1 year into pandemic, experts discuss safety of opening schools
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On the 1-year anniversary of WHO declaring a pandemic over COVID-19, the Infectious Diseases Society of America convened a press briefing to discuss reopening schools.
Although the CDC has issued guidance on safely getting children back to in-person learning, “there are a couple of questions that always surround the reopening of schools,” Tina Q. Tan, MD, FIDSA, said during the discussion.
Tan, an attending physician in the infectious diseases department at Lurie Children’s Hospital of Chicago, said that as new data become available, they can help schools in their plans to reopen.
According to Education Week, at least six states require that in-person K-12 instruction be available in all or some grades either part-time or full-time, but in most states, decisions are being made at the local level.
“Over this last year, we have learned that when appropriate mitigation protocols are in place, the school environment itself does not seem to serve as a superspreading environment, and in-person learning in schools has not been associated with substantial community transmission,” Tan said.
CDC Director Rochelle Walensky, MD, also emphasized this in announcing the CDC guidelines last month, saying that the available data show that “in-person learning in schools has not been associated with substantial community transmission.” A recently published study showed that there was “limited” in-school SARS-CoV-2 transmission during a 9-week period of in-person learning in 11 North Carolina school districts. Another study indicated that educators are “central” to the spread of SARS-CoV-2 in schools.
The CDC included five mitigation strategies for schools to follow to safely reopen, including two that Walensky emphasized: universal and correct use of masks, as well as staying at least 6 feet apart.
Although teachers are in a priority group for vaccination, the CDC guidelines say that teachers, administrators and staff do not need to be vaccinated to work in the building.
As for students, only one out of the three available vaccines in the United States — the one made by Pfizer-BioNTech — is authorized for use in any pediatric population. Children aged 16 years or older can receive it.
According to Tan, experts have estimated that at least 70% of the population will need to be vaccinated in the U.S. in order to reach herd immunity. She said the pediatric population is estimated to be about 25% of the overall population.
“You can see that even though the pace of vaccination in the adult population is increasing, a good portion of the pediatric population will need to be vaccinated in order for us to reach herd immunity,” Tan said.
Pfizer recently completed enrollment for trials testing its vaccine in children aged 12 to 15 years, and Moderna also has begun testing its vaccine in children as young as 12. Both are expected to release data by the end of spring or beginning of summer, Tan said.
“Vaccination of this age group may be available at the start of the school year in the fall,” she said.
Tan said Johnson & Johnson, whose one-dose vaccine was recently authorized, has just begun vaccine trials in the 12- to 16-year age group, and results will not be available for a while. She said trials for vaccine use in infants and in children through the age of 12 years are scheduled to begin by early summer.
“Results from these trials will probably not be available until the end of the fourth quarter or the start of 2022,” Tan said. “When vaccine becomes available, it will be phased in based on age, with those 6 to 12 years of age being vaccinated first ... followed by those 2 to 6 years of age, and finally those 6 months to 2 years of age.”
Could COVID-19 vaccination become mandatory for students, just as other vaccines are?
“It is always a possibility, given that this is a virus that is transmitted very readily, especially some of the newer variants,” Tan said. “We're just going to have to see.”
Preeti N. Malani, MD, MS, MSJ, FIDSA, chief health officer and a professor of medicine in the division of infectious diseases at the University of Michigan, noted some differences between reopening K-12 public schools and reopening colleges and universities.
Testing among K-12 populations “is not quite as nimble,” Tan added.
Tan said many American school districts do not have the financial capabilities to test children in younger age groups, and that testing does not seem to work most of the time in younger children because they are often asymptomatic or have only mild symptoms.
“The recommendation, at least in the pediatric population, is really not to do testing on a routine basis in the case of K-12 space,” she said.