As schools reopen, they鈥檙e prioritizing in-person instruction. But the highly contagious Delta variant of COVID-19 has risen sharply. Most children, and 3 in 10 adults, haven鈥檛 been vaccinated against it. The protection of universal masking isn鈥檛 available everywhere, since some states and districts don鈥檛 require masks or forbid mask mandates.
Education Week asked Dr. Paul A. Offit, a pediatric infectious-disease and virology expert at Children鈥檚 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鈥檚 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鈥檚 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鈥檚 more transmissible.
The question of whether or not it鈥檚 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鈥檚 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 in the first week of August], that鈥檚 a bigger number than we鈥檝e 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鈥檚 definitely worrisome. It is a confluence of four events that make one worry that we鈥檙e 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鈥檛 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鈥檛 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鈥檙e 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鈥檛 true last year. And most importantly, we鈥檙e 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鈥檚 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鈥檙e in a state that鈥檚 forbidden them from requiring universal masking?
Yes. If you鈥檙e in a community where transmission is high, the vaccine rates are low, where you know that you鈥檙e going to have a critical number of children in that classroom who are unvaccinated, one, because they can鈥檛 be, because they鈥檙e too young, or two, because they鈥檝e chosen not to be, even though they鈥檙e 12 to 17, and you know that you have teachers who are also choosing not to be vaccinated, even though they could be, that鈥檚 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鈥檙e 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鈥檚 right. I think that鈥檚 what鈥檚 happened. What you do is mitigate, which is to say lessen. We do the things that lessen risk. We don鈥檛 eliminate risk. But do the responsible thing.
It鈥檚 just so maddening when you watch certain governors prohibiting the only weapon you have for a child who can鈥檛 be vaccinated. Remember, even for children who can be, like the 12- to 17-year-olds, not all can be vaccinated, because they鈥檙e on immunosuppressive therapy or chemotherapy for their cancer.
When people say to me, what bothers you most about the anti-vaccine movement? It鈥檚 when they say to me, 鈥榃hat do you care what I do? You鈥檙e vaccinated.鈥� 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.
