Tomás Ryan: Schoolchildren need protection from Delta variant

Mitigation measures such as masks and serial testing must be used in classrooms

In Ireland and the UK, about 0.5 per cent of Covid child cases have been hospitalised. Photograph: AndreJ Cukic/EPA

In Ireland and the UK, about 0.5 per cent of Covid child cases have been hospitalised. Photograph: AndreJ Cukic/EPA

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Schools have been open for two weeks, and we are about to start seeing the effects. No environment is intrinsically safe, unless it is managed well. Schools are safer when virus numbers in the surrounding community are low. Schools are safer when serious mitigation measures are in place. Schools are safer if you’re vaccinated, and a critical mass of people sharing the space you are in are vaccinated.

So far in the pandemic, schools have contributed to virus spread to some extent. But whether they were open or closed, we always protected the schools. We did so by protecting all of society. public-health measures – whether mask-wearing, social distancing or lockdowns – protected everyone in the community and, as a result, helped to protect children in schools.

Now, we are protecting individuals by vaccination while relaxing the public-health measures for the population as a whole, and many of us can now enjoy the benefits. As a result of these changes, our children are more vulnerable to infection than at any previous point in the pandemic. We have never opened schools with such high case numbers. We have not seen how the Delta variant transmits in Irish schools, as the Alpha variant was dominant until late June. And most worryingly, we are moving towards the removal of protective measures in our schools, such as the isolation of asymptomatic contacts.

We are told that children are of low risk to the effects of Covid-19. That depends on what you mean. In Ireland and the UK, about 0.5 per cent of Covid child cases have been hospitalised. This is quite a low proportion compared with the unvaccinated hospitalisation rate in adults over the age of 45, which was over 10 per cent. Children also seem to be at lower risk of long Covid than adults, but reports suggest that somewhere between 2 per cent and 15 per cent of child Covid cases present symptoms for at least many months.

Vaccination

Certainly, individual children with Covid have a low risk of hospitalisation and long Covid compared with adults. But here’s the thing – it’s no longer about comparing the risk to an individual child with that of an individual adult. The comparison that matters today is between the risk to a largely vaccinated adult population and an unvaccinated child population.

Only a small subset of the adult population were infected with the virus while unvaccinated. Before the vaccine cavalry arrived, public-health measures have allowed us to limit known Covid cases to about 7 per cent of the adult population and 4 per cent of the schoolgoing child population. Today, the adult population is largely vaccinated, greatly reducing the risk of illness. Thankfully, teenagers are now being vaccinated rapidly. But all children are currently at risk of exposure and are still unvaccinated.

Vaccinated individuals can still transmit the virus, and there are 548,693 unvaccinated five-12 years olds in Ireland. In a worst-case scenario where most children were infected, we could be exposed to 2,000-4,000 child hospitalisations (including hundreds of cases of severe illness) and tens of thousands of cases of long Covid.

Australian contact tracing in a classroom environment has shown that the Delta variant can have an attack rate of more than 70 per cent when transmission is unmitigated. Recent modelling by the US Centers for Disease Control indicates that three-quarters of all under-12s could be exposed to the Delta variant over a period of months if mitigation measures such as masks and serial testing are not used in classrooms.

Surge

In Ireland, the National Public Health Emergency Team’s own modelled projected scenarios mean that a large surge in cases in the coming months, primarily among younger people. The virus will likely enter the schools from the surrounding environment and put all our children at risk of infection, unless stronger public-health protection measures are used.

This tragedy is we can chose put effective measures in place, and we can do so without closing society. We can follow France, Germany, Italy,and many parts of Canada and the United States and have protective mask-wearing in all classrooms. We can improve ventilation and provide high-quality Hepa filters to every school room at minor cost. We can employ serial saliva-based testing of all classrooms. We can trace and properly support the isolation of all contacts of confirmed cases.

All symptomatic individuals spread the virus for days before first symptoms appear, as do asymptomatic individuals. Because of this, the isolation of all asymptomatic contacts of Covid-19 cases in schools remains essential, however burdensome it is to us in the absence of other protective measures that would keep the numbers in schools down in the first place.

These mitigation measures are not aspirational, we could employ many of them tomorrow, as other countries already do. The question we all must ask is: why has our Government not done everything in its power to protect children?

This is the children’s moment in the pandemic, and it ends when either we vaccinate under-12s or case numbers come significantly down. We can be hopeful that vaccination for children will become possible in the coming months. In the meantime we have a duty of care to protect the child population from needless infection by a dangerous virus.

Children can’t fully understand the risks of Covid and can’t plan their behaviour to prevent infection. Children cannot refuse to go to school. Children can’t choose to exercise the presented notion of personal responsibility. And right now, children can’t get vaccinated.

Personal responsibility alone is powerless in a pandemic, which is why a pandemic’s trajectory, as we have seen around the Covid world, is dependent on public-health measures and government leadership. We, the adults, need to focus instead on social responsibility (our responsibility to each other) and State responsibility for those things that it is responsible for protecting, such as child health.

Tomás Ryan is associate professor in the school of biochemistry and immunology and Trinity College Institute of Neuroscience and a member of the Independent Scientific Advocacy Group

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