This commentary is by Anne N. Sosin, a policy fellow at the Nelson A. Rockefeller Center at Dartmouth College and the co-lead on research on Covid-19 and rural health equity in northern New England.
Two narratives are taking hold in Vermont and in other states across the Northeast: Reckless behavior among young people is driving growing Covid-19 case numbers, but these rising caseloads don’t matter because young people are not “high-risk.”
The problem is that both of these claims belie reality and, read together, they form the basis for public health and policy decisions that undermine our shared goal to protect their health and well-being.
Dismantling the myth of reckless young people: Since the onset of the pandemic, we have read story after story of young people flocking to crowded beaches, holiday cookouts and campus parties. These accounts form a convenient explanation for the high rates of infection we see among 18-29-year-olds.
Yet, a closer reading of the data reveals a more mundane reason for consistently high rates of infection among young people: They live and work in conditions that create far greater opportunities for exposure. Vaccination among older adults is further shifting the median age of infection downward.
Low median ages of infection can be explained by employment data alone. Young adults are more likely to work in the essential workforce or in public-facing settings such as restaurants, coffee shops and retail stores. College-age students live in dormitories or apartments with shared bathrooms and dining spaces. Even with careful public health practices, campuses are a fertile environment for a virus that spreads through airborne and asymptomatic transmission.
A recent study from New Zealand revealed contactless, airborne spread in the hallway of one of the country’s pristine quarantine hotels, pointing to the difficulty of controlling transmission even in the best of circumstances. We all know that young people are more likely to engage in risk-taking behaviors; however, the dangers of these behaviors are magnified in unforgiving living and working spaces.
Young, healthy and still at risk: All of us see the impacts of a year of lost rituals and social time on the mental health and well-being of young people around us. Yet, as hospitalizations and deaths among older populations fall quickly, growing data on the risk of long Covid, or chronic disease, among young people upend our thinking on easy trade-offs between physical and mental health.
Young people infected with mild and even asymptomatic Covid-19 in March 2020 describe their yearlong experience of debilitating illness that has left them unable to work, learn, and enjoy other activities. The true burden of long Covid is still coming into focus; however, early estimates suggest that somewhere between 10% and 30% will experience chronic disease. Allowing significant numbers of young people to be infected with Covid-19 mere weeks before they are eligible for vaccination may impose a significant — and preventable — toll on our health system, economy and social services for years to come.
Rising case counts also threaten Vermont’s more immediate goal of returning more students to classrooms in April. Growing infection rates may not only shift the state into a higher community transmission threshold, under revised CDC school guidance, but may also make for a less stable return to classrooms.
Vermont educators and families across the state attest to the disruption of even a small number of cases of Covid-19 in schools and communities. Even a single case can send a carefully constructed pod into quarantine, sideline workers reliant on schools for their children, and incite fear among families and communities. These impacts will be greatest in rural areas of the state with poor broadband coverage and limited access to technology.
Just weeks ago, I witnessed these consequences when a campus outbreak sent my college students into isolation and quarantine midway through our semester.
Rejecting false trade-offs between physical and mental health: It’s time to stop blaming young Vermonters for the state’s swelling Covid-19 epidemic and enact policies to protect them.
First, Vermont’s leadership should recognize the danger posed by surging cases and aggressively seek to reverse the upward trend rather than continuing to “turn the spigot.” Vermonters have largely demonstrated their willingness to comply with restrictions to protect the health of their loved ones and preserve in-person education, and we should highlight the benefits of sustaining these sacrifices for the next few weeks.
Second, Vermont should stop relaxing restrictions on high-risk settings, including restaurants and bars, until that workforce can be vaccinated. We have ample evidence from both Vermont and other settings that even capacity constraints of 50% are insufficient to reduce transmission and that restaurants contribute disproportionately to community spread.
More importantly, data from Vermont and other settings across the U.S. show that food service workers are at significantly greater risk of infection, and the harms of rapidly reopening these settings will concentrate among our young workforce.
Third, Vermont should reject the false choice between taking measures that increase risks to student’s long-term physical health and investments in activities to improve their mental health. As the weather warms, we should enable a broad range of safer outdoor social and recreational options for young people across school and community settings. We have overwhelming data showing that outdoor sports, social gatherings and other activities, even with less than ideal mitigation measures, are many orders of magnitude safer than indoor dining and other indoor maskless activities.
Finally, we must abandon a well-worn discourse of “young, healthy and undeserving” and vaccinate all young people, including out-of-state college students, without further delay. Accelerating the vaccination of the population with the highest infection rates is the single most effective way to reverse Vermont’s current trends.
Moreover, discounting the risks of Covid-19 within younger age groups or framing it as a benefit rather than a critical public health tool may inadvertently undermine our efforts to reach herd immunity. Instead, we should celebrate vaccination of our healthy young people as a rite of passage into safer workplaces, joyful milestones and carefree times.
As a parent, in-person educator, and public health practitioner, and researcher, I’ve seen firsthand that our kids are not OK. Yet, we must resist the desire to blame young people for the failure of older generations to control the pandemic. We must guard against rationalizing short-term public health and policy decisions that have the potential for long-term impact on the health and well-being of our young people.
Instead, we must see the ways that Vermont’s young people have protected older generations and enact public health measures and policies that honor, rather than undermine, their sacrifices.
