If you and I chat daily, you’ve got an idea of how much space this has taken up in my brain, and for how long (hi, Lisa). The topic is multifaceted, evolving, and we barely understood it. I’ve avoided writing about it here because I’m meant to keep this short and sweet, and I don’t know how to keep “Covid and kids” short and sweet, but I don’t think we can ignore it anymore, so… this is a TOME. If you have no interest in kids or schools (which: fair), scroll down for a treat. Thanks for bearing with me.
1. 🤔 Why now?
If this conversation was the mental equivalent of a thin layer of breadcrumbs on your (my) sheets, B.1.1.7 straight up turned your (my) memory foam into broken granite.
This England report from the end of December showed that the so-called Kent variant was more prevalent in kids, and that the attack rate (percentage of infected people amongst contact cases) was nearly 50% higher for kids 0-9 compared with “regular” variants. For the population at large, the increase in the attack rate went from 10% to 70%.
It doesn’t look like the variant is deadlier or more harmful to children — or anyone, for that matter. But if it’s more contagious and kids are helping, you know why Her Majesty’s Government’s latest shutdown includes schools.
A virus that spreads more easily is a virus that can, and will, make more people severely ill. It’s a numbers game. Also, a virus that spreads more easily is a virus that can mutate more quickly. AND GUESS WHAT
🚨 READ: B.1.1.7 has already mutated.
The proportion of kids becoming infected is rising around the world. Until mid-December, before schools closed in the U.K., the 2-6 age group represented the fastest rising percentage of the population who tested positive. By now, according to Britain’s Office of National Statistics (ONS), all are proportionally falling, except for that age group.
Early in January, this happened:
At the same time, this was going on in Canada:
The same day in Switzerland, Université de Genève Global Health Professor Antoine Flahault wrote a column in Slate (I’m translating):
A number of studies show that the role of children [in transmission] was most likely underestimated, if not neglected. Using more systematic testing of children for the virus or antibodies these studies highlight the fact that they are at least as susceptible as adults to SARS-CoV-2. They also present a viral load as significant as that of adults. There is, therefore, no reason to think that they’re less contagious.
(…)
The SARS-CoV-2 mutation in England and the situation in Ireland initially led us to think that the new variant was more transmissible by children than adults. That variant, however, is just more contagious. The explanation we consider most likely that there was, between September and now, an increased transmission amongst children, was that the safety measures dictated schools to remain open: the youngest were amongst the sole social vectors remaining in a society of adults massively confined to remote work.
Speaking of Ireland, this was last week:
The level of positive Covid-19 cases from mass testing in childcare facilities currently stands at 10 per cent, according to latest Health Service Executive (HSE) figures.
Massachusetts needs a better age breakdown (FFS, data people, stop lumping 5-year-olds in with 17-year-olds), but it’s clear that young’uns are driving it there (screen cap lifted on 3 Feb):
This *gestures vaguely* is why now.
2. 🏫 Schools
I’m going to try to stay calm for this one (ay Dios mío). I don’t even know where to start, so let me tell you about my own evolution.
Previously: early on, we decided as (western) societies that kids were fine, they were not going to get as sick as us olds, and they were not going to be major vectors of Covid. Still, schools in many parts of the world shut down. For a bit. And then, a large group of experts agreed that access to schools was more important. Everyone began to work toward reopening. In some cases, they did so immediately and without safety protocols in place.
Thus began the debate. You’d often hear things like “schools don’t contribute to superspreading.” This is a line all parents, employers, authorities, wanted to believe. And it makes sense. If kids go to school, you can keep a job. You can keep the economy running. If nothing else, as a family, you can keep your sanity. Paediatricians around the world settled on that recommendation. In the autumn, U.S. Economist Emily Oster issued a similar ruling, reassuring her audience.
By September, here was the situation in the places that I follow most closely:
France started reopening progressively on May 11, 2020, no distance, no ventilation, no masks before middle school. (In late October, they made masks compulsory in primary schools. Preschools are still exempt.)
In the U.K., they began to reopen in June, then for the new term on August 26th. No distance, no ventilation, no masks (except in communal areas, and then only for older kids).
Many states of the U.S. followed a similar line.
Here in New York City, the return to classes was initially scheduled for September 10th, then got pushed a couple of times because teachers’ unions were fighting it tooth and nail, looking for any assurance of safety. NYC public primary school kids went back into classrooms, with very strict, elaborate protocols and following a hybrid schedule (with the option to go full remote), on September 28th. Masks are compulsory from age 2.
In other corners of the U.S., California amongst them, schools have yet to reopen.
In some places, the “Reopen Schools” mantra began to border on fanaticism. A woman gave evidence at the U.K. All-Party Parliamentary Group on Coronavirus:
Here’s an anecdote in response to this testimony:
Others mentioned that they’d heard similar stories from Germany and Austria, where the logic is “your kids’ mental health is more important than you.” But isn’t that a false choice? Take this week’s thread by a French teacher about one of his pupils. Because of the absence of safety protocols in the school, the kid brought Covid home. The father was infected, died, and the kid now blames himself for not being careful enough. How does that preserve the boy’s mental health?
To say that I was sceptical about reopening is the euphemism of the century. It may have been a reaction to the death tsunami we went through as a city. It may have been that I’m not one to trust easy solutions to complicated problems.
It may have also been that from June to September, there were nagging stories of Covid tearing through summer camps in the Midwest, daycares in Texas, primary schools in Scotland, and a report by the CDC that showed infants and kids under 10 could infect their parents, even when asymptomatic. And this was when the weather allowed for plenty of time outdoors!
I just couldn’t fathom cramming 25+ children in one room. I also thought that if anyone should have first dibs at a spot in a classroom, it should be children whose parents could not be at home with them and those who’d fall behind for lack of access to the internet or a library. So when the city’s Department of Education asked families to choose between in-person and remote schooling, we picked remote for our first-graders.
In the interim, experts of all stripes were expressing concern at what they were seeing (see above). A major Korean study of 60,000 contact cases had determined that kids were less likely to pass on the virus, and everyone was citing this one as key evidence that schools could reopen. But when you looked at it more closely, only 237 of these contact cases were related to children.
Then an Indian study of nearly 85,000 people showed that in fact, kids were infecting others at the same rate as adults. In October The Lancet ran an examination of 131 countries that showed opening and closure of schools had the strongest effect on the reproduction rate. In November, Nature published a study of measures in 200 countries that showed closing educational settings was the second most effective measure. In the U.S., others looked at the result of school closures on new cases and mortality: it was a 60% reduction on both.
In truth, aside from the fact that kids typically get less sick from Covid than adults, we knew next to nothing about the incidence of Covid amongst them. One reason is that they are chronically undertested because it’s easy to miss. They vomit more, or they develop weird rashes, symptoms that aren’t associated with Covid in the collective consciousness. Also, they tend to have higher rates of false negatives. Dermatologist Esther Freeman, of Harvard and Massachusetts General Hospital, reported finding the virus in skin biopsies of children who’d otherwise tested negative. Saliva tests would also contradict nasal swabs. Similarly, the digestive tract may be a better site to find the virus than the nasal passages — China certainly seems to think so.
Still, we know that the impact of not attending in-person instruction can be catastrophic, and the ones who bear the brunt of it are those who are already at a disadvantage.
But it was bad. I watched parent-teacher associations in France howl at the growing number of cases in schools (primary and middle schools), where administrators told them not to reveal their Covid status to other families in order to stay open. Schools there do not test systematically, so families and teachers must do it themselves, and some parents reported having difficulty convincing doctors to swab their children. Due to this culture of secrecy, there are no studies, but what is clear is that there are clusters popping up in classes across the country. By mid-January 2021, the positivity rate amongst children aged 0-9 reached 10%, nearly double the population average.
Emily Oster, who had been widely amplified by large media outlets, was chided for cherry-picking her numbers to support her advocacy, and more specifically for ignoring the problem of income and race in school districts. With their eyes on a long history of racism, Black and Brown families across the U.S. opted out of in-person schooling en masse. The most at-risk demographics aren’t gambling with their children or their health.
Meanwhile, I evolved. Because of a registration error, our kids were not included in the remote group. The teacher expected them in class two to three days a week. We were told the cohorts would be small (eight to ten children), the tables more than 6 feet from each other, windows and doors constantly open (the kids wear coats and blankets inside when it’s cold). At lunchtime, each pupil sits at their desk, and they mask back up as soon as they’re done eating. Whenever possible, the teacher takes them outside. These measures have been imposed across the board, along with regular weekly testing, followed by class/school closures when cases are identified. We caved with the understanding that we’d pull them out at the first sign of fuckery, but the positivity rate in NYC schools has remained well below 1%, even as case numbers in the broader community rose.
And last week, the CDC confirmed it: with precautions, schools are safe. Say it with me: WITH PRECAUTIONS.
This will be my conclusion: As usual, it isn’t one or the other. Yes, schools are essential to the social, emotional, and intellectual development of most kids, and each community should make reopening them their priority (looking at you, Calif.). That being said, precautions are not optional, and they can represent a logistical challenge as well as a burden for families—ask me how I know. If the community at large does not keep a lid on infections, schools will not just become unsafe, they will worsen community spread.
3. 😓 Kids and long Covid
On October 16, 2020, the BMJ ran an opinion piece by two medical professionals in England who called for more research on long Covid in children. One of the two writers, Frances Simpson, has two kids who, like her, had been dealing with the aftermath of Covid for seven months. As with anything related to children in this crisis, next to no work had been done on the topic.
Last week from Italy came a study that got the attention of scientists who are interested in this topic. It is too small to be representative (129 children with Covid, 5% of whom were hospitalised), but it still made a bit of a splash: 52.7% of them still had at least one symptom four months after diagnosis. Just as for adults, these were found even in kids who’d shown no symptoms during the illness:
Insomnia (18.6%), respiratory symptoms (including pain and chest tightness) (14.7%), nasal congestion (12.4%), fatigue (10.8%), muscle (10.1%) and joint pain (6.9%), and concentration difficulties (10.1), were the most frequently reported symptoms. Although they were more common in symptomatic or hospitalized children, they were also described in those individuals who were asymptomatic during acute phase. 29 out of the 68 (42.6%) children assessed ≥120 days from diagnosis were still distressed by these symptoms.
Note that we’re not even talking about the much-dreaded multisystem inflammatory syndrome in children (MIS-C), which is still super rare — though it is serious enough that Boston Children’s Hospital just began a five-year study on kids they are treating for it.
But at this point, we’re talking about more than anecdotes. Britain’s ONS estimates that 12.9% of babes 2-11 and 14.5% of the 12-16 group are dealing with symptoms five weeks after infection.
We were quick to dismiss the risk for kids, but nearly a year after the first confinement measures, the wisdom has changed. What you need to know is that kids do appear to be transmitting the virus more than we realised and that it’s starting to look more and more as if a non-negligible proportion of them is susceptible to long-term difficulties. Just like for grown-ups, it’s impossible to know ahead of time who will handle it and who won’t.
How to use this: “Kids and Covid” was taken too lightly for too long. With rising numbers, research is pouring in. The main point here is that if you’re advocating for open schools, you must advocate for masks, distance, ventilation, testing, tracing, isolating in schools, as well as reducing risky activities in the community at large. You cannot be serious about one and casual about the other. This cohort will feel the effects of Covid physically, intellectually, and emotionally for a very long time and it’s on us to lighten the load however possible. And while we’re at it, we need to work harder to restore trust for Black and Brown families in the U.S. Corollary: we need Covid vaccines for kids ASAP.
🍭 As promised…
Bedlam at the Handforth Parish Council meeting — Part 1:
Part 2: