From the bus stop to after-school activities, here's how kids can help stay safe during this Delta variant surge
Updated 1525 GMT (2325 HKT) September 12, 2021
(CNN)Millions of students are heading back to school with a challenge they didn't have to face last year.
The more contagious Delta variant is fueling a nationwide Covid-19 surge that's sending hundreds of children to hospitals every day.
The best weapon for students ages 12 and up is vaccination, the US Centers for Disease Control and Prevention says. But kids too young to get vaccinated also have ways to help dodge Delta.
Here's how students can help stay healthy before, during and after school:
Going to school
Before heading out: Minor symptoms that may have been overlooked in the past -- such as a runny nose -- shouldn't be ignored now, said pediatrician Dr. Steven Abelowitz, regional medical director of Coastal Kids Pediatrics in California.
"With the current rise in Covid cases, especially in children, it is advised that parents of children even with minor symptoms should contact their pediatrician to rule out Covid," Abelowitz said, matching guidance from the CDC.
Of course, some kids can get or spread the Delta variant without symptoms. So precautions during other parts of the day are important.
At the bus stop: When chatting with a friend outdoors, "the risk of acquiring coronavirus is very low," CNN medical analyst and emergency physician Dr. Leana Wen said.
"Therefore, waiting at the bus stop or recess or coming out of the school, masks can be taken off."
But if there are many children crowded together, "even though it's outdoors, if you're unvaccinated ... the advantages of masks are going to outweigh the disadvantages," Abelowitz said.
On the school bus: "Mask wearing is absolutely critical because you're in close proximity in an enclosed space," Wen said.
"Make sure to be wearing a mask that covers your nose and your mouth. It should be at least the quality of a 3-ply surgical mask," she said.
"There are also KN95s, depending on the age of the child, that are even better. But the mask should be at least a 3-ply surgical mask. A cloth mask is not sufficient."
Research has shown properly worn surgical masks generally give more protection than a cloth mask. If a cloth mask is used, the CDC said it should have multiple layers.
When carpooling with another family: Carpooling might be safer if you're in a "pandemic pod" with another family.
In that situation, "all adults should be vaccinated, the adults should be trying to reduce risk in their lives as much as both parities agree to, and essentially, you're in a household with that family," Wen said.
"If you are not in a pandemic pod with someone and you're still carpooling, everybody in that carpool should be wearing masks. Windows should be rolled down," she said. "It's not zero risk, but that also reduces the risk substantially."
In the classroom and hallways
The importance of masks this year: The CDC recommends students from kindergarten through grade 12 wear masks in school as the highly contagious Delta variant spreads nationwide.
The American Academy of Pediatrics now recommends masks in schools for everyone over age 2.
The Delta variant has been a game changer, Abelowitz said.
New pediatric Covid-19 cases are "significantly higher than a few months ago -- and climbing quite rapidly," he said.
"We do know that masks reduce the chance of spread. We do know that there's a significant increase in the Delta variant," Abelowitz said.
"If these numbers are not controlled, eventually, unfortunately, the kids are not going to be in-person schooling."
Get masks that kids actually like: There's no point in wearing a mask if a child keeps tugging at it or taking it off in school.
"This is something that does take getting used to," Wen said. "It may be good to practice wearing the mask at home and making sure that you're OK with that type of mask."
Wen said her own son had to adjust to wearing a mask. But after "a couple of days into school ... it felt like second nature."
"I think it's worth trying, if you can, different types of masks," she said. "Different people have different comfort levels."
Some students might like one brand of well-fitting surgical masks over another. Other kids might feel more comfortable wearing child-sized KN95 masks, which allow more room for the nose and mouth.
"The most important thing is to find the best that you can consistently wear throughout the day," Wen said. "You don't want to find a mask that you're trying to pull off your face every 20 minutes."
Explaining masks to young kids: It can be tough explaining the importance of wearing masks in school to a young child. But it's not necessary to go into too much detail, Abelowitz said.
For a 6-year-old, "You could simplify it as: 'There are people out there that are getting sick from other people. By wearing a mask, you will reduce the chance of you getting sick, and also reduce the chance of other people around you getting sick,'" Abelowitz said.
"'So that's why it's not only important for you to wear the mask to protect yourself, but it also can help protect other people.'"
Another perk for young children: By wearing a mask and not getting sick, kids will be able to keep seeing their friends at school, Abelowitz said.
Dealing with potential bullies
Some students might get bullied for wearing a mask. So it's important for children to be confident and prepared for such scenarios, psychologist Dr. Sanam Hafeez said.
"Parents need to instill in their children that they are doing the right thing by protecting their own health and the health of others around them," said Hafeez, director of Comprehensive Consultation Psychological Services in New York.
"They need to boost the child's confidence so they don't feel like they have to 'ditch' the mask to fit in or make the bullying stop. The more confident that the child is with the decision to wear a mask, the easier it will be for him/her to stand their ground."
Parents can also help prevent such bullying in the first place.
"There is an old saying, 'children learn what they live.' A child who bullies over face mask-wearing has most likely learned that behavior from his/her parents," Hafeez said.
If such bullying does happen, a child's response might depend on the age.
"For younger children, such as grade school, the simpler the answer the better," Hafeez said.
"Something like, 'I am being considerate by wearing a mask because I am protecting you from getting Covid. If you wore a mask you would protect others too.' Advise the child to say that and walk away and not engage with the bully," Hafeez said.
If the bully becomes aggressive, the child should seek the help of a teacher.
On the flip side, some students might get bullied for not wearing a mask -- for example, if their parents don't want them to.
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"This is a tough situation for a child to be in. They might face words like "selfish," "germ spreader," "Covid Creep" or any number of insults kids might hurl at them," Hafeez said.
"If a child is in this situation and they do want to wear a mask, they should speak with their parents about doing so and explain how the bullying is making them feel and share what they might have learned about Covid prevention through mask wearing," she said.
"If a parent has forbidden a child under 18 to wear a mask, the student can say that he/she would like to wear a mask, but that is not the choice his/her parents have made for them."
Wen said children have an opportunity to flex their maturity if they get bullied over wearing a mask.
For example, they could say: "I wear a mask because of my grandmother. I don't want my grandmother to become ill. And I am doing this to protect people that I love."
Returning to recess
If recess is outside and the school doesn't require masks outdoors, "I don't think that masks are (necessary) during recess," Wen said.
That doesn't mean a student can't get infected outdoors. "At this point, there is no such thing as zero risk," Wen said. But "I would rather focus the mask wearing on indoor situations that are much higher risk."
In areas with high Covid-19 numbers -- and when children are too young to be vaccinated -- "encouraging more distanced kind of games, even in outdoor settings, may be beneficial in mitigating" the Delta variant, Abelowitz said.
Both Wen and Abelowitz said it's a good for students to enjoy mask-free breaks outside.
"If they're outdoors, and they can maintain some distancing, and it's not that there's a major outbreak in a specific community, we prefer that they would be without masks," Abelowitz said.
Enjoying lunch safely with friends
It's impossible to wear masks while eating. And after a year of remote or hybrid learning, some cafeterias may be back to full capacity.
"I am worried about lunchtime. That is a high-risk setting, depending on how this is set up," Wen said.
"The best setup, obviously, would be outside. But if it's going to be inside, there should at least be excellent ventilation, some degree of spacing, and the kids should all be facing in the same direction instead of ... facing one another."
But once students are done eating, they can put their masks on and chat face-to-face, Wen said.
Some schools have allowed students to take their lunch to their classroom desks to help minimize crowds.
"Eating in socially distanced classrooms is certainly better than in a lunch hall with hundreds of other children in a small, enclosed indoor space," Wen said.
One way students can socialize with different groups of friends is to eat outside, if the school allows it, Wen said. That could be in a courtyard, on the grass, or even a designated portion of the parking lot.
Getting back to after-school fun
Even the best precautions during school can be nullified if kids get Covid-19 during after-school activities. And some students might let their guard down after school, Wen said.
"Remember that informal settings can have just as much -- if not more -- risk than formal settings," Wen said.
"I think so many people are worried about what happens when we're actually playing the sport and not thinking about wait, what about in the locker room?" she said.
"If kids are getting together in the locker room, spending time together, no masks on, that's a much higher risk setting that being outdoors playing a sport."
The CDC warned about outbreaks connected to extracurricular activities last school year.
And that was months before the Delta variant -- the most contagious strain of novel coronavirus to hit the US -- took over as the dominant strain.
Those who were infected last year might not be fully protected from the Delta variant this year -- especially those who are not vaccinated, Abelowitz said.
"We've seen that ... based on the Alpha variant or the variant prior, you have folks that have been infected with Covid can be infected again," the pediatrician said. "So we know for sure that you can be infected again, especially because there are different variants."
Abelowitz said children should get vaccinated as soon as they're eligible.
In the meantime, "close-contact sports, indoor sports are considered to be risky," Abelowitz said. The risk is amplified in areas of high Covid-19 numbers and low vaccination rates.
Activities such as choir and band -- when students propel their breath into the air -- can also be high-risk, Abelowitz said.
But that doesn't mean such activities and indoor sports need to be sidelined. Abelowitz and Wen said schools can consider regular Covid-19 testing for students in higher-risk activities.
And whenever possible, after-school practices should be held outside, Wen said.
If Covid-19 numbers are high in a community and not many children are vaccinated, a school may want to consider pausing higher-risk activities until the situation improves, Abelowitz said.
All these safety precautions might seem daunting to some children. So it's important to emphasize what children can do now -- not what they can't do -- as they return to in-person learning, Wen said.
"It becomes more empowering to be able to say, 'Here is what you can do at school, including playing outdoors ... including being part of sports again,'" she said.
"We should be empowering and talk about what the child can do that's fun -- and what are the things that the child can do to reduce risk for them and for others around them."
