Dr. Alessio Fasano, director of the Center for Celiac Research and Treatment at MassGeneral Hospital 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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Greetings from the Center for Celiac Research and Treatment at MGH. During these challenging times, we have been constantly in touch with our celiac community and we have received many many queries on many aspects of celiac disease related to this pandemic. And one of the most frequent questions (because it is timely and important) has been, 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? And most importantly, when given the opportunity to choose between in-person education and remote, we're really struggling with which direction to go, because we prefer to be more conservative and protect our kids and therefore we're biased toward the remote education? So those are the kind of questions that we are facing on a regular basis from the people who follow us on our media. I have to reiterate what I've said at the very beginning, and I believe that this has not changed as an aspect of the situation. Provided that celiac disease is well controlled by a strict gluten-free diet (with no symptoms, no positive antibodies, everything is fine, and so on and so forth) people with celiac disease, including kids, are pretty much indistinguishable from the general population. Also, when it comes down to the capability of the immune system to fight enemies like the COVID- virus. For that reason, the same decisions that apply for all the other kids apply for kids with celiac disease. That said, I understand that there are additional challenges when it comes to attending school for kids with celiac disease, particularly for the lunch needs and the fact that there are some schools that will only provide lunch during the first phase or if they do, will not provide lunch in cafeteria (this can be a good thing or a bad thing depending on how you see the story and how you evaluate this). The reality is that even if what I said stands, we are in a very steep learning curve and therefore [to know for sure] what the SARS-CoV-2 virus has to do in terms of infringing on the immune system of people with celiac disease is not 100% known. And a while ago, we launched a survey among people with celiac disease to see what is the rate of attack of the virus among celiacs. We're evaluating this data and as soon as we have some more firm results we will definitely share with everybody. So far, anyhow, what I just said stands. So long as there is no condition or situation that eventually will prevent to go to school. The reality of this story is that, like any other kids, we need to make everybody aware (and we've been publishing this and this has raised a lot of media interest) that contrary to our early beliefs, kids are not spared by the infection. They can be infected. What is interesting and still puzzling to understand is that, when infected, they develop little or no symptoms and 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 because they were 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). What that means, we don't know yet. 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. These all suggest that they are not only infected, but the immune system can see the enemy coming in and react accordingly. 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 if you send your kids to school or not. Because 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; what reassurances the policy makers 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 if that's the case. The only way that this will be minimized as a risk is what has been proven successful so far. So physical distance, frequent hand hygiene and, most importantly, wear a mask. If we send our kids to school and these three measures are implemented, I think that the minimal risk is worthwhile to be eventually considered in exchange to have these kids finally be capable to have an in-person teaching experience. If these measures, for whatever reason, cannot be or are not implemented, together with the low threshold in testing now that testing is more available, of course the element of risk increases. So keep that in mind and act accordingly. So with that, again, stay tuned because this is an evolving situation. As soon as we have other news we will definitely share. Stay well. Stay safe.