Editor’s Note: The footnotes containing relevant citations for this article can be found at the end of the article.
I, like others, have gone through many other channels trying to
get my voice heard. Medical professionals, other concerned parents, teachers
and staff members, and public health officials have all told me that they have
given up trying: No one is listening, and nothing will make a difference. I
have a Ph.D. in Immunology from the Johns Hopkins School of Medicine and as a
professional in the field, a member of the community, and a parent of young
children in the schools I feel obligated to speak out publicly and say that we,
as a community, must do better.
Let us start by stating that we
have a shared goal: keeping children in school for in-person learning with
minimal disruptions. However, that does not need to come at the
expense of safety. From the start of the school year, it has been clear that
most of the community schools have adopted the attitude that COVID-19 is over
as far as they are concerned. This seems to be based on two false premises:
first, that the majority of our community is vaccinated, and second, that COVID-19
is not a significant concern for children.
MYTH 1: Vaccines make other preventative measures
unnecessary.
The vaccination rate in our community is actually lower than
people realize (50 to 60% as noted by Yitzy Schleifer and Dalya Attar in a
community-wide message erev Yom Tov).
Some of the parent body and several staff members of many schools have opted not to get vaccinated though the
vaccines are widely and easily available. Nationally, only 45% of 12- to
17-year-olds are fully vaccinated.1 Additionally many of
the teachers were among the earliest to get vaccinated and thus are already at
the six-to-eight-month mark, at which the vaccine effectiveness at preventing
infection decreases. In an elementary school you are dealing with
a population that is not yet eligible for the vaccine and thus
extremely vulnerable. Note that schools can mandate staff vaccination but have
chosen not to.
Delta is 200% more
transmissible and results in up to a 1000x higher viral load than previous
variants. Vaccines continue to be extremely effective at decreasing
hospitalizations and deaths, but the greatly increased transmissibility of
Delta, and the waning immunity of those vaccinated over six months ago, have
resulted in many cases among those vaccinated. Vaccinated individuals who are
infected with COVID-19 can, and do, transmit infection to others (especially
those unvaccinated like all children under age 12).
When community case numbers
are high, even the vaccinated need to take additional preventative
measures. According to current CDC guidance,2 all
people over age two should wear masks in indoor public places, regardless of
vaccination status, in areas of “substantial” or “high” community transmission.
Currently all of Maryland3 falls
within those categories. So even if
everyone were vaccinated (which they aren’t), we would still need other measures until case numbers go down (as in
this nearly fully vaccinated community4). As
vaccination rates increase, including vaccination of children when approved,
case numbers will go down and other measures can be relaxed. Just hang in a bit
longer.
MYTH 2: COVID-19 is NOT a serious concern for children.
In the United States, over 5605 children
have died of COVID-19, and it is currently one of the top 10 causes of death of
U.S. adolescents. The CDC estimates there have been 209,264 cumulative
pediatric hospitalizations in the U.S. Pediatric Intensive Care Units (PICU)
around the country are full, and doctors are concerned about Maryland
ICUs6 as well.
A local PICU doctor told me that there are children in Baltimore who are being admitted to the hospital due to COVID-19.
Keep in mind that when hospitals are full of COVID-19 patients, they are unable
to care for patients with other medical needs.
While most children, thankfully,
do not require hospitalization, we have data showing that even children with
mild and asymptomatic cases can have long-term consequences from COVID-19. Again, it must be stressed that
hospitalizations and mortality are not the only negative outcome.
There have been reports of damage to organs such as heart, lung, brain,
kidneys, vasculature, and more. Long-COVID has been reported in children.7–10 As of July long-COVID
is officially a disability with protection under the Americans with
Disabilities Act (ADA)11 which
describes it as a physical or mental impairment that can substantially limit
one or more major life activities. The British National Health Service reported
that seven to eight percent of children experience long-COVID-19 and has been
opening new pediatric clinics around the country to treat it. A study
from Rome10 reported
that more than one-third of children had one or two lingering symptoms four
months or more after infection, and one-quarter had three or more symptoms.
We also know that children DO
transmit to each other and to people in their households.
What Needs to Be Done?
While we all wish COVID-19
were no longer a concern, that is not the case yet, and operating as if it were
is irresponsible and foolhardy.
Guidelines by experts in
public health as well as children and education, such as the Centers for
Disease Control and Prevention (CDC),12 American Academy of Pediatrics (AAP),13 United States Department of
Education (USDE),14 Maryland State Department of
Education (MSDE),15 Maryland State,
Baltimore City and Baltimore County Departments of Health, are all being
ignored. Concerns of local pediatricians, infectious disease doctors, and
public health professionals are being dismissed.
The consensus is clear: The
best way for schools to be able to have safe continuous in-person learning is
to take several layered mitigation measures so as to prevent outbreaks that
cause students to stay home and classes to close. These include
masking, cohorting, social distancing, proper ventilation, limiting visitors,
being outdoors as much as possible, vaccine mandates, etc. Schools need plans
for testing, contact tracing, quarantining, and reporting. I was completely
shocked recently to hear from multiple sources that parents are being told not to test and, if testing, not to share
children’s positive results with other families (carpools, classmates) so that
contact tracing doesn’t need to be done, quarantining and class closures won’t
occur, and case numbers need not be reported to the health department. In
other words, instead of taking action to actually decrease case numbers, they
are focusing on making them invisible and have no problem causing COVID-19 to
spread throughout the community.
Study after study shows the
effectiveness of a layered approach in K-12 schools. While 96% of schools have
offered in-person learning during the 2021-2022 school year, COVID-19 continues
to cause disruptions as
closures due to COVID-19 have affected more than 900,000 students.16 One
cautionary report17 shows a
case of a teacher who was unmasked for story time in a classroom and infected
12 out of 24 students in the classroom, several of whom went on to infect
family members at home.
A recent study18 in Arizona looked at the impact of mask policies on school-related outbreaks at 1,020 (98%) of K-12 public schools from July 15 to August 31 2021. It showed that schools without in-school mask requirements were 3.5 times more likely to have a COVID-19 outbreak than schools with mask requirements. Another study19 concluded that in 520 counties across the United States, counties without school mask requirements experienced larger increases in pediatric COVID-19 case rates after the start of 2021 school year compared with counties that had school mask requirements. During the Fall 2020 school year, we saw a layered approach also worked in schools in, for example, Missouri,
http://www.wherewhatwhen.com/article/op-ed-a-plea-to-our-schools-and-our-community-continued
