COVID-19 Is a Disease of the Unvaccinated: What Does That Mean for Schools?

School years always start off with palpable excitement: After a summer of lollygagging and just being allowed to be children, it’s off to another school year (or, for some, their first school year) for youngsters in the United States. This year, after COVID-19 forced many schools to teach students remotely, the excitement might be at a greater pitch than usual.

But … (and in this time of pandemic, there’s always a “but”) this year’s exceptional excitement about the return to the classroom in person mixes with some fear and wariness among parents and public health care officials.

As Infection Control Today^® (ICT^®) reported last week, some teachers fill the ranks of the nearly 47% of Americans who remain unvaccinated—and that presents problems that might not be easily solved. That article—written by Saskia v. Popescu, PhD, MPH, MA, CIC, a member of ICT^®’s Editorial Advisory Board (EAB)—cites a recent study in Morbidity and Mortality Weekly Report (MMWR—a publication by the Centers for Disease Control and Prevention) that describes just how fast the Delta variant can spread among schoolchildren, since there is no vaccine yet for children 5–12. The study examines a COVID-19 cluster among children after they had been exposed to an unvaccinated and infected teacher in a classroom in Marin County, California.

“This outbreak of COVID-19 that originated with an unvaccinated teacher highlights the importance of vaccinating school staff members who are in close indoor contact with children ineligible for vaccination as schools reopen,” the study states.

(One of the limitations of the study was that “the teacher’s specimen was unavailable for WGS [whole genome sequencing], which prevented phylogenetic identification of the outbreak’s index patient.”)

The attack rate within the classroom was 50%, despite high rates of masking and distancing guidance within the school. CDC investigators note that the spread likely occurred during instances when the teacher was unmasked while reading out loud to the class and underscores the need for all those working in a school to be vaccinated.

The CDC cites another study that shows “that rates of COVID-19-associated hospitalizations in children and adolescents increased following the rise of the Delta variant in the United States. Prevention strategies, including vaccination of school staff and eligible students, universal indoor masking, staying home when sick, and routine testing, are critical to schools reopening and operating safely.”

The CDC’s concerns stem from the rise of the Delta variant, and that rise continues. The seven-day average of new cases yesterday was more than 300% higher than Labor Day of last year, according to Johns Hopkins University. And deaths are also on the rise, averaging close to 1600 a day, according to Johns Hopkins.

Megan Ranney, MD, MPH, is the professor of emergency medicine and associate dean of public health at Brown University. She tells CNN that every patient she needs to send to the hospital is unvaccinated. Those who’ve been vaccinated are spared that experience. Ranney adds that “this is a disease of the unvaccinated right now.”

But for how long? Evidence mounts that the effectiveness of the COVID-19 vaccines wane over time, hence the call for booster shots.

Then there’s the problem of the mu variant waiting in the wings, which very preliminary data suggest might be resistant to antibodies produced by the vaccines and by prior infection by COVID-19.

Kevin Kavanagh, MD, another member of ICT^®’s EAB, recently asked if the US should adopt an elimination strategy for COVID-19. “In Beijing the total cases in an outbreak were reported to be less than 10. China used over 100 million tests to eradicate what would be classified as a very small outbreak by US standards,” Kavanagh wrote. He added that the US “may need to pivot as a nation to an elimination strategy and break the cycle of repeated waves of deaths and disabilities caused by emerging variants.”

An article written by Kavanagh posted to ICT®’s website yesterday looks at the same MMWR study that Popescu looked at. Kavanagh notes that the COVID-19 virus infected two of the four children in the row at the very back of the classroom. The virus is aerosolized and that stopping the spread would have required a social distancing of more than 6 feet, never mind the 3 feet that schools now maintain between students.

“There were also another 8 cases identified in parents and siblings demonstrating that children at school can be significant vectors for spreading COVID-19,” Kavanagh wrote. “The students also wore masks, illustrating that masking as a sole intervention is inadequate. Masks need to be upgraded to well-fitted medical grade, KN95 or N95 masks, along with testing of all students and staff twice weekly, and better school ventilation. Even with these strategies the virus may still be expected to cause outbreaks, necessitating the need for smaller class sizes, podding, hybrid classes and teleschooling.”

Kavanagh circles back to elimination strategy.

“After the Delta surge subsides, another surge is expected, possibly from the mu variant,” Kavanagh wrote. “If mu completely escapes immunity from vaccines and past infections, we must resort to stringent public health strategies. Eventually, the United States may need to adopt an elimination strategy, sacrificing short-term for long-term societal benefits. But whatever strategy is adopted, all Americans must embrace public health measures, or we will not be successful in viral mutations and the pandemic.”