Kids, parents, educators, and doctors all agree that remote learning is a crummy substitute for in-person classrooms. The American Academy of Pediatrics has declared that in light of the inequities and mental-health issues created by remote learning, along with the problem of students falling behind academically, “the benefits of in-person school outweigh the risks in almost all circumstances.”
But with the highly contagious delta variant leading to surging Covid cases in much of the US, plus rising concerns about the variant’s impact on children, some parents may be concerned about their kids’ safety—and wondering what they can do to mitigate risks. Quartz spoke with three infectious disease experts to get some answers.
It’s true that the delta variant is leading to more cases of Covid-19 in kids than previous strains. According to the latest data from the Centers for Disease Control and Prevention (CDC), hospitalizations of kids between 10 and 17 are up 31% the week of Aug. 11 from the previous seven-day average. The overall portion of kids who are sick enough with Covid to be hospitalized is still quite small—0.36 per 100,000 children between ages 10-17. But at this time last year, it was 0.16.
The reason for the uptick in kids with Covid-19 is that the delta variant is more transmissible. “Clinically, we’re not really seeing anything that indicates [delta] is more severe,” says Yvonne Maldonado, a professor of pediatric infectious diseases at Stanford and the chair of the American Academy of Pediatrics’ (AAP) Committee on Infectious Diseases. “We’re seeing more severe cases now because the overall number of cases is higher.”
In unvaccinated people, including kids, Maldanodo says, about 80% who contract Covid will be asymptomatic. Of the 20% with symptoms, about 5% may go to the hospital, and about 1% might die.
Of the 600,000 people who have died from Covid in the US so far, 400 have been children. That’s a small portion, but any number is too high. “I think we fall into this flawed thinking of saying that only 400 of these 600,000 deaths from COVID-19 have been in children,” CDC director Rochelle Walensky said recently. “Children are not supposed to die, so 400 is a huge amount.”
The outlook is much better for vaccinated children and adults who come down with Covid, Maldano says: More than 90% would be asymptomatic, less than 1% would be hospitalized, and the mortality rate is miniscule: less than 0.001%. That’s why it’s important for parents to make sure that any children who are eligible for vaccines (ages 12 and up) get them as soon as possible.
Right now, children under age 12 aren’t eligible to get the vaccine—although the AAP recently called upon the Food and Drug Administration (FDA) to work aggressively toward approving the vaccine for younger kids.
Paul Offit, director of the Vaccine Education Center and professor of pediatrics in the infectious diseases division at the Children’s Hospital of Philadelphia, says he’s hopeful that the FDA will approve the vaccine for kids between ages 6 and 12 before the end of the year.
In the meantime, the best line of defense for kids who can’t yet be vaccinated is for schools to strictly adhere to guidance from the CDC and AAP. In addition to social distancing, good ventilation, and promoting vaccinations for everyone who is eligible, that includes mandatory masks for all children over age 2, teachers, staff, and visitors—even if some kids find wearing masks difficult.
“For kids who can’t get vaccinated, there’s really no other choice,” says Maldonado. Her advice to parents whose kids struggle with masks is to communicate carefully with their children about why wearing a mask is so important, and find “what kind of mask they use that they feel the most comfortable with.” The CDC and AAP recommend universal indoor masking for all kids who are vaccinated, too, since that helps cut down on breakthrough cases and further contagion.
For kids 12 through 17, it’s already possible to get the vaccine. About 43% of kids between 12 and 15 have received at least one dose, while 53% of kids between 16-17 have at least one dose, according to the latest CDC data. Teens who remain unvaccinated are going to be at significantly higher risk than vaccinated kids when schools reopen, according to Offit.
“You have a susceptible population that is about to go back to school,” says Offit. “And we will approach fall and winter, when this virus is much more easily transmitted. That’s a big combination of three events: susceptible population, highly contagious virus, and a season in which the virus is more easily transmitted. So I worry that this is going to be an at risk population that’s going to suffer this.”
Why haven’t more parents gotten their kids vaccinated? “Parents are not necessarily great at assigning relative risks,” Offit explains. “I think people assume that children are healthy and will stay healthy.”
Some parents may also overestimate the risk of the vaccines. Offit notes, for example, that some parents grew concerned over reports that mRNA vaccines can, in rare cases, cause myocarditis, particularly in male teens and young adults. “It was generally short-lived, generally self-resolving, but there’s no way you’re ever going to make inflammation of the heart muscle sound mild,” he says.
But a study published in JAMA Cardiology found that college athletes diagnosed with Covid had a 1 in 43 chance of getting myocarditis, while Offit says the chances of getting myocarditis from a vaccine are about 1 in 30,000. “If I assume over the next few years that my child has a reasonably high likelihood of being infected, which is a good assumption, I’m going to take the lesser risk to get the vaccine,” Offit says. “There aren’t ‘never-risk’ choices. I think for parents, the goal is always to choose the lesser risk.”
While masks are a crucial tool to prevent and reduce Covid-19 outbreaks, eight US states (Arizona, Arkansas, Iowa, Oklahoma, Florida, South Carolina, Texas, and Utah) have actually barred school districts from requiring masks, while 32 others are leaving the matter up to individual school districts.
For parents in the position of sending their kids to schools without mask mandates, “I recommend making sure their student has high-quality masks and knows how to wear them correctly,” says Tara C. Smith, a professor of epidemiology at Kent State University’s College of Public Health. “They should either be cloth with a tight weave, or one of the KF94 or KN95 masks that are increasingly available. If they use the latter, they should be sure to buy them from reputable retailers and that they have a tight seal to the face.”
Smith notes that masks are generally more effective at protecting others than protecting the person who wears them, so “families should keep in mind that their student may still be exposed.” Regular Covid tests can help families stay abreast of any infections.
If schools follow Covid safety guidelines, Maldono says, they typically shouldn’t expect to see outbreaks that would require them to shut down. But she says there will likely be some school closures this fall and winter, particularly for those that aren’t enforcing masks and other rules. (Indeed, some schools are already being forced to shut down in-person classes just days into the school year.)
Smith says that families should plan ahead and think about what they’ll do if their kid needs to quarantine after exposure or getting sick. “Do you have any back-up caregivers who could step in to assist if needed? Do parents have the ability to take time off work if they need to quarantine due to a child’s exposure at school? The earlier they can have plans for such eventualities, the smoother it will make the school year. They may also want to think of a plan if a school needs to quickly pivot to an online-only modality, for example after a large outbreak at school (which we’re already seeing in some areas).”
Maldano says that based on what’s happened with delta in countries like the UK and India, the US should start seeing a reduction in cases because the people who are most at risk will have already gotten infected. But there may be another surge in the fall as people start gathering more indoors, and unvaccinated people will again be at the highest risk.
Some families may reasonably decide to take extra precautions in the face of delta, particularly if the children or another family member have underlying conditions that puts them at more risk from a Covid infection. “Higher risks of potentially serious outcomes from infection may weigh more than in-class learning, particularly if a child has been doing okay in a remote or hybrid environment,” Smith says.
But most kids are low-risk for serious illness, and as Offit says, “if you walk outside, you’ve taken a risk.”
“We need in-person learning,” he says. And the best way to ensure that kids are able to access it this fall is for everyone who is eligible for a vaccine to get one.