal with the uncertainty of illness in children on a regular basis and they are experienced at reassuring parents. They can lead the way in returning children to school safely.

In order to understand the risks of returning to school, children cannot be bunched into a statistic from 0-19 years. The age distribution of severe illness may vary by age group. That is why the data in San Antonio needs to be reported in different age groups. There are developmental characteristics and vulnerability to infection that need to be defined more accurately.

Children under one year of age and greater than 15 are more likely to be hospitalized with an acute coronavirus infection. Children greater than 15 are more likely to have more serious disease and require intensive care. Children with multi-system inflammatory syndrome, a rare complication of mild coronavirus infections, have different symptoms that vary with age.

The pediatric medical community needs accurate and detailed information to identify concerning trends. Southwest Texas Regional Advisory Council (STRAC) needs to provide more detailed information to pediatric epidemiologists for these concerns to be addressed properly. With schools planning a return to campus after Labor Day, pediatric concerns should not be left out of the COVID-19 response.

When I was managing critically ill children in the pediatric ICU, I felt it was my responsibility to research and document the reasoning behind every medical decision and list every potential life-threatening cause to be considered moving forward. Decision-making in a crisis is difficult, results are unpredictable. In a critically ill child, rapid deterioration can occur unexpectedly.

The American Academy of Pediatrics released guidance on how to return to school safely. Along with these steps, pediatricians can provide education on COVID-19 symptom management in healthy children, routine vaccination, and safe mask use. Local orders require children 10 years of age and older to wear masks in public, but the CDC recommends that children 2 years old and up wear face coverings.

Pediatricians can also identify children with high risk for more serious outcomes from coronavirus infections and provide recommendations on how to resume their education when they return to school.

Engaging and educating the family early in the decision-making process while maintaining transparency during rapidly changing circumstances develops trust and cooperation with future advice. A physician is uniquely qualified to establish and maintain these relationships. Physicians must be allowed the opportunity to communicate with the community like a family. Senior physicians in leadership need to take part in media presentations such as the mayor’s daily news conference in order to do so. To establish this relationship with the community we need Metro Health and the medical community to work together with the support of the City.

When the mayor addressed safety precautions prior to the Fourth of July weekend, hospital administration leadership gave added credibility to the importance of the safety precautions the mayor and judge have been emphasizing for months. We need this presence at every news conference, and it should include physicians of color, female physicians, pediatricians, pediatric infectious disease physicians, and children’s hospital representation to be able to reach the widest possible audience.

Physicians of color can better connect with vulnerable populations. Families can deal better with the anxiety of returning to school if pediatricians provide clarity about children’s health. The community will benefit from the unified efforts of Metro Health, the City, and the medical community.

Daniel Deane

Daniel Deane is a pediatric pulmonologist who retired in 2016 after 35 years in pediatric medicine.