It’s back-to-school season in the United States, and school districts across the country are bringing students back into classrooms after a year of remote learning. But all of this is amid a resurgence of COVID-19 driven by its highly contagious Delta variant, and some communities have already been forced to change their plans on account of spiking infection rates. “More than 80 school districts or charter networks have closed or delayed in-person classes for at least one entire school in more than a dozen states,” the Associated Press reported last week. “Others have sent home whole grade levels or asked half their students to stay home on hybrid schedules.” Though many schools are hopeful that public-health measures such as masking, social distancing, improved ventilation, and testing for the virus will help them maintain in-person instruction safely, all these interventions have practical limitations. They’re also part of an ongoing culture war, with some states banning mask mandates for schools. Meanwhile, an approved vaccine for children under 12 isn’t expected for several months. What are the public-health risks of this school year, and how might it affect the trajectory of the pandemic in the U.S.?

David Rubin—a medical doctor, the director of PolicyLab at Children’s Hospital of Philadelphia, and a professor of pediatrics at the Perelman School of Medicine at the University of Pennsylvania—says resuming in-person schooling “increases the risk of continued community transmission” of the virus. But he emphasizes that “the risk of severe illness is still really low for children” and that schools can use “layered mitigation strategies” to “create an environment where there will be some outbreaks but they’ll be infrequent and not the major driver of community transmission.” At the same time, Rubin sees only a “finite use” for mask requirements, arguing that the best schools policies might require masking and other restrictive measures now—as there’s substantial transmutation of the virus—but maintain the flexibility to ease up as time goes on. He’s also convinced of the importance of local decision making, knowing that the experience of schools in Philadelphia may be very different from that of those in the city’s suburbs. “We focus a lot on school policy, but the best way to protect kids is to have highly vaccinated communities,” Rubin says. “States with the highest vaccination rates also have the lowest rates of pediatric hospitalization in this wave of the pandemic. We have to be careful about looking at schools as a panacea for managing transmission among children, because their masks are off as soon as they hit the parking lot.”


Graham Vyse: How risky is the return to in-person schooling in the U.S., given the way COVID cases are rising across the country?

David Rubin: It’s not ideal that this is happening. We’re seeing a major resurgence of the virus. It’s created a lot of anxiety. That said, I’d still remind folks that we’re at a different point in this pandemic now that adults have been offered vaccination, which has—at least to this point—reduced the likelihood of severe disease among them.

The calculus has changed for kids, who were asked last year to shoulder a burden as part of a collective response, protecting vulnerable adults who hadn’t yet been vaccinated. That came at some cost to kids emotionally in social isolation. Does the resumption of school increase the risk of continued community transmission? Absolutely. But the costs are higher not to try to err on the side of normalcy for kids at this point. Focusing on what kids need to resume their lives is really important this year.

Vyse: From a health perspective, why is returning kids to in-person school—despite the risks—better than having them stay home?

Rubin: Despite a lot of anecdotal reporting about some children who’ve experienced severe illness, the risk of severe illness is still really low for children. That’s very important. Kids have endured a long period of social isolation and disruption in schools.

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