Are seniors being put at risk if children return to school?

Researchers found that 3.3 million seniors lived with school-aged children.

By Dr. Jay Bhatt and Dr. Laith Alexander
This article was originally posted on abcnews.com on July 21, 2020.

Millions of seniors – particularly those of ethnic minorities – are living with school-aged children and could be put at risk when kids return to school, according to a new report by Kaiser Family Foundation (KFF), a health policy group.

Children represent a small portion of the total number of coronavirus cases, with recent CDC reports showing figures around or under 5%, although the precise percentage varies from report to report.

Nevertheless, concerns have been raised that children could transmit the virus, even when asymptomatic. The consequences of this are amplified if the children are living with vulnerable adults at home, such as elderly relatives.

Children are less likely to transmit COVID, but not zero risk,” Dr. Lenore Jarvis, an emergency medicine physician and director of advocacy and health policy at the Children’s National Hospital in Washington, D.C., told ABC News. “Special considerations are needed … for seniors in the home.

The report by KFF also warned that reopening schools might be more dangerous for families of color, which are more likely to live together in multi-generational households.

I have actually been talking to parents of my patients about this very issue this week," said Dr. Keila Lopez, a pediatric cardiologist at Texas Children’s Hospital. “In school districts where there are predominantly minority populations and often times lots of essential workers, multi-generation households are already at higher risk of exposing the older generations.

Added Jarvis, “Unfortunately, persons of color are disproportionately affected with regards to many factors: for both in-school learning and keeping children at home.

Collectively, researchers found that 3.3 million seniors lived with school-aged children. That’s approximately 6.4% of people over the age of 65, according to figures from the 2018 Census Bureau.

The proportion varied state by state. California, Florida and Texas had particularly high numbers of older people living with school-aged children. The proportion was highest in Hawaii, where 15% of seniors lived with a school-aged child.

It’s a real conundrum,” Terry Fulmer, nursing leader and president of the John A. Hartford Foundation told ABC News. “Because working mothers can’t stay home and older relatives and friends try to help. Until vaccines it’s really a quandary.

What does this all mean? Well, it’s hard to say.

We still don’t know much about coronavirus transmission from children. While it can occur, studies suggest that it’s pretty rare. According to a review of recent research by pediatric doctors, “studies of multiple family clusters have revealed children were unlikely to be the index
[first] case.”

When it comes to COVID-19 and reopening schools, experts agree that the situation is complex and there’s a balance of risks to be struck.

Keeping schools closed has substantial consequences for kids’ education and their long-term development. The American Academy of Pediatrics “strongly advocates that the goal should be to have students physically present in school,” according to recent guidance. “This should happen with careful measures to keep students and staff safe.”

But the possibility of transmission from school-aged children to elderly household contacts, while rare, is there, and increases for certain segments of the population.

The reality is that because of the deep structural aspects of racism past and present, people of color are at much higher risk of living in crowded multi-generation households,” said Dr. Diane Meier, professor of medicine at Mount Sinai Hospital and director of the Center to Advance Palliative Care. “For older adults living with their adult children and their grandchildren, this is triple jeopardy — being older, being economically impacted and unable to keep at a physical distance.

One action that could mitigate this unfair and unjust risk is investments in senior housing with both medical and social resources, added Meier.

These statistics reflect just one factor amongst many that officials need to think about when reopening schools.

While there is certainly the potential to further widen disparities, how significant that potential is depends on the health, comoribid conditions and age of the persons living in the household, as well as individual school policies, abilities to social distance, hand washing procedures, and having everyone masked at all times,” Lopez said.

Flexibility will be key,” Jarvis said, “and there’s likely not a ‘one-size-fits-all’ approach. Each community, school and family will have to make choices to keep them safe.

Dr. Jay Bhatt is a practicing internist, an Aspen Health Innovators Fellow and an ABC News contributor. Dr. Laith Alexander is an Academic Doctor at St Thomas’ Hospital, London, U.K., working with ABC News Medical Unit.

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