I'm a pediatrician and I think we should reopen schools, even with the risk of coronavirus outbreaks

• At least 55 million US students are out of school due to the coronavirus pandemic.
• Being away from friends and school can lead to mental health issues and other problems.
• Dr. Kelly Fradin, a pediatrician, is urging administrators to open schools in the fall, despite the risks.
• Fradin argues that the risks children face from being out of school could be worse than coronavirus-related ones.

It's understandable that parents, administrators, and teachers are hesitant about schools opening up again as the coronavirus pandemic continues. Children tend to have worse hand hygiene than adults, touch their faces often, and invade personal spaces more frequently, putting them at a heightened risk for getting sick and infecting others.

As a pediatrician, at the start of every school year, I see the steady stream of colds and the other viral illnesses that come with children spending time together in close quarters in the classroom. While it appears that children are less susceptible to contracting and spreading the coronavirus, they're still at risk.

But keeping children home, away from peers, teachers, and a structured routine, will put them at risk for problems that could outweigh the dangers of the coronavirus.

Keeping children out of school puts them at a greater risk of developing mental health issues

Those risks include missed learning opportunities, developing mental health issues, and engaging in less physical activity. Children with disabilities are at an even greater risk for regressing and worse developmental outcomes, especially if they rely on school-based therapies.

As individual families, we often prioritize and invest in our children — selecting our neighborhoods based on school options. As a society, one of the first priorities is education and wellbeing of our children.

However, during the pandemic, children seem to have been our last priority.

Stoking the fear around sending children back to school is the news about small outbreaks linked to school openings in other places, including Israel, Canada, and France. When these outbreaks occur, it creates doubt for those who hope that children will be able to return to school.

It's nearly impossible to understand with certainty how transmission occurs. We do know that young children are less likely to spread coronavirus than adults. We've seen some reassuring anecdotes. Data from the Netherlands and Australia show that despite cases in open schools with hundreds of exposures, infection of other students was rare.

If among about 100,000 schools that have reopened, there are a handful of small outbreaks, that doesn't necessarily indicate failure.

The bottom line is, children need school — not remote lessons. They need live instruction and socialization.

Schools will have to implement safety measures, including frequent handwashing and reducing class sizes

In order to safely and confidently reopen schools, we can take a number of precautions, like encouraging handwashing, decreasing class sizes, ending class mixing, closing school playgrounds, and canceling specialties that rely on mixing or moving students around, such as art and music. We can screen students for fever and halt sports. We can ask everyone to wear masks. We can install plexiglass shields and separate student desks.

We can do that, and more.

The best choice will be to balance the costs of interventions with their benefits.

Aiming to create a zero-risk school environment may be impossible. It will also be costly at a time when budgets will inevitably be slashed during an economic downturn.

The money for these interventions — including extra buses and sanitation stations — will take away from other school services that benefit children.

Of more concern, some of these interventions may cause harm.

Some measures, like temperature checks, fall short, and could lead to infection

Sharing thermometers could lead to the spread of the disease. It could also exclude students who ran or biked to school overdressed while not catching the majority of children with coronavirus. Additionally, multiple studies show less than half children with active coronavirus have a fever.

Closed playgrounds and cancelled sports will result in less physical activity, which is detrimental to children's mental and physical health and can lead to worse academic outcomes. Masks may decrease comprehension and ability of students to respond to social cues adequately.

The question that hasn't been addressed sufficiently is what our ultimate goal is in schools. We began with an effort to flatten the curve to prevent hospitals from being overwhelmed. Now, we are stuck waiting for an effective vaccine to be created, scaled and distributed.

Children cannot afford to wait for that, though.

Kids cannot afford to wait for the unrealistic goal of zero transmission. Avoiding exponential growth in outbreaks should be enough.

Communities will have to collaborate with their key stakeholders, parents and teachers to understand what level of risk is tolerable. Many may be willing to accept some small risk to get most kids back to school quickly. Rather than aiming for a risk-free school environment, I would suggest coming up with a plan to provide education to all in a way that satisfies local public health authorities, parents, and teachers.

They do not need to aim for a no-contact school day.

More specifically, class sizes should be reduced, schools should focus on hand hygiene, and limit the presence of unnecessary adults in schools. Schools may consider foregoing masks and face shields, particularly in children under 10. Given that as many as 80% of children with active coronavirus have no symptoms, we should acknowledge that temperature screening is theatrics and unlikely to decrease the presence of coronavirus.

Children cannot speak for themselves, so I will speak for them. Let them go back to school. Make a good faith effort to make schools cleaner and students and staff will be safer. Just because we can do more, it doesn't always mean we should.

• Read more:
• How 6 countries are opening up schools again, with temperature checks, outdoor classes, and spaced out desks
• There's evidence that kids stuck in quarantine may experience higher levels of depression and anxiety
• The riskiest and least risky activities you can do with kids this summer, according to an infectious-disease expert