Many schools lack mitigation efforts needed to protect children from the pandemic

Doctors provide tips for parents concerned about the delta variant in schools.

Many Iowa schools don’t use key tools — face mask mandates, COVID-19 testing and quarantines — that can make schools safer during the coronavirus pandemic, according to a webinar for parents about schools and the delta variant.

“This is unfortunately the reality that we’re in with delta,” said Dr. Katelyn Jetelina, during the webinar. ”We need to implement many mitigation measures in schools because we have high rates of COVID in the community and low rates of vaccines.”

According to PM Pediatrics’ “Fall Focus: Framing a safe school year despite the delta variant,” children face rising hospitalizations for COVID-19 as classes resume. The webinar featured Drs. Christina Johns, Eric Weinberg and Jetelina. Children need to be in school — but with coronavirus mitigation efforts in place, the doctors said.

Their guidance comes at a time when many Iowa children have returned to classrooms amid rising delta cases, fights over mask mandates, an investigation by U.S. Department of Education's Office of Civil Rights, lawsuits by parents challenging the state's anti-mask law and Iowa Gov. Kim Reynolds’ continued resistance to mask mandates.

“We need our schools open. We need it for structured learning, but we also need it for other things like food for kids and safety and mental health,” Jetelina said. “So it’s really important we have balance — opening schools in a safe way so they can continue getting the education they need while being safe from the pandemic.”

Nearly 5 million pediatric COVID-19 cases have occurred in the U.S, and about 400 children have died since the pandemic began, said Johns. In the last few weeks, more than 200,000 children under the age of 18 have become infected with the virus, and between 1-3% of those cases will result in hospitalization, she said. The doctors warned 10% of children could experience long COVID symptoms which can persist indefinitely.

Jetelina, author of Your Local Epidemiologist, discussed a new report by the Centers for Disease Control and Prevention that found pediatric hospitalization rates were five times higher in August compared to June. The highest rates of COVID-19 hospitalization in children were among those under four years old and adolescents aged 12-17. About 6% of those admitted to the ICU required ventilation. She said delta isn't more "severe for kids" but increased rates are due to high community transmission.

‘A layered approach’

According to guidance from the Iowa Department of Public Health, COVID-19 testing, contact tracing and quarantine after exposure aren't required in schools. The doctors on the webinar emphasized the need for face masks, physical distancing, hand hygiene, cleaning, ventilation and contact tracing in schools.

“So If there’s a positive case, schools need to let those classrooms know so those kids can isolate and quarantine and not bring it into the community of pockets of the unvaccinated,” Jetelina said.

Last year, school openings didn’t cause an uptick in cases because students and staff wore face masks and schools operated remotely, they said.

An outbreak in a California school where an unvaccinated, symptomatic elementary school teacher took off her mask to read aloud caused an outbreak in the classroom.

“What this tells us is that we really need vaccinations among staff and teachers,” Jetelina said. “That is going to be the best preventative measure we can have for our kids.”

Masks, fans and the great outdoors

The virus is spread by aerosols that float in the air when people speak and cough. That’s why the doctors said face masks and ventilation in schools are key.

For children to wear face masks comfortably, “fit, filtration and comfort” make the biggest difference. Jetelina recommended KN95 masks for children and Mask Nerd by Aaron Collins on YouTube.

The doctors said classrooms need windows open, with fans aimed outward. More classes — even lunch — could be held outdoors, they said. Multiple open windows in a room decrease transmission 14-fold, Jetelina said.

“If an infected kid is in the classroom with no windows open, the virus accumulates inside,” said Jetelina. “Think of it like smoke. When you’re smoking a cigarette indoors, it can accumulate inside. And that puts all the other kids at risk.”

Lunchtime when children remove their masks to eat and talk, is a source of worry, the doctors said.

“There is the chance for COVID spread during lunch.” Johns said

It’s also important that adults on school buses are vaccinated, windows are open and children are wearing masks, Weinberg said.

Parents with young children in daycare can also ask for mitigation efforts, including making sure teachers are vaccinated, letting children spend more time outdoors and asking for positive cases to be reported to parents.

Need for vaccines

“Vaccines remain very, very effective at preventing hospitalizations and death,” Johns said.

When the COVID-19 vaccines were released last December, about 3,000 people a day were dying, said Jetelina. With cases, hospitalizations and deaths rising from delta, the doctors said there are strategies parents can take to keep their children, many of whom aren’t eligible to be vaccinated, safe.

Children 12 and older can be vaccinated, and children 5-12 are expected to be eligible for the Pfizer vaccine later this year. Johns said parents are familiar with vaccine series. Children currently need five DTaP shots, four polio shots, three Hepatitis A shots, two chickenpox and measles shots. The HPV vaccine needs a booster. Adults need a tetanus booster after 10 years, Johns said.

The doctors explained why delta is still troubling.

  • Delta is four times more transmissible than the original coronavirus
  • One person can spread delta to five to nine other people
  • Delta is more contagious than the cold, flu and Ebola
  • People who have delta carry 1,000 times the viral load of previous variants

The doctors also debunked some myths.

  • mRNA vaccines don’t change a person's DNA.
  • No live virus is contained in the vaccines.
  • No link to fertility issues.
  • COVID-19 vaccines can be administered with the flu and other vaccines.

What are the symptoms of COVID-19 in children?

Symptoms to watch out for in children include, fever, chills, cough, shortness of breath, sore throat, fatigue, muscle aches, headache, nausea/vomiting/diarrhea, congestion, loss of smell and taste. Symptoms may not include a temperature.

“I think the key piece here is that clinicians and parents really can’t tell the difference between COVID and other viruses or even seasonal allergies, which of course we’re heading into fall season right now, without getting a test,” Johns said. “And, that is really important. It’s important that we keep on testing.”

Weighing decisions

Families must determine if the activities they want to participate in, like sports, is a need or want and compare that with the level of delta variant circulating in their communities. Vaccinated individuals can tolerate more risk, the doctors said.

With sports, avoid those requiring buses, locker rooms and huddles, said Weinberg.

“There is no way this pandemic is going to end unless every single eligible person gets vaccinated and that includes kids,” he said. “Or else this is just going to continue for years and years.”

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