Dr. Alessio Fasano, director of the Center for Celiac Research and Treatment at Mass General for Children, answers FAQs regarding school reopening during the COVID-19 pandemic. He discusses specific challenges for students with celiac disease, and acknowledges the steep learning curve of COVID-19 research.
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Note: This video transcript has been edited for length and clarity.
Greetings from the Center for Celiac Research and Treatment at MGH. During these challenging times, we have constantly been in touch with our celiac community and have received queries on many aspects of celiac disease related to this pandemic. Some of the most frequent, timely, and important questions are: “What should we do with our kids now that school reopening is on our doorsteps? Is it safe for a child with celiac disease to attend school? What are the challenges and what are the measures that we have to implement to protect our kids? What is the best option when given the opportunity to choose between in-person education and remote?”
These are the kind of questions that we face on a regular basis from the people who follow us on our media, and I have to reiterate what I've said since the very beginning. Provided that celiac disease is well controlled by a strict gluten-free diet (no symptoms, no positive antibodies, etc.) adults and kids with celiac disease are pretty much indistinguishable from the general population. This also applies to the capability of the immune system to fight enemies like the COVID-19 virus.
For that reason, the same decisions that apply for all the other kids apply for kids with celiac disease. With that said, I understand that there are additional challenges when it comes to kids with celiac disease attending school, particularly for their lunch needs.
The reality is that we are in a very steep learning curve and therefore it is not 100 percent known what the SARS-CoV-2 virus has to “do” in terms of infringing on the immune system of people with celiac disease. A while ago, we launched a survey among people with celiac disease to see the rate of COVID-19 infection among those with celiac. We're evaluating this data and as soon as we have some firm results, we will definitely share them with everybody. So far, as long as there is no condition or situation that will eventually prevent kids from going to school, what I just said stands.
The reality of this story is that we need to make everybody aware that, contrary to our early beliefs, kids are not spared by the infection. They can be infected. What is interesting and still puzzling is that when infected they develop little or no symptoms. That's the reason why at the beginning of the pandemic we didn't see kids among the people that were flowing into the hospital infected with the virus. And therefore, we reached the conclusion that kids were not affected by this infection. But actually, they are in the submerged part of this huge iceberg of this pandemic (the people who have little or no symptoms and therefore don't come to the attention of the healthcare professionals). We don’t fully know yet what this means.
A consideration of the facts suggests that kids are not only able to be infected, but their immune systems can see the enemy coming in and react accordingly. The fact that they have a lot of virus in their upper airways, the fact that they have the receptor for the virus that we didn't know before, the fact that they mount an immune response against the virus… If these kids can eventually spread the virus, and what the consequences of this spreading will be, we don't know yet. And this, of course, applies to kids with celiac disease.
So, to summarize, we are not here to suggest whether you should send your kids to school or not. This is a decision that really requires a variety of variables to be considered including: how "hot the air" is where you live in terms of the pandemic, what kind of measures the school is implementing, and what reassurances the policymakers are giving to keep the kids and the teachers safe.
But assuming that the decision is to send your kids to school, you need to be aware that they can contract the virus and once contracted they can possibly spread the virus. We don't know yet if that's the case.
The only way that this risk will be minimized is to adhere to strategies that have been proven successful so far: physical distance, frequent hand hygiene and wearing a mask. If we send our kids to school and these three measures are implemented, I think that the minimal risk is worthwhile in exchange for an in-person teaching and learning experience for these kids. If these measures for whatever reason cannot be implemented, the element of risk increases. So keep that in mind and act accordingly.
So with that, stay tuned because this is an evolving situation. As soon as we have other news we will definitely share. Stay well and stay safe.