IDSA Leaders Brief Press on the Current State of Pediatric COVID Infections
On Sept. 2, the Arlington, Va.-based Infectious Diseases Society of America (IDSA) conducted a media briefing featuring Jason Newland, M.D., member IDSA, professor of pediatrics and infectious diseases at Washington University School of Medicine in St. Louis, and Noelle Ellerson Ng, associate executive director of policy and advocacy for the American Association of School Administrators (AASA). Chris Busky, CEO, IDSA, moderated. The briefing focused on the current state of pediatric COVID infections, the need for multiple prevention strategies in schools, and the role of superintendents in safely holding in-person school.
Newland began the briefing by saying that “I’d like to fist begin with some recent data that many of you know, and that’s the fact that we are now seeing a lot more children infected with COVID-19 every week. As of the end of the week, Aug. 26, the American Academy of Pediatrics and the Children’s Hospital Association published that we had just over 200,000 confirmed COVID-19 cases in children for that week—the most that had been reported. And that suggested a nine percent rise. As we have seen an increase in cases, children’s hospitals and hospitals across the country have seen an increase in admissions for children to their hospitals with COVID-19. While early in the pandemic we had some notion that children weren’t going to be impacted, the reality is that children, while at low risk, thankfully, compared to adults, they aren’t at no risk. We are seeing children in the hospital, and we are seeing deaths. As we hear of more and more kids being admitted, there will likely be more deaths following. Thankfully, it is not to the level of adults—that must be stated.”
Newland explained that as we are seeing an increase in COVID-19 in children’s hospitals, we are also seeing an unusual summer season of respiratory syncytial virus and other respiratory viruses that we normally see in the winter.
He continued that “As we are seeing this [rise], we are headed back to school, being a father of three—one in college, two in high school—this is something near and dear to my heart, making sure my children are safe when they return to school. Last year during the peak of the winter surge, we had numerous schools throughout the country in person, with the layered strategies that were recently sent out in a statement from IDSA, and has also been stated by the American Academy of Pediatrics and the Pediatric Infectious Diseases Society, and we have learned to do school safely. That’s with these mitigation layered strategies that include masking, distancing, staying home when you are sick—which goes underappreciated, we need to do that, mild symptoms could mean COVID-19—and lastly vaccination.”
Newland added that “We can have adults vaccinated and a lot of our teenagers to make sure the schools are even safer. There’s data that has demonstrated that if you have an increased adult population vaccinated, you will also then see a decrease in cases of unvaccinated children—this phenomenon of cocooning, so to speak. We know how to do school safely; we know that if we do these sorts of strategies that we can do this. With the Delta variant, we have more to learn, and that is going to include that we are transparent with data but going forward we will learn a lot in the coming weeks and these strategies will work.
Next, Ng said that “It is back-to-school time across America right now, which is a joyous and wonderful time, and this year is absolutely joyous and wonderful, with a slight level of deep concern and wonder about what is going to happen because COVID-19 is continuing to persist. And the Delta variant is particularly problematic because it is so infectious, and as Dr. Newland highlighted, infecting children at a rate that wasn’t a reality a year ago. So, on [I am here on] behalf of AASA, representing superintendents— they are the people in the nation along with the school board, who have professional expertise to run and lead a school system. What they don’t have is an expertise is in epidemiology and infectious diseases.”
Ng went on to explain that the nexus is between trusting your local educational professionals who work in coordination with state and local health policy experts for guidance on recommendations for the best practices and mitigation. She said that “Where we sit, this is just allowing and empowering and trusting your school superintendents, who I promise you, are focused on safety and wellness of their students and staff above all else.”
Ng added that “We know that mitigation strategies come with a cost, a dollar cost, or having access, or being able to have the supply chain get everything [to go] where it is [needed] to go. Trust your superintendents, and let’s empower them. On any given day, if this wasn’t a COVID year, we’d have a lot less state-level, heavy-handed approaches going on, [but] because it is COVID, and because there is an opportunity to send a message, and pick a position, we are seeing a heavy-handed approach from players who otherwise would be much more in the background around reopening schools. AASA remains adamantly committed to trusting and empowering state and local leaders to make these decisions, with the ultimate decision making, because this is where ultimately accountably lays, with the superintendents.”
She concluded that “That [the accountability] is echoed in the national organization [AASA], we align with the revised guidance from the CDC and the American Academy of Pediatrics, as it relates to the recommendations for schools. We are proud to align with these recommendations, while also reiterating that is a recommendation, because a recommendation defaults to informing the decisions of the local superintendents. We are very clear and repetitive in our positioning here, but I also think it illustrates how simple it is, and perhaps the best and most sufficient path forward.”
When the briefing was opened to the press, Healthcare Innovation asked, “Given that there is no uniformity to mask mandates in schools, as it differs from school to school and state to state, what is your level of concern with this lack of consistency across the U.S.?”
Newland responded that “I have big concern. If you look at a house, and you have someone come into your household with COVID-19, and you don’t know they are in your house [with COVID-19], you aren’t going to be masked and [are going to] be in this congregate setting—like a school, you might say. And we know that early on, before Delta, at least 50 percent of individuals in that house would get COVID-19. I have been doing test work, and I can tell you now it seems a lot higher, I don’t have any data, but when it comes into the house, it seems like almost everybody gets it unless they are able to put in mitigation strategies.”
“So, let’s think about school,” he continued. “We learned [about] this one percent transmission rate versus 50 percent rate—one percent is what we learned last year, with work done in Missouri, Wisconsin, and North Carolina. In North Carolina when they said, ‘Hey, what is the thing that wasn’t happening at the time of transmission?’ It was no masking and that’s what we continue to see. So, I think the lack of uniformity in places where they made it very difficult to even put mask mandates in place is problematic. We all know what it meant when kids couldn’t be in in-person school. We’ve talked about; it we’ve seen it. And it was hard for a lot of people. I had a student say to me, ‘Don’t ever make me go virtual again.’ If you don’t do a mask mandate you are going to have a lot of people out of school, because they’re going to be quarantined, they’re going to be out because they’re sick. In the end, what we were all after was making sure we had more people in in-person school, everybody agreed to that. Without these layered mitigation strategies that have been mentioned, including masking, now you really hurt the kids in the end, and that’s what’s hard for myself and my colleagues—about what we have learned—and now we can’t put that in place because people are putting barriers to it.”
Busky chimed in with a follow-up question, asking, “Do you have a recommendation about the best type of mask for children?”
Newland responded that “At this time, when we have looked at masking in schools, obviously, there’s the basic layered cloth masks, surgical masks, some KN95 [masks]. In a big environment like this, a mask that has been recommended by CDC, cloth or not, works. You don’t have to get sophisticated with KN95 or 95. But you have to wear them, under chin, over nose, and sometimes we don’t think kids are going to do this, but they’ve done way, way better than [we] ever dreamed of and that’s what we have to trust.”
Ng then said that “Plus one to all of that—the kids are going to be all right. I honestly think we are raising future leaders, let’s follow their lead, kids don’t have the issue wearing the mask, I’ll just leave it at that.”
Ng concluded that “Are we concerned about lack of continuity? I’m not. We’re 14,000 school districts by design, that’s 14,000 different approaches to dress codes, which by the way, school districts have no issue enforcing. So, it’s the same point—enforcing a mask mandate at the local level, with the same concept, a dress code for your face. When we talk about masking in classrooms, there’s a truth that held true a year ago, and that still rings true even more so now—the ability to for a school district to stay open directly correlates to the ability and the willingness of the broader community to make decisions about what they know works, as informed by data and science, to help policy recommendations. To the extent of benefits of masks, we want to superintendents have the ability to make the decision, because at the end of the day, there is a lot of tension over masking, which unnecessarily complicates something that should be easier. We don’t need to unnecessarily burden the work of opening schools [with] the postures on masking that aren’t to the betterment of individual students in the classroom and overall stated widely accepted position of wanting schools to be open. We need to get out of our own way in a lot of ways.”
