It’s been a busy summer of school emails. Districts have been surveying parents: Would you send your child back to school? Or would you want to continue with virtual learning? Or do you want something in between: some in-person school a couple of days a week or part of the day and some at-home learning?


Austin Independent School District sent parents an email on July 2 with potential schedules that children might follow for in-person, hybrid or virtual learning.


The Texas Education Agency came up with guidelines for reopening schools and said schools should be open, but parents should be given a choice in whether to have school in person or online.


How do parents decide which choice to make?


The Trump Administration is pushing for schools to reopen in person and threatening funding.


The union for teachers in the Austin school district is asking for the state and the school district to be online only for at least the first part of the fall semester.


The American Academy of Pediatrics released a statement in late June with this in bold: "The AAP strongly advocates that all policy considerations for the coming school year should start with a goal of having students physically present in school."


Why? It points to the negative effects of kids being out of school in spring: social isolation, a lack of physical activity, food insecurity, an increase in suicidal thoughts, depression and anxiety, as well as a school’s ability to intervene in suspected cases of child abuse. For kids with learning differences, being in school might also be essential.


The Academy, along with the American Federation of Teachers, National Education Association and the School Superintendent Association then issued a joint statement on Friday that adjusts the Academy’s initial recommendation to account for the different levels of disease across the country.


"Local school leaders, public health experts, educators and parents must be at the center of decisions about how and when to reopen schools, taking into account the spread of COVID-19 in their communities and the capacities of school districts to adapt safety protocols to make in-person learning safe and feasible," the statement reads.


Both chief medical officers at Dell Children’s Medical Center of Central Texas and Texas Children’s Pediatrics and Texas Children’s Urgent Care agree that kids should be back in school.


"As much as people worry about it, (kids) need to have that environment," says Dr. Stanley Spinner, vice president and chief medical officer at Texas Children’s Pediatrics & Texas Children’s Urgent Care. "... Kids benefit in a social environment. They’re going to do better."


The Centers for Disease Control and Prevention and the AAP are recommending that school look very different: reduced class size, groups of kids (cohorts) staying together throughout the day, meals served in the classroom, masks and hand-washing, increased cleaning and limited visitors.


"Every child should be able to go back if we can maintain some of these strategies," says Dr. Meena Iyer, Dell Children's chief medical officer. "I wouldn't have any problem sending any child back depending on what the school can do."


Doctors are reporting an increase in kids with depression, mood disorders or psychotic breaks. Iyer says while summer is typically a less busy time for the hospital’s mental health services, it has seen more kids coming in for these reasons.


Being at home all the time is triggering for them, Iyer says.


Spinner says there are some families that need to have a thoughtful discussion before sending children back to school. For him, that’s families with kids with truly suppressed immune systems or kids on chemotherapy.


"In those special situations, on a one-on-one basis after careful discussion with their doctor and with that school ... those kids really should have special consideration," he says.


Part of the reason these doctors are not more alarmed about sending kids to school during the pandemic is what they are seeing in their hospitals and what pediatricians think we know about COVID-19.


For some reason, unlike other diseases in which kids are often the primary spreaders of the disease, that doesn’t seem to be the case with COVID-19, Spinner says.


At Dell Children’s and at Texas Children’s, they have had cases of kids coming into the hospitals with COVID-19 and needing ventilators, but it’s at a much lower level than what the adult hospitals are seeing.


Instead, often normally healthy kids with COVID-19 might have some fever, some trouble breathing. Kids who are immunocompromised get much sicker and have complications and then could need to be hospitalized, Iyer says.


Spinner says adolescents and young adults tend to be sicker than younger kids, and kids who have underlying conditions or are obese also have more symptoms.


Dell Children’s has also had one case of the multisystem inflammatory syndrome that in rare cases follows the disease and is marked with a rash and affects the heart and other organs.


Texas Children’s doctors are now following up with kids who test positive two to four weeks afterward to make sure they aren’t showing signs of the syndrome.


Even though doctors are recommending a return to the school building, it’s not a return to school as normal. Right now parents can work on making mask-wearing, hand-washing for 20 seconds and social distancing from people not in your immediate family part of the everyday routine.