How to Avoid the COVID-19 Disaster in Southern Schools

Somehow, COVID-19 cases and hospitalizations are accelerating as quickly and dangerously as they did in last summer’s outbreak in the southern United States. This time around, many governors aren’t just refusing or reducing social distancing, they are abandoning children and teens with a reluctance to better protect them from the risks posed by the Delta variant.

The current approach – a toxic stew of milquetoast vaccine advocacy, anti-mask madness and bogus health freedom rhetoric – is a recipe for failure. More than ever, we need pragmatic, committed and non-ideological leadership.

Among other things, in this time of crisis, it means that we must have a mask and compulsory vaccines for schools in the South.

Here’s the current situation: In low-vaccination areas of states like Louisiana, Florida, Arkansas, Mississippi, and Alabama, we’re seeing rates of COVID-19 infection that resemble the summer outbreak of Last year. And now hospitalizations are rising sharply again, especially among young adults who refuse COVID-19 vaccines, sometimes putting medical workers in worse situations than ever. Biggest concern: An ever-growing number of unvaccinated children in states like Arkansas, Florida, Louisiana, Mississippi and Tennessee are now admitted to pediatric intensive care.

Two factors explain the rise of young people in the South. The first: Less than 20% of teens in Louisiana, Alabama and Mississippi, to take just a few examples, are vaccinated, which is among the lowest rates in the country. Immunization rates among young adults are also low.

The other factor is the recent discovery that the Delta variant of the coronavirus is much more transmissible or contagious than any other variant of the SARS-2 coronavirus that we have seen so far. As has been widely reported, an internal CDC memo concluded that the variant is as contagious as chickenpox, one of the most contagious viruses that hit children hard.

I’m not the only one worried that the COVID-19 pediatric and young adult hospitalizations we are seeing now are just the act of warming up, and that COVID-19 is accelerating just as schools start to reopen. for in-person classrooms. But the scale of the potential horror is not taken into account as the country rushes to emerge from our 18-month national nightmare.

By mid-August, most schools will open for in-person classes in Louisiana and elsewhere in the South; my own Houston Independent School District (HISD) opens on August 23. School reopens could act as an accelerator, resulting in thousands of children and adolescents infected with COVID-19, with high admissions to pediatric hospitals and pediatric intensive care (PICU).

This confluence of events means that the rapid drop in Delta cases in the UK in recent weeks may not materialize here. This, in turn, suggests that our best hope for preventing a back-to-school tragedy in the South is to make vaccines and masks mandatory.

If we don’t, we already know that many young people and children will likely contract COVID-19 as we head into August and September, and many will be hospitalized.

The fact that Delta is as contagious as chickenpox is instructive: In the fall of 2018, the state of North Carolina reported its largest chickenpox outbreak in recent memory, or at least since the introduction of the chickenpox vaccine. . In a private Waldorf school, a type of school known for its high rates of parental reluctance to vaccination and even “anti-vaccination fervor,” 110 of 152 students were not vaccinated, resulting in a diagnosis of chickenpox in 36 students in one day.

Based on this example, it is fair to expect that many unvaccinated children and adolescents will also contract Delta COVID-19 in southern school districts. We already have a glimpse of the future, as COVID-19 outbreaks linked to early school openings in southern Mississippi have forced a return to virtual classrooms, while more than 400 Arkansas students and staff in a school district are now in quarantine a week after opening.

Even when children don’t get sick enough to require hospitalization or to pack PICUs, the long COVID and its neurological complications are a second concern.

There is strong evidence to suggest that about a quarter of infected young adults will experience lengthy neurological and other complications from COVID, that is, a saga that will last for months or longer. It is less clear whether teens and young children will also experience a lengthy COVID at similar rates. So far, studies are few or contradictory or incomplete. Many of them are smaller in terms of the number of children enrolled; hopefully they will eventually converge on a more cohesive story.

So far, we know that an analysis from Rome, Italy has found that 50% of infected children ultimately endured a lengthy COVID, with at least one symptom lasting at least four months, while in the UK a group known as the Long Covid Kids follows more than 1,200 children with long-lasting symptoms, many of whom have severe disabilities. Still others identify lower percentages of children with long-term COVID. This is important to address given a yet to be peer reviewed report from the University of Oxford and Imperial College London suggesting that in adults, brain gray matter degeneration from long COVID may begin. to resemble that associated with aging or even Alzheimer’s disease.

Another concern is the potential emergence of even more new variants that flourish when transmission of COVID-19 goes unchecked due to low vaccination coverage. Already, a disturbing new variant of B. 1621 from South America has gained a foothold among unvaccinated populations in Florida. Unless we vaccinate the South, our national epidemic will not end with Delta.

COVID-19 vaccine school warrants for children 12 and older, as well as teachers and staff, would be the most effective way to avert this catastrophe. Before the pandemic, we saw examples of vaccine requirements for entry to school working effectively to increase immunization coverage. However, Alabama, Arkansas and Florida, all led by Republican governors, have already passed legislation banning public schools from requiring COVID-19 vaccines. The drivers of this have little to do with protecting the health of children and everything to do with an accelerating destructive (and self-destructive) anti-vaccine political movement of “health freedom” or “medical freedom”. for the first time here in Texas in 2015.

It is important that the governors of all 50 states, including the blues, recognize the urgency of implementing the mandates of the COVID-19 vaccine schools. But the need is much more pressing in the South at the moment.

As for the masks, at least there are signs of governors in the area responding to the danger signs.

Louisiana Democratic Gov. John Bel Edwards has moved to reimpose a statewide mask mandate, while GOP Arkansas Gov. Asa Hutchinson has asked the state legislature to reconsider his previous ban local mask mandates. Meanwhile, Alabama GOP Governor Kay Ivey was at least willing to call unvaccinated people to explain the recent increase in that country.

Other Republicans are digging their heels and preparing their children for an uncertain and risky school year.

Florida Governor Ron DeSantis just signed an executive order banning school districts from imposing masks, instead insisting that parents have the right to make the decision. Missouri Governor Mike Parson took the time to take to Fox News last week, a place of anti-vaccine misinformation, to explain why he would not impose a new mask mandate. And Mississippi Governor Tate Reeves announced Tuesday that he, too, was not interested in a new mask policy.

Without warrants – for COVID-19 vaccinations for eligible children and school staff, or for masks – our options are limited and our children are subject to unnecessary health risks. We need to step up advocacy and public messaging to get parents to vaccinate their teens and increase rates in the South, while promoting the benefit of masks. At the same time, we must continue to eliminate aggressive non-governmental anti-vaccine groups from the Internet as advocated by the Center for Countering Digital Hate, and continue to woo GOP champions, or at least voices ready to break with this new and self. – to undo the conservative orthodoxy of the freedom of health.

The sad reality is that we must now prepare for an even greater increase in hospitalizations, including pediatric hospitalizations and intensive care admissions to children’s hospitals. We also need to anticipate a significant number of young adults and children with signs of long COVID, and develop a plan for their outpatient follow-up and neuropsychiatric counseling and treatment.

While these recommendations seem modest in scope given the gravity of the situation, they also reflect a reality that despite months of warning, including my own, there was simply no political will to do more. . Schools are opening and Southern pediatricians and nurse practitioners are holding our collective breath.