MILWAUKEE — As kids head back into classrooms this fall, they’re not the only ones who should be brushing up on some science.

Navigating the school year while keeping students safe is a delicate balance. And knowing what’s fact and what’s fiction when it comes to kids and COVID-19 can get complicated.

Here, we break some of the latest science-backed takeaways to keep in mind as another pandemic school year starts up — from current surges to mask guidance to vaccine outlooks.

As delta spreads, more children are getting infected… 

Across the country, pediatric COVID-19 cases are spiking amid the ongoing delta surge. 

“Despite what you may hear in some circles, there is no denying that our children are affected by COVID,” Dr. Ben Weston, director of medical services for the Milwaukee County Office of Emergency Management, said at a media briefing this week.

In Milwaukee County, children made up one out of every three new COVID-19 cases last week, local health officials said. That’s up from just around 20% of cases in mid-July, they pointed out.

One key difference for kids right now: “Delta, delta, delta,” said Dr. Gregory DeMuri, a pediatric infectious disease specialist with UW Health. The latest variant spreads much more easily than earlier versions, and kids have been feeling those effects.

“That change in the virus was just enough to really make it super transmittable and infect kids,” he said. “And, of course, most children are unvaccinated, so they don't have the protection that older people can get from the vaccine.”

And some are getting really sick

Even though younger people still tend to get milder symptoms, more kids are struggling with severe illness than ever before. 

Hospitalizations for children with COVID-19 have reached record highs in recent weeks. New hospital admission rates for minors are almost six times as high as they were at the start of July, according to CDC data.

Around 13% of COVID-19 hospitalizations in Milwaukee County are children, officials said at a briefing this week.

Children’s Wisconsin reported this week that it has not yet seen a significant increase in kids being hospitalized with COVID-19 — though it has been seeing an increase in kids testing positive for the virus.

Compared to other age groups, kids still have relatively low rates of severe illness and death from COVID-19, DeMuri said. But it’s all a “numbers game” — and if more kids get infected with the virus, more will end up getting really sick. 

More than 500 children under the age of 18 have died from COVID-19 across the country, the CDC reports. 

Wisconsin has seen a handful of cases of MIS-C, a rare inflammatory syndrome that has been linked to COVID-19. Another key question for doctors right now is how long-haul COVID-19 might affect younger age groups, too, DeMuri said.

Plus, while we should be worrying about kids’ health for their own sake, we should remember that they can also pass along infections to others — including older family members who may be more vulnerable to serious symptoms.

“Kids are an important link in the transmission, especially with delta,” DeMuri said. “So we're not going to get anywhere progress-wise in combating this disease unless we address the disease in children.”

Masks are safe and recommended for kids

Across Wisconsin, school masking policies vary from district to district. But to get back to in-person learning, DeMuri said mandatory masking policies are “absolutely a must at this point.”

“It’s just a matter of time with the delta variant before you have an outbreak,” DeMuri said. “You’re a ticking time bomb if you’re a school that’s not masking right now.”

The CDC and the DHS both recommend universal masking for students, teachers, stuff and visitors while they’re indoors at school — whether or not they’re vaccinated.

A common argument against school mandates is that masks are harmful for kids to wear. But DeMuri and other health experts stress that, according to the wider scientific evidence, masks are safe and don’t cause low oxygen levels for kids.

In fact, one of the major studies that circulated — which claimed to show masks expose children to harmful carbon dioxide levels — was retracted by the medical journal where it had been published. Editors of the journal raised concerns that the study didn’t use the right equipment to accurately measure carbon dioxide levels.

Some parents have also raised questions about whether wearing masks will cause problems for kids’ social and emotional development, since they won’t be able to read facial expressions. 

That’s a “legitimate concern,” DeMuri said — but the research so far has not shown significant effects of masks on development. Kids are pretty good at reading other nonverbal cues, he said. And other experts have noted that getting unmasked time with family at home (a much safer setting when it comes to COVID-19) can help fill in some of the gaps.

Vaccines may be coming soon for younger age groups… 

One big reason kids are making up a bigger share of COVID-19 cases: The vaccines are still only authorized for those over 12 years old, DeMuri said.

That could change soon, as U.S. officials have reported that authorization for younger age groups may be coming this fall. Trials across the country, including at UW Health, have been working to test the shots’ safety and efficacy for kids.

Though he’s “kind of impatient” waiting for the approval to come through, DeMuri said he appreciates the effort to make sure vaccines are 100% safe for kids — and expects to hear news by the end of the year.

Technically, now that the Pfizer vaccine has full FDA approval, doctors can prescribe it for “off-label” use in those under 12 years old. But experts, including the American Academy of Pediatrics, have advised parents to wait for the federal go-ahead.

“Children are not just small adults,” Weston pointed out. Researchers also have to figure out the right dosage for these younger age groups, he said — one that minimizes side effects while maximizing immunity.

And kids over 12 are urged to get their shots

For kids 12 and up, though, experts emphasized that getting the vaccine can help create safer classrooms.

In Wisconsin, younger age groups are lagging behind in vaccination rates. Around 45% of residents aged 12 to 15, and around 51% of those 16 to 17, have gotten at least one dose, according to DHS data.

In a back-to-school webinar, experts from Children’s Wisconsin explained that vaccines are safe and effective for older kids and teens, according to clinical trials and real-world data. 

There have been some reports of myocarditis — an inflammation of the heart — in older teens who received the vaccine. But these cases are extremely rare, and the risk of myocarditis is much higher for a teen who gets COVID-19 than one who gets a vaccine, said Dr. Smriti Khare, president of primary care at Children’s Wisconsin.

“We strongly believe that the benefit of the vaccine, even with this rare complication, is significantly more than the risk,” Khare said.

In-person school makes a big difference for kids’ mental health and learning

There’s no doubt that returning to in-person learning during a pandemic brings up big challenges — and we’ve already seen plenty of bumps in the road, experts said.

But getting back to the classroom is worth the effort, pediatrician Dr. Kristin Bencik-Boudreau said at the Children’s Wisconsin webinar.

“Kids have to be in school. They need it so much,” Bencik-Boudreau said. “Their emotional needs, their educational needs. For some, it’s a way of getting food.”

Research has found that the last pandemic school year led to major learning loss for students. A McKinsey analysis estimated that children were months behind in their learning after the 2020-21 school year — and some studies have found that low-income and minority students saw steeper declines.

Young people’s mental health also suffered last year, DeMuri said. A number of mental health indicators skyrocketed in kids and adolescents during the pandemic — including eating disorders, depression and anxiety symptoms and emergency room visits for mental health crises.

“We attribute that to the isolation that occurred,” DeMuri said. “We know that kids need to be around other kids. They need to interact.”

Multiple layers of protection can keep kids safe

Some kids with compromised immune systems, or other complex health conditions might still consider opting for virtual learning this year, experts noted. 

For many children, though, keeping kids in school — safely — is a big priority this year. Doing that will require “risk balance” and multiple layers of protection, DeMuri said.

There will always be some risk involved with gathering groups of people together, Weston pointed out. But measures like maintaining social distancing, keeping kids home when they’re sick and improving ventilation in the classroom — as well as wearing high-quality masks, like KN95s or surgical masks — can keep students safer, he said.

Even those who are vaccinated should be careful, Khare said. Like she explains it to kids, Captain America still uses his shield to protect him even after his "super soldier serum" makes him strong — and you can still use masks and other tools even after the vaccine boosts your immune system.

DeMuri also emphasized being careful about activities outside of school, like sports and family gatherings, since contact tracing last year found that many kids were infected in other settings besides the classroom.

As a whole, experts encouraged paying attention to the constantly changing COVID-19 situation in your community — and adding as many preventive layers as you can to stop the spread.

“We can do this, and we can do it safely,” Bencik-Boudreau said. “And we absolutely have to do it.”