As schools reopen, they’re prioritizing in-person instruction. But the highly contagious Delta variant of COVID-19 has risen sharply. Most children, and 3 in 10 adults, haven’t been vaccinated against it. The protection of universal masking isn’t available everywhere, since some states and districts don’t require masks or forbid mask mandates.
Education Week asked Dr. Paul A. Offit, a pediatric infectious-disease and virology expert at Children’s Hospital of Philadelphia, to advise educators on how these dynamics should inform their choices as they reopen schools. The interview has been edited for length and clarity.
Is the Delta variant more dangerous for children?
I think this Delta is a more transmissible virus. Consistent with the fact that it’s more transmissible, studies out of China comparing this virus to the ancestral strain show that when people are infected with Delta, they will shed roughly a thousand times more virus from their nose and throat than people who were infected with the ancestral strain, and a hundred times more than people infected with the Alpha strain. And we also know it’s taken over. What was originally 25 percent of circulating strains that were Delta became 50 percent, became 80 percent, became 93 percent. So that also is consistent with the fact that it’s more transmissible.
The question of whether or not it’s more virulent, meaning more likely to cause severe disease, is a hard question to answer. If something is more transmissible and more people are getting infected, more people will get seriously infected. It’s hard to separate transmissibility away from virulence because more people are getting sick.
Are more children getting sick?
That seems to be true. When you have the AAP [American Academy of Pediatrics] saying that there were 94,000 [additional cases in the first week of August], that’s a bigger number than we’ve been dealing with. It does appear that more children are getting hospitalized.
Are we setting ourselves up for a train wreck of illness by reopening schools full-time in-person?
It’s definitely worrisome. It is a confluence of four events that make one worry that we’re about to fall off a cliff. Number one is the Delta variant is more transmissible. Number two, children less than 12 years of age can’t receive a vaccine. They also are now all going to be congregating in one place. So you have a lot of unvaccinated people in one place. A lot of schools didn’t open last year. Of those schools that did open, they opened very carefully, making sure that everyone was masked, making sure there was social distancing, especially in the cafeteria. We were really good about it last year. We’re not so good about it this year. And this year our behavior is different, right?
We have weddings and birthday parties and 30,000 people at baseball games. That wasn’t true last year. And most importantly, we’re heading into fall and winter when this virus is more transmissible anyway, because it is, at its heart, a winter virus.
I am worried that you have a confluence of events where children are going to be unvaccinated, or in the case of the 12- to 17-year olds, under-vaccinated, because only about a third have been vaccinated, and that’s a bad confluence, especially in communities where this virus is circulating, especially in communities where vaccine rates are low.
Would you advise superintendents to consider all-virtual if they’re in a state that’s forbidden them from requiring universal masking?
Yes. If you’re in a community where transmission is high, the vaccine rates are low, where you know that you’re going to have a critical number of children in that classroom who are unvaccinated, one, because they can’t be, because they’re too young, or two, because they’ve chosen not to be, even though they’re 12 to 17, and you know that you have teachers who are also choosing not to be vaccinated, even though they could be, that’s a dangerous situation. You now have children who are being put in a dangerous situation. How do we avoid it? Do virtual learning.
Because we’re worried about loss of in-person instruction, and we want to provide it, is it possible that now we are not sufficiently considering the medical risks in a lot of places?
I think that’s right. I think that’s what’s happened. What you do is mitigate, which is to say lessen. We do the things that lessen risk. We don’t eliminate risk. But do the responsible thing.
It’s just so maddening when you watch certain governors prohibiting the only weapon you have for a child who can’t be vaccinated. Remember, even for children who can be, like the 12- to 17-year-olds, not all can be vaccinated, because they’re on immunosuppressive therapy or chemotherapy for their cancer.
When people say to me, what bothers you most about the anti-vaccine movement? It’s when they say to me, ‘What do you care what I do? You’re vaccinated.’ Which makes two incorrect assumptions. One is that the vaccines are 100 percent effective, which is true of no vaccine, and two, that everybody can be vaccinated, which is also not true.