Late last week, the U.S. Centers for Disease Control and Prevention released sweeping new guidance for public schools, prioritizing in-person learning and making masks optional for fully vaccinated students (a recommendation that Virginia will soon adopt, the Richmond Times-Dispatch reported).
The news came less than 24 hours after the state’s Department of Health announced that a second child under the age of 10 — a boy from Stafford County — had died from COVID-19. The risk of severe disease and hospitalization among children is still lower than it is for adults, according to the CDC. But for many public health experts, the upcoming school year is a looming reminder that children remain one of the most vulnerable populations for catching and spreading new cases of COVID-19.
“It’s going to depend so much on the local context of the school system,” said Dr. Taison Bell, an infectious disease specialist at the University of Virginia. Children under 12 aren’t yet eligible for a shot, and likely won’t be until later this fall. But growing research shows that vaccinations among adults can be key to protecting younger age groups.
“For instance, I’m in Charlottesville, and we have relatively high uptake rates,” Bell continued. “The teachers, the custodial staff and other adults in the building — they’re much more likely to be protected. That’s a much lower-risk scenario compared to some areas of Virginia that still have low rates of vaccination.”
Some of the clearest data comes from countries or regions with exceptionally high vaccination rates among the adult population. Israel, for example, has one of the highest per-capita vaccination rates in the world, and reopened most school buildings by March. But case rates still dropped dramatically among children younger than 11, as they did for people 16 and older.
Similar evidence came from Serrana, Brazil, where 98 percent of adults have been vaccinated. Research found that symptomatic infections dropped by roughly 80 percent among both adults and unvaccinated children as a result, according to reporting in Nature, an academic journal.
“So, there’s data showing that once vaccinations start picking up in adults, you actually have protection in children,” Bell said. “Children are less likely to be infected, and that’s because the most common mode of transmission to a child is from an adult they’re in close contact with.”
Experts are hoping the message will resonate as schools prepare for what, in some cases, will be the first return to full in-person learning since the start of the pandemic. Kids and young adults have made up a growing share of the state’s new infections since early April — a trend that could be driven by the rise of more contagious variants. And while the risk of severe outcomes are lower for children, they can happen.
A recent CDC study of hospitalizations among 12 to 17-year-olds found they were far more prevalent among Black and Latino children, as well as children with underlying medical conditions. Virginia has also recorded 76 cases of multisystem inflammatory syndrome in children, or MIS-C — a rare COVID-associated condition that’s also disproportionately affected Black and Latino youth.
For Bell, it underscores the importance of individual vaccination, a message many public health experts worry has gotten lost in the later stages of the state and national campaign. Much of the early messaging around vaccines focused on herd immunity — the idea that with enough people vaccinated, COVID-19 would eventually stop circulating.
But some officials have become less than enamored with the concept as a way to promote vaccination. One reason, Bell said, is that there’s no clear understanding of how many people need to be protected to actually attain herd immunity. The more contagious a disease, the larger the percentage of the population. And with variants now making up the vast majority of infections, officials have been raising their estimates.
“The problem is that it tends to simplify it down to, ‘What’s the percent that we need to get protection?’” he said. “And it’s much more complicated than that.” It also tends to gloss over the impact that vaccinations can have at the local level. By early May, for example, researchers were estimating that Northern Virginia could avoid another surge in cases thanks to high uptake in the region.
“We put the focus so much on herd immunity that the importance of personal vaccination has kind of gotten lost,” Bell said. “And now the people we need to vaccinate are the ones who are reluctant or just don’t feel that it’s necessary for them.”
Protecting children who aren’t yet eligible for a dose is just one area where individual vaccination can make a significant difference. While the U.S. may never reach true herd immunity, the virus can be significantly curtailed as more people are immunized at the local level. Those protections extend to adults who — in some rare cases — can’t receive the vaccine, or who may receive less protection due to pre-existing conditions.
It’s especially important given the rise of the Delta variant, which now makes up just over 20 percent of sequenced cases among Virginians aged 0 to 19, according to data from VDH. Spokeswoman Melissa Gordon said those numbers are likely an undercount, given that not all samples of the virus are tested.
Delta, which can evade immune system protection, is more contagious than other forms of the virus. Preliminary research has also indicated it may cause more severe disease. A single dose of vaccine is much less protective against the variant, which makes high uptake rates — and complete vaccination — especially important for fighting the spread. Cases are currently surging in states like Missouri, where low vaccination rates and a lack of protective measures have allowed the virus to circulate widely.
“Their ICUs are over capacity,” Bell said. “Their staff are overwhelmed. So for communities here with low vaccine uptake rates, I’m very, very concerned about the fall and winter. I can’t express it any better. The difference is that it’s truly preventable at this point.”
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