How Long Should Kids Stay Out of School After They’ve Had COVID?

When the daughter of MedPage Today‘s editor-in-chief Jeremy Faust, MD, got COVID in September, he strategized how best to prevent spread of the virus while causing the least disruption to her school schedule.

He debated whether the CDC’s most recent isolation guidelines — which recommend resuming activities when symptoms are resolving and you’ve been fever-free for 24 hours — went far enough to stop the spread.

You can read his full plan in Inside Medicine, but in the meantime, we asked other healthcare professionals with children how they’ve been handling return-to-school after their kids had COVID.

Some answers have been lightly edited.

Katelyn Jetelina, PhD, MPH, Your Local Epidemiologist

As a mom to two toddlers, I struggle with this a lot. My girls seem to always be sick with the sniffles. I really only question it if/when they have a fever or are really lethargic (which is rare!) and have them stay home. Sometimes I test for COVID-19, but only if we are going to go to great-grandpa’s home or about to go on a trip.

They go back to school if they are feeling better; they either got their energy back, or have no fever. If I test them, they will stay home until they are negative.

Leana Wen, MD, George Washington University

The CDC is now treating COVID like other respiratory illnesses, and it’s good that there is clear guidance around return-to-school. Many schools have policies that conform with the CDC’s recommendations (returning after symptoms are improving and fever-free for 24 hours).

I have two young kids who are both in school. I’m fully expecting that they will come down with all sorts of viral illnesses this year, and that they will pass the viruses on to me and my husband. Of course, I don’t want them (or us) to get sick, but this is the reality, as it was the reality pre-COVID.

Becky Dawson, PhD, MPH, Allegheny College, Meadville, Pennsylvania

This year my return-to-school policy extends beyond COVID-19 and includes all upper-respiratory viruses. We are again expecting a tripledemic of viral infections, COVID, influenza, and RSV (could be a bonus year with pertussis, pneumonia, and measles — a sextupdemic?). I’m working with a single policy for simplicity; one set of criteria that does not change based on the underlying cause of disease, but is based on symptoms.

My kids (or students) can return if — they have been fever-free for at least 24 hours (without medication), their sore throat has gone away, their cough has subsided, and they are not leaking snot from their nose; no vomiting or diarrhea in the past 24 hours. I am also requiring my kids to wear a mask for a couple of days upon returning to school and asking students to do the same — to stop the chain of transmission.

As I’ve watched my own kids and students suffer from various illnesses during the past few months, I have seen so much fatigue associated with illness. I do not think kids should be returning to school until their energy levels return to normal. Fatigue is an important symptom that should not be ignored.

Mary C. Meyer, MD, MPH, The Permanente Medical Group, California

I follow the CDC guidelines if either of my children comes down with COVID-19 — or any illness with fever and respiratory symptoms, for that matter. Since fever is a reasonable marker of infectiousness, I think it’s reasonable to keep them out of school until they’ve had 24 hours without a fever and it’s clear their symptoms are improving.

Like many working parents, I groan when I first realize one of my kids is sick. There’s the double whammy of having grumpy kids for a few days plus having to rearrange their schedules and my own. It can be tempting to dose them with ibuprofen and send them back to school quickly (like most kids, they really perk up with ibuprofen on board). But I realize that’s not in anyone else’s best interest, so I try to do the ethical thing and wait until they’re genuinely improving.

The flip side of this is that I want my kids to be physically in school as much as possible, illness notwithstanding. My two teenagers had a lot of virtual school during the pandemic, with all the expected mental and physical health side effects. Plus, the school environment is mostly made up of healthy people with normal immune systems who are able to get vaccinated (and respond to vaccination). So it’s back to school as soon as possible.

Wendy Sue Swanson, MD, Stanford University

As a pediatrician and mom to teenagers, I think this is super tricky because teens typically have such mild disease presentation, we may not even consider COVID when they get sick. Also: they fight absences because they typically don’t want to miss anything (school, sports, etc.) so they may not even reveal their symptoms to us.

I want to get to a place where we think of COVID like we think of all the other respiratory infections like flu, RSV, even rhinoviruses. But I don’t think we’re perfectly there yet with the risks COVID can bring to immunocompromised folks and the somewhat tepid vaccine uptake and low community protection. It’s all about testing and information sharing, in my opinion.

So, with children’s return-to-school, that means following CDC’s advice, yes, and ensuring fever is gone and symptoms are resolving. But it also demands vigilance on awareness and information sharing (tell people if you’ve exposed them!) to protect the most vulnerable who can get early treatment and prevention.

I was served a hearty reminder back in June when I got COVID from my son (who we didn’t test because his infection was so mild and so brief — he seemed to have COVID for an afternoon — it didn’t even dawn on me). When I got COVID, I didn’t test either (also didn’t even occur to me to think I had COVID) and in those first days, before I got much sicker and felt puny and miserable, I exposed my immunocompromised mom and an infant.

The lesson here is test, test, test with respiratory illnesses — even mild symptoms — and return when symptoms can be easily controlled to avoid transmission to friends and others and make sure to let others know why you were out sick: COVID!

Marisa Vanpoznak, MD, physician in Rhode Island

As a physician working in college health, I am happy to report that the new CDC guidelines around return-to-school after COVID are so far working well for students on campus. Most students are at low risk for complications for COVID, and overall have mild symptoms which they are able to manage with a few days rest and supportive care (such as plenty of fluids and over-the-counter cold medications).

Students have been able to return to classes within a few days, which has been beneficial both academically and socially; and at the campus health center we have not seen any uptick in severe illness or in complications of COVID since the guidelines changed. Overall, the change in guidelines has been positive for students.

My own kids have not had COVID since the guidelines changed, but as it is now an endemic respiratory virus, they will surely get it again! And when they do, I will follow the CDC guidelines allowing them to return to activities when their symptoms have improved and they are fever-free.

I am glad that the CDC has changed guidelines so that COVID is now treated like other endemic respiratory viral illnesses. However, it is important to note that COVID was NOT endemic when the pandemic started, so the stricter CDC guidelines made sense at the time, as our population had little to no immunity and an increased level of caution was needed. Now that COVID is endemic, it is reasonable for guidelines to relax.

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