Heading Back to School (Safely) During COVID-19

The Basics

Early in the pandemic, we saw steep declines in well-child care from physicals to routine and catch-up vaccinations. Fortunately, over the past year many practices re-opened and many patients returned to the office for routine care, but for some families, the preventive care gaps have not yet been closed. Back-to-school wellness visits are a great time to get back on track with appropriate screenings and vaccinations.

This year, in addition to the routine vaccines, be prepared to talk to families about the COVID-19 vaccines. The Advisory Committee on Immunization Practices and the AAFP recommend use of the appropriate COVID-19 vaccines for everyone ages 12 and older within the scope of the FDA’s emergency use authorization for the particular vaccine. The CDC has a helpful website that includes FAQs on the topic.

I am often asked two questions about COVID-19 vaccines and well-care visits:

1. My patient is due for other vaccines, like Tdap, HPV and MCV13. Can they be given on the same day as a COVID-19 vaccine? Yes. COVID-19 vaccines and other vaccines may be administered on the same day.
2. My patient needs a tuberculin skin test or interferon-gamma release assay to check for tuberculosis. Can this be performed at the same visit as a COVID-19 vaccine? Yes. Testing for TB infection with a TST or an IGRA can be performed before or during the same encounter as COVID-19 vaccination. It is recommended that the TST be placed or blood drawn for the IGRA before the COVID-19 vaccine is administered.

Supporting Vaccine-hesitant Families

The AAFP recommends that members strongly recommend vaccination to their patients, including against COVID-19, but not all patients will immediately agree with your recommendation. Vaccine hesitancy certainly isn’t new to family physicians. Long before COVID-19 was in our vocabulary, we have been helping our patients understand the value of vaccination and risks of vaccine-preventable diseases. The AAFP offers resources to help FPs communicate effectively and with empathy as well as information designed specifically for patients.

Patients who otherwise have no concerns about vaccination may raise concerns about the COVID-19 vaccine. These questions typically center around creation of the vaccine, emergency use authorization vs. full approval, and concerns about safety and adverse effects.

Unfortunately, misinformation about COVID-19 vaccines is widely available in the media, especially on social media. You can help by first hearing your patient out and listening with empathy to understand the source of their concerns. Then, you can clarify any misconceptions or misinformation by pointing them to reliable and accurate sources of information. Use AAFP resources such as the COVID-19 and COVID-19 Vaccine webpages to stay up to date. Lately, I have found myself brushing up on simple ways of explaining concepts like relative risk, herd immunity and breakthrough infections. Having go-to examples has made these conversations much easier for me.

Finally, be mindful about your own biases and preconceived notions about why parents may hesitate about giving COVID-19 vaccines to their children. Visit the AAFP’s EveryONE Project and the diversity and health equity resources from FPM to learn more about implicit bias and the underlying systematic racism that may cause some of your patients to not immediately assume the medical field has good intentions with novel health care treatments.

To Mask or Not to Mask

I have been surprised at the level of debate over the use of facemasks in general, but specifically in our schools, given that children under age 12 are currently unable to be vaccinated. If someone had told me before that community mitigation strategies such as wearing a mask and handwashing campaigns would drop the infection rates of influenza, RSV and colds to historic lows, I’d have worn a mask every fall and winter without hesitation!

The AAFP continues to support masking in indoor environments to reduce the spread of COVID-19, consistent with the current CDC recommendations. The AAFP also continues to support leveraging other mitigation strategies, such as social distancing, sanitation, handwashing, contract tracing and remaining home when ill.

Return to Sports and Activities

Over the past year we have seen our professional, collegiate and Olympic athletes return to modified activity, so it is no surprise that youth sports will resume as the school year starts again. Like routine well-child visits, sports preparticipation physicals are great opportunities for catching up on preventive care.

This year in addition to asking about injuries, concussions and nutrition plans, be sure to mention COVID-19 precautions. Helping athletes protect themselves and their teammates is a key message of the Made to Save campaign, which has some great patient information for parents and athletes about COVID-19 vaccination.

Another great way to hardwire COVID-19 vaccination into your practice could be as simple as updating your physical forms with COVID-19 vaccination status to help you remember to ask about (and recommend) this vaccination. In fact, earlier this month the Academy joined with several other organizations in encouraging clinicians to make COVID-19 vaccination part of the conversation you have with patients and parents as part of a preparticipation physical. Also, since sports does involve close contact, sharing your practice’s procedure for getting tested or evaluated if an athlete develops symptoms would be helpful anticipatory guidance.

Consider Mental Health and Social Needs

Finally, we all know that returning to school is going to produce a wide range of emotions for parents and kids, from fear to excitement. Be intentional about asking how they are feeling and allowing a safe space to share their feelings. Allow your pediatric patients to share their feelings, which may not be the same as their parent’s or guardian’s.

While being away from friends felt traumatic for some children, for others it was a welcome relief from bullying. And some children may be excited to return to school as a source of reliable meals or as a safe place free from abuse. Use your well-child visit as an opportunity to check in on how your pediatric patients are doing mentally as well as physically. Learn about their support system and provide parents with any needed guidance or support for behavioral health or social needs. The AAFP’s Neighborhood Navigator is a helpful tool for connecting your patients to local resources that address these needs.

Margot Savoy, M.D., M.P.H., is the AAFP’s senior VP for education.