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The Delta variant is the latest setback on our way to a new normal. This is the fourth major wave of Covid-19, and there is a palpable sense of morbid familiarity. We know the drill: cases increase, hospitals are pushed to their limit, and then deaths start to pile up. We have grown numb to the event of many ongoing victims, even as friends and neighbors share their stories of debilitating chronic symptoms. But data from around the world indicates that the Delta variant is different, especially when it comes to children.
Given everything we know about the Delta variant and the longest Covid in children, it is immoral to send unvaccinated children, teachers and staff into classrooms. The Delta variant dramatically increases the risk of long-term disability or death for everyone, but especially for the 73 million children living in America. We need to adjust our back-to-school plans immediately.
The chances of passing the Delta variant are more than 1.6 times higher than the Alpha variant, which fueled the previous wave. A study from Imperial College London found that the positivity of the Covid-19 test in British children aged five to 12 was two to six times higher than in people 45 and older. One in 10 Covid-19 test result for American children aged five to 11 on Wednesday is positive, and the week-over-week increase in test positivity is increasing fastest for this age group . The positivity of the Covid-19 test in American children aged 12 to 17 (12.3%) is higher than for any other age group.
A published Scottish data report noted that the Delta variant doubles the risk of Covid-19 hospitalization, regardless of age. The number of American children hospitalized with Covid-19 doubled between June 30 and July 31. U.S. hospitals on Thursday reported 249 pediatric admissions due to Covid-19, four admissions less than the all-time high of a day (253). On a population-adjusted basis, the weekly average of American children admitted to hospitals with Covid-19 is increasing faster than any other age group (as of Wednesday).
There is growing evidence showing that even mild or asymptomatic cases of Covid-19 in children can progress to chronic (“long”) Covid. Recently published research suggests that at least one in 25 children with Covid-19 has symptoms that last longer than four weeks. A separate UK government report estimates that at least one in eight children still have symptoms five weeks after their first infection. Emerging data also suggests that up to one in 50 asymptomatic cases of Covid-19 in children will progress to chronic Covid.
The good news is that our vaccines are very effective against the Delta variant. Fully vaccinated people have a significantly lower risk of developing symptoms, requiring hospitalization, or dying from Covid-19. The rate of Delta variant infection is three times lower in fully vaccinated people, and the risk of developing a long Covid is halved. There is even preliminary data suggesting that mRNA-based vaccines may alleviate some symptoms of the long Covid.
Make no mistake: vaccines save lives, but they alone are not enough to stop the spread of the Delta variant. A new report from the UK has found that 44% of Delta variant infections have occurred in fully vaccinated individuals. The US share of new Covid-19 cases among fully vaccinated individuals is expected to increase as more people are exposed to the Delta variant. Once infected, fully vaccinated people can (and transmit) the new coronavirus to others, although at half the rate of unvaccinated people. Within a household, the transmission rate of the Delta variant from a fully vaccinated person to an unvaccinated household member is at least 10%. Officials in Mississippi and Florida are learning the hard way that the Delta variant is spreading like wildfire inside school buildings, especially without universal masking and proper ventilation.
Masks reduce transmission and save lives. Surgical masks have been shown to reduce the risk of infection for the wearer by up to 67%. The latest projections from the Institute for Health Metrics and Evaluation at the University of Washington estimate that more than 47,000 lives could be saved by October 31, if more than 95% of the population masked themselves in public. But masks are not enough, and we should expect at least 24,000 Covid-19 deaths from the current wave.
It is biologically impossible to test our children for safety. A new study has shown that people infected with the Delta variant had produced around 1,000 times more copies of the virus by the time they tested positive, compared to people infected with the original strain (novel coronavirus-2019). The study traced 167 infections to a single index case. A separate study traced a total of 47 cases (including 21 secondary cases) to a single person. Simply put: The Delta variant turns each of its hosts into a walking super-spreader event before the person even realizes they’ve been infected.
The practical implication of these findings is that plans to reopen schools that rely on universal mask mandates and frequent testing are doomed to failure. The UK experience offers a real world lesson that we in the US must take to heart. Despite aggressive mitigation efforts and a $ 4.2 billion government-wide testing program, one in 250 schools in England has experienced at least one Delta variant outbreak in the past four weeks. The reason for the failure is obvious: Children in the UK are not yet eligible to receive the Covid-19 vaccine.
We know what we have to do. Financial services, media and tech companies are delaying plans to return to the office. Several states require masking indoors. New York City will require proof of vaccination for indoor meals, and other major cities are poised to follow suit. Employers are stepping up efforts to vaccinate employees; and some even make vaccination against Covid-19 compulsory. We know better than sending unvaccinated and / or unmasked people into confined spaces. We should extend this logic to children and the spaces they also inhabit.
We have solid data to support a set of federal minimum standards for schools. At the bare minimum, every classroom should be properly ventilated and everyone who sets foot on a school campus should be masked at all times. For their own safety and that of the children, all teachers and staff should be fully immunized. For their own safety and to mitigate the impact of rupture cases, classroom instruction should be restricted to fully immunized students. For the same reason, campuses with indoor cafeterias should be required to schedule meal breaks based on immunization status. When space and time permit, outdoor seating should be made available for children. If one of these measures cannot be instituted, for whatever reason, then schools must offer the possibility of virtual learning.
Schools have the funding to implement these changes, but they lack clear and concise federal guidelines. Billions of federal funds have been specifically earmarked for protecting children from Covid-19. Several federal agencies must work together to clarify their orientations and coordinate the application of these minimum standards.
If the task is approached thoughtfully, but with urgency, we have a good chance of navigating the school year without jeopardizing the health and well-being of the 45 million children who are currently not eligible for the vaccination. Above all, you have to approach the start of the school year with your eyes wide open: the Delta variant leaves absolutely no margin for error.
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