Shira Shafi, PhD, an associate professor of epidemiology and community health sciences at the UCLA Fielding School of Public Health, recently sent her 3-year-old son to preschool. So I asked her a few questions about how she prepped him—and her household—to best keep everyone protected. Below, her best advice on how to keep kids safe from COVID-19 this school year.
Well+Good: Let's start by establishing the precautions your son's preschool is taking. Are there vaccine and mask mandates in place?
Dr. Shafir: There is a mask mandate at the school, and that is the only reason we felt comfortable sending him back. Kids wear masks the entire day, inside and outside. The only time they take off their masks is when they're eating, and then, because they're small, when they're napping. But even when they're napping, they socially distance cots to ensure six feet of distance between the kids.
The preschool teachers are also required to be vaccinated. And while technically, by Los Angeles County mandate, the teachers would not have to wear masks while outside, the teachers (at my son's preschool) do because it really helps to set an example for the kids about the importance of mask-wearing.
Is there a specific type of mask you looked for that you felt would best protect your son?
The biggest thing for us was a mask that he would be able to wear all day comfortably. For kids, it can be a challenge to find the right one. We looked for the ones with at least two layers of fabric that covered up to his nose and under his chin, and that fit snugly against the face. And then, in our specific circumstances, dinosaurs were a must.
N95 masks are tested by OSHA here in the United States—the Occupational Safety and Health Administration—and since children don't work, there hasn't been the same level of testing [for efficacy] for child-size N95 masks. The data has shown that children who consistently wear masks—as long as they have multiple layers and they fit—are well-protected. They don't have to be N95 masks.
If I had a child who was immunocompromised, or I had someone in the household who was immunocompromised, I might think about the N95 masks. But for now, I feel comfortable with him in cloth masks. And then it's important to have some backup disposable masks, in case the cloth masks get soiled or they get wet—it is important to have multiple masks for use throughout the day to ensure that they can work.
He's obviously very young, but did you give your son any instructions before sending him off to school?
We talked about mask-wearing and hand washing. We also talked about what happens if you don't feel good, who you should tell, and how do you cover your mouth when you cough or sneeze—because even though he's wearing a mask, using his elbow [to catch the cough or sneeze] is not going to be a harmful thing. So those were the big things.
And then the school itself has really good procedures in place. We have symptoms screening on the way in, and if a child has any symptoms of any kind, they are excluded from the preschool.
You can't really have a conversation with a 3-year-old about social distancing. But if he had been 7 or 8, in addition to talking about mask-wearing, I would have talked about social distancing. I would have talked about the continued importance of consistent hand washing, and I would've given a bit more of an explanation of germs and why we want to make sure that we're doing everything we can to protect ourselves and our friends from them.
I know your expertise is not in psychology, but was there anything you did to prepare your son emotionally for returning to school?
This is really just from a parent's perspective, but he had spent eighteen months in the house with us, so we did have some conversations about going back to preschool, and who were the friends that were going to be there, etc.
The preschool sent over photos of the classrooms so that kids could see a picture of what it was going to be like at drop-off—because parents can no longer come in for drop-off. So they provided us with some really outstanding resources to help have those conversations with him about what to expect.
Then we emphasized that he was going to be with friends and he was going to get to be on the big play structure, and we said things like, 'Oh my gosh, they have all these trucks there.' So, we were explaining what it would be like but also doing a little bit of the childhood 'pump up' to get him excited for the experience.
Are there any precautions you take when he gets home?
For us, the most important thing we do when he comes home from school is making sure he washes his hands. There's nothing wrong with having a kid wash their face or get in the shower after school—that's never going to hurt—but it's not critical. Really, we're sort of relying on other measures happening at the school to reduce the risk of exposure.
There are five primary things that can be done in school-based settings to reduce the risk of COVID. The first is mask wearing all the time inside. The second is vaccination of everybody eligible. So, depending on the age of the schoolchildren, that might mean just the teachers and all of the adults who are in the school setting. It also might mean the students, if they are over the age of 12 and eligible for vaccination.
Good ventilation is absolutely key. Here in California, in many parts of the state, we are lucky that we're able to keep windows open or be outside for much of the day. Testing is also a key strategy to ensure that kids who are infected but not showing symptoms don't come into the school setting and expose other children. And then finally, the utilization of contact tracing and case investigation tools is important. All of these things together can help really keep kids at low risk during face-to-face instruction.
How would you change your safety strategies if he were in a school without vaccine and mask mandates?
So, in a setting where those who are over the age of 12 aren't vaccinated, and in a setting where kids aren't being tested and with the presence of the delta variant, we know it's extremely likely that the virus is going to circulate and children are going to get exposed and potentially infected.
I think wiping down high-touch surfaces isn't going to hurt. Having a kid wear an N95 mask if they're in a place where there is no existing mask mandate is probably reasonable if the child will wear it all day. And really trying to encourage children to make sure that they are keeping distance between themselves and other kids (which can be really challenging). But in places where there's not a vaccine mandate or a mask mandate, I think the calculus is very different on how to keep a child as safe as possible. And unfortunately, I don't have magical answers about how to do that because the magical tools I know of are masks, vaccines, distancing, and good airflow.
Do you have any other advice for parents on how to keep their kids safe from COVID-19 this school year?
We have incredibly safe and effective vaccines right now for children over the age of 12, and it's important to ensure that eligible kids are vaccinated, so they are protected to the greatest extent possible. We are optimistic that we will have vaccines available for children between the ages of two and 12, hopefully by the end of this year, but it may be the beginning of 2022. So vaccination is incredibly important. We also know that masking, helping kids understand the need to wear a mask all day, and social distancing are hugely important—all that can help minimize or reduce the risk for a child.
This interview was edited and condensed for clarity.
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