Viewpoint: We’re Reopening Schools Too Quickly

As schools open in the United States it is apparent that many regions have not fully prepared for this eventuality and our haste and lack of preparation have placed students and staff at risk. Our society is deeply divided, both sides live in a different reality which is based upon different “facts.” But nobody can make correct decisions if they are unable to identify and accept valid information.

One of the most telling outbreaks in schools occurred in Marin County, California. The report was published in Center for Disease Control and Prevention’s Morbidity and Mortality Weekly Report and described a single classroom outbreak which affected 12 of 24 students. The index case, or reported cause of the outbreak, was an unvaccinated teacher who took off her mask to read to her class. (Genomic Sequencing of 18 available specimens from 27 cases all showed the Delta Variant. The index case specimen was not available for sequencing.)

Kevin Kavanagh, MD

The media coverage of this outbreak has been fraught with spin. It has been used as an urgent cry to vaccinate all who can be, and the need to wear masks. These are valid observations but there are many more lessons.

First, talking can spread the virus. This outbreak underscores the dangers of congregating in indoor settings. All indoor settings are high-risk but especially bars and restaurants where loud talk occurs and masks are not worn.

Second, it was the school’s policy that everyone wears a mask, and it can be assumed that the children were all wearing masks and these masks did not prevent them from becoming infected. I would assert this exemplifies the need to wear a well-fitted medical grade, N95 or KN95 mask. The schools should provide these. It is not realistic to expect families, who do not even have reliable internet, to be able to obtain high quality masks for their children.

Third, the viral attack rate in the first 2 rows of the classroom was 80% and in the last 3 rows was 28%. Two of the 4 children in the very last row became infected. This illustrates two characteristics of SARS-CoV-2, first the further away from an infected person you are, the less likely you are to contract the disease. But you are still not safe at 6 feet. The virus is airborne and can spread much further to the back of the classroom. The logic behind the CDC’s reduction of physical distancing in schools from 6 feet to 3 feet makes little sense and I feel was largely based on the prevention of droplet not aerosol spread. The COVID-19 virus spreads by both; to decrease infections attention must be given to air filtration and air sanitization.

Fourth, infected students can spread the virus to others. The virus was also detected in 6 other students in a separate grade and 8 cases were identified in parents and siblings.

Fifth, vaccines are not fully protective. Of 5 infected adults, 3 were fully vaccinated. The vaccinated adults were symptomatic with fever, chills, cough, headache and loss of smell. There were no hospitalizations. Vaccines appeared to have prevented severe disease in these individuals.

Sixth, air filtration alone will not stop this virus. The classroom had a portable high-efficiency air filter and windows were left open. However, the delta variant can produce up to 1000 times more virions and can defeat interventions if they are just used independently without other measures.

The MMWR report also underscores the difficulty in stopping spread of the delta variant. No single intervention is 100% effective, and a layered approach is needed. Masks help. If the teacher had worn a high-quality mask, the infection rate would probably have been less. If the teacher was vaccinated, the chances of spread would again be lessened. Podding with smaller class sizes will also help. And testing twice a week of all students and staff, regardless of vaccination status, is also a prerequisite to opening safer.

Unfortunately, with the delta variant, even doing all these interventions, viral spread and outbreaks may still occur. There are those who advocate for herd immunity, but in reality, this is a fool’s dream. One misinformation flyer which was mailed to me stated: “Thus, as many ‘freaked out’ at the surges, the facts are we should have applauded them in the young and healthy because that shows herd Immunity is finally taking hold.”

Only smallpox has been eliminated by herd immunity. Polio, measles, and smallpox were around for decades, only brought under control by widespread adoption and use of vaccinations. Unfortunately, with the COVID-19 virus, achieving long-term herd immunity is all but impossible because the virus is rapidly mutating, and is also seeking animal hosts. A study recently published by the CDC found that pre-Delta, over 83% of 1.4 million samples from blood donations in the United States had antibodies to the COVID-19 virus. Others may also have been “immune” with memory B cells after their antibody levels subsided. In late July 2021, some of our leaders even announced herd Immunity had probably been achieved, but then the United States was crushed by a summer surge fueled by the delta Immune escape variant.

And other variants with even more immune escape potential are waiting in the wings.

Finally, we must prepare for the possibility this pandemic will worsen over the winter holidays. We cannot have our children repeatedly infected with immune escape variants. Teleschooling and hybrid programs may be a vital long-term strategy. They were not fully successful last year, but instead of discarding this strategy we should be developing improvements. It is apparent that the SARS-CoV-2 pandemic is an extremely difficult ever-changing problem. We must slow down the spread of this virus by adopting a layered approach so our pharmaceutical industry has time to catch up with development of therapeutics and next generation vaccines.