Sosin, Winterbauer & Hoen: Vermont should reopen schools cautiously

This commentary is by Anne N. Sosin, a policy fellow at the Nelson A. Rockefeller Center at Dartmouth College; Liz Winterbauer, a consulting epidemiologist currently supporting national Covid-19 testing efforts; and Annie Hoen, an associate professor of epidemiology at the Geisel School of Medicine at Dartmouth. All are parents of school-age children in Vermont.

When Vermont reopened its schools last fall, many feared that Covid-19 cases would threaten the health of students, educators and communities. A year later, Vermont has demonstrated that schools can reopen for in-person instruction. 

Conditions for the coming academic year are more favorable in many ways: The state has achieved the country’s highest vaccination coverage among its adult and adolescent populations and continues to sustain one of the country’s lowest infection rates. Yet the virus is evolving in ways that pose serious challenges to planning for the coming school year. 

In just over two months, the new Delta variant of the virus has become a major concern, accounting for over 80% of new infections. Delta spreads so easily that our thinking about how to control Covid-19 in our communities and schools must change. 

Current data shows that, while vaccines remain highly protective against severe illness from Delta, vaccinated people can not only become infected but also transmit to the unvaccinated, including children. 

We are already seeing the impacts of the variant on schools even in the best of circumstances. Israel — one of the world’s most vaccinated countries — had outbreaks across its schools when it  dropped mitigation measures. Similarly, 1 in 7 children were absent in the UK as cases in school flared when the UK abandoned controls.  

Children can become infected with the SARS-CoV-2 virus, and they can transmit it to their contacts.  Reassuringly, most children infected with the SARS-CoV-2 virus are asymptomatic or develop mild illness. Yet, some children experience severe, life-threatening illness. 

To date, Covid-19 has claimed the lives of at least 335 children in the United States. Children have accounted for 1.2% to 3.1% of hospitalizations nationally, and nearly one-third of adolescents hospitalized in the U.S. required intensive care, with 5% requiring invasive mechanical ventilation. 

A recent study found that nearly 1 in 25 children hospitalized with Covid-19 developed neurological complications, including stroke, Guillain-Barré syndrome, encephalopathy, and seizures. An unknown but larger number of infected children, including those who experience only mild illness, will go on to develop long Covid, or chronic disease. 

While the chances of these outcomes are small, the long-term consequences are unknown, underscoring the importance of prevention in this age group. 

Vermont is well-positioned to restart the year with in-person education; however, the state and its schools are not immune from global and regional trends. Roughly one-third of students 12 and older in Vermont have not yet been vaccinated. Younger students will not be eligible for vaccination until later this fall, at the earliest. Many families have resumed visits out of state, traveling sports, and other activities that will bring virus into our communities and schools.

Vermont has already shown the U.S. that we do not need to choose between our children’s health and education. Yet, we must build on four lessons that enabled our success as we begin the new school year. 

1. Adopt a statewide approach

First, Vermont should adopt clear statewide guidance setting common standards for schools across the state, with adjustments as conditions change over time. 

State guidance benefits everyone: It ensures common practices rooted in the most recent science, provides a similar level of protection to children and staff across the state, and insulates schools from local political pressures and access to public health expertise. School districts should not be asked to make epidemiological decisions, and children in still undervaccinated Essex County should be afforded the same protection as those in highly vaccinated Addison County.

The state should also acknowledge local variation in risk and set targets for schools to lift mitigation measures when vaccination rates within school communities reach a critical threshold. Such targets would ease the burden of decision-making by providing an objective criterion for changes. They might also encourage some families to choose vaccination. 

2. Follow the science

Building on its success and the growing science around schools and Covid-19, Vermont should adopt evidence-based mitigation practices, including promoting vaccination of staff and eligible students, universal masking, enhanced ventilation, and routine screening tests of students and staff. 

As a priority, the state should adopt the recommendation of the American Academy of Pediatrics for universal masking for staff and students regardless of vaccination status. 

At the same time, a year of data tells us that some mitigation measures can be eliminated. Industrial cleaning practices, daily health screens, temperature checks, and plexiglass installations are not only unnecessary but also consume time and resources. 

While masks and other restrictions may seem burdensome, their benefits outweigh the inconvenience. Absent mitigation measures, we can expect the Delta variant to enter our schools and spread along with colds and flus. For kids and families alike, this means the added cost of testing, school absences, and lost work days from both Covid-19 and other respiratory illnesses will far outweigh the discomfort of mask-wearing.

3. Protect the vulnerable

Robust mitigation practices are especially critical for ensuring that children at elevated risk due to medical conditions can attend school with their peers. 

However, a small number of children with certain high-risk medical conditions need continued access to remote learning and other accommodations until vaccines become available. An estimated 6.2% adults and 2.6% of children are immunocompromised, and these staff and children face substantially higher risk of severe illness if infected. 

Other parents might be reluctant to send kids too young to be vaccinated to schools with the uncertainties surrounding Delta and subsequent variants. At a minimum, Vermont should put in place statewide support for schools to enable them to meet the needs of these families with remote education.  

Our goal as a state should be to ensure to build on the pandemic adaptations that enabled some students, including those with disabilities and risk of severe illness, greater accessibility during the pandemic.

4. The Vermont Way

Vermont communities across the state came together to reopen our schools and redoubled their efforts once again when a spike in cases threatened to close them. Data from other settings have shown that social gatherings outside of the schools play an important role in community transmission, and indoor sports were associated with most outbreaks in Vermont schools.  

As we wait for authorization of a vaccine for young children, we must maintain mitigation measures, including masking, in higher-risk activities outside of school.

Vermont children have made sacrifices to keep older generations healthy. Now, we must put their health and education first.

The views represented in this article do not reflect the views of Dartmouth College or the Geisel School of Medicine.


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