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How to Make Spring the Last Lost Semester

Scott Gottlieb, M.D.
 

By WWSG speakers Scott Gottlieb and Caitlin Rivers

This month marks one year since schools around the country closed classrooms and moved instruction online. In many communities, children continue to learn from home or attend school only one or two days a week. Many families want to know what to expect for the fall. Classroom learning might look a little different than it did before the pandemic, but expect a closer return to normal classrooms, sports and clubs by September.

By sometime in April, most adults will be able to get a vaccine appointment regardless of age, occupation or medical history. This means that educators and older relatives at home—who are more vulnerable than children to severe disease—will be able to get vaccinated long before fall.

A primary argument for closing schools is to reduce community spread. Schools can amplify disease, as kids may be more likely to catch and spread an infection than adults. A lot of this thinking is inference based on flu, though it’s now clear the pathogens behave differently.

Widespread vaccination will reduce community transmission to more manageable levels and reduce exposure for those who can’t or won’t get vaccinated. Covid may become seasonal, though epidemic waves will be much less likely, assuming that treatments and vaccines can keep up with new mutations. The early evidence is that the vaccines also reduce the likelihood that vaccinated people can become asymptomatic carriers and spread the infection. If that is borne out in later studies, widespread vaccination will mean that many, if not most, people are viral dead ends, unable to spread the disease to others.

But no vaccine has been authorized for children under 18, and only the Pfizer vaccine has been authorized for 16- and 17-year-olds. Clinical trials collecting data on children 12 to 17 are under way for all vaccines and should start to produce results in the coming months. The Centers for Disease Control and Prevention should encourage larger trials now if the agency thinks those will be needed to recommend vaccination in children. Most children won’t be able to be vaccinated by fall, but it will be important to get kids vaccinated eventually, especially if Covid worsens.

High-school students are most likely to be vaccinated first, as they are more likely both to catch and to spread the virus. Middle schoolers will follow. Grade-school kids are unlikely to be eligible for vaccination this year. Clinical trials for them will take longer to complete and may require lower doses in the youngest kids, who can mount strong immune responses to vaccines. It may be 2022 before young children have a vaccine option.

This means classrooms will need mitigation measures in the fall. Masks are a simple and effective way to reduce transmission and should remain a staple. School assemblies, crowded lunchrooms, and other gatherings will probably be avoided, but the 6-foot distancing requirements that are keeping many districts in hybrid mode will likely be relaxed. This will allow children to resume full-time schedules. Schools should also look to improve air circulation and filtration inside buildings.

Asymptomatic screening with contact tracing can help reduce risk where substantial community transmission persists. Districts that conduct regular testing have been able to prevent outbreaks by identifying cases early. Federal and state government should support testing options for schools, as these operations can be difficult to set up.

The substantial public-health harms of having so many kids out of school for so long must be considered along with the risks of the virus. Against the backdrop of lower prevalence, and declining risk from Covid through vaccination, normalcy for children ought to be a priority.

Dr. Gottlieb is a resident fellow at the American Enterprise Institute and was commissioner of the Food and Drug Administration, 2017-19. He serves on the boards of Pfizer and Illumina. Ms. Rivers, an epidemiologist, is a senior scholar at the Johns Hopkins Center for Health Security.

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