Fort Worth, Texas,
14:59 PM

Back to School Letter from the Physicians of Cook Children's

To the leadership at North Texas Regional Schools:

We, the physicians at Cook Children’s Health Care System, are directly connected to the district or school either as concerned parents or as pediatricians who care for the children we mutually share with your district/school.

We are writing to you to express our concerns about the Delta Variant of COVID-19 and to recommend that our school district implement safety protocols beyond those that have been in place this summer to address this exigent threat. The rapid increases in COVID-19 cases, hospitalizations and deaths locally and throughout the US in recent weeks are alarming and require an appropriate response. Indeed, we are seeing rising COVID-19 cases in our practices.
















Please find below the Cook Children’s 10-Point Guide for Safely Reopening Schools crafted by Marc Mazade, M.D., Medical Director of Infection Control and Prevention at Cook Children’s Medical Center.

We stress key recommendations to mitigate the spread of this infectious new variant of the COVID-19 virus with the start of this school year:

  • Strongly encourage universal masking for students and staff in accordance with CDC and American Academy of Pediatrics recommendations.
  • Minimize contacts for each student to the greatest degree possible.
  • Encourage and support all opportunities for eligible children to receive COVID-19 vaccination.

The Cook Children’s Promise states: “Knowing that every child’s life is sacred, it is the Promise of Cook Children’s to improve the health of every child through the prevention and treatment of illness, disease and injury.” Please help us honor the health and sanctity of our children’s lives through your sincere attention to these recommendations. We would welcome the opportunity to collaborate with the district/school in promoting the health and safety of our community during this new and troubling phase of the pandemic. We will gladly provide additional data if it would be helpful, and we are available to answer any questions that arise.

We appreciate your time and look forward to further conversation on this important topic.

With respect and care,

Cook Children's Physicians

Cook Children's 10-Point Guide for Safely Reopening Schools 

1. Make sure all children are up to date on the routine childhood vaccinations needed for school entry. Access to medical offices, fear of leaving home and of waiting room exposures, and closed schedules of weary medical providers taking long-awaited vacations could result in a drop in vaccination rates against measles, mumps, rubella, pertussis, and the bacteria causing meningitis. A slight drop in vaccine coverage for measles, pertussis, and mumps translates quickly to a loss of herd immunity and outbreaks of serious, vaccine-preventable illnesses.

2. Revisit the latest masking decisions in light of the recent surge in COVID-19 cases. The American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) advocate for masking in schools, especially in areas with moderate to high transmission of COVID-19. Follow guidance from your local health department, which will be in line with the current state of the pandemic and regional community health recommendations. We have learned during the pandemic that most children, 2 years of age and older, can wear a mask.

3. Encourage COVID-19 vaccination of all eligible children and adults. COVID-19 efficiently spreads from adults and teenagers to younger children, not often the reverse. The key to keeping schools open during the COVID-19 pandemic is getting unimmunized parents and all eligible family members vaccinated.

4. Arrange for mobile COVID-19 vaccination units to be present during orientation and events such as 'meet–the-teacher' nights. Gains in U.S. vaccine acceptance are likely to come amidst the group of people who don’t have a solid reason to avoid vaccination. Surveys reveal that most of these people were hoping that the pandemic was wrapping up and that they would not have to take a risk by taking an “untested” vaccine. They are reasonable people who describe themselves as cautious, slow adopters of things that are new. Most are not necessarily opposed to vaccination philosophically. They were just hoping to wait out the pandemic while relying on social distancing, masking, and herd immunity to keep them from having to getting a vaccine. With the loosening of restrictions and the surge in cases due to the Delta variant, many are now ready to stop holding out.

5. Continue to utilize strategies promoting social distancing in the classroom (by using partitions, separating desks, and cohorting of student groups), during passing periods (by keeping them short to discourage standing around in small groups and conversing), and during meal times (by moving meals outside in the fresh air, limiting line length for meal service, and by observing social distancing).

6. Re-enforce good hand-hygiene practices and cleaning of shared workstation areas with demonstrations that highlight effective hand hygiene and disinfection techniques.

7. Quarantine unvaccinated children and school staff members exposed to COVID-19 per CDC guidance. Vaccinated exposed persons may still get sick with COVID-19 and could be contagious, though their risk of hospitalization and severe disease is extremely low. Quarantine exposed, vaccinated persons if they develop symptoms of COVID-19 until testing results are available.

8. Provide interactive and technologically sound, distance-learning alternatives for immunocompromised students who should not be in the classroom during the pandemic.

9. Encourage precautions for bus riders like masking and opening windows to promote adequate ventilation and reduce the transmission of COVID-19 while traveling to and from school.

10. Above all, send recurring reminders to parents not to send ill children to daycare and to school. Many parents are returning to the workplace for the first time in over a year. They may be experiencing pressures to be physically present, rather than staying home with an ill child. Memories are short when pressures are high. However, we are still in the midst of a global COVID-19 pandemic that has already claimed the lives of more than 600,000 people in the U.S.

Direct link to the top ten list available at: