Rachel M. Roth
Rachel M. Roth
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Facing another school reopening

Requiring (and enforcing!) masks and distancing would protect our children in school, so why are we either sending them back unprotected or keeping them home day after day?
Israeli elementary school students wearing protective face masks at school in Tel Aviv. (Chen Leopold/Flash 90)
Israeli elementary school students wearing protective face masks at school in Tel Aviv. (Chen Leopold/Flash 90)

With our town reopening school, I am a bundle of emotions: I am relieved, I am afraid, but mostly, I am angry.

I am relieved. The weight of the evidence continues to indicate that school transmission reflects community transmission. While releasing our children into the school system may increase the numbers among children slightly, they are unlikely to have severe disease, and increasingly are bringing it home to vaccinated adults who will have mild or no symptoms. This should be reassuring, since we all agree that schools are extremely important to open. The mental health and education of our children are one reason, and another is the burnout and inability to work of the parents.

I am afraid. While the death rate in children remains very low, and most children have mild symptoms or are asymptomatic, I remain nervous to roll the dice on my children catching coronavirus. New mutations make it ever more catching, and the hospitals remain overwhelmed with corona cases; Hadassah is opening a new COVID pediatric ICU in preparation. But beyond the small but scary risk of severe disease, I worry about future.

Just because viruses are silent, it does not make them benign. Viruses can have long-term implications: 40, 50 years down the line: Hepatitis B is a silent virus with no symptoms at all until it causes liver cancer decades later. Human Papillomavirus (HPV) is a completely silent virus of which certain strains cause cervical cancer. For both of these, we vaccinate children before they are exposed – Hepatitis B vaccine is administered to newborns before leaving the hospital and repeatedly through childhood; HPV to young children before exposure. There are just two examples of where we do not assume that because these viruses are asymptomatic, it is safe for our children to contract them. The COVID vaccine appears to be safe and effective in children and will likely be available to them by Sept 2021, but until then…?

I am angry. Because it does not have to be this way. It does not have to be a choice between sending our children back unprotected or keeping them home day after day. Innumerable countries have reopened schools safely; Australia, New Zealand, Cambodia, Laos, Vietnam, Singapore, Taiwan, Iceland, to name a few. It does not take vaccines or money or being a geographic island (all of which we have/are), nor does it take extreme or authoritarian measures. All it takes is for us to agree that we would like to prevent our children from catching this unknown virus, and to set clear, enforced guidelines for schools.

  1. Masks. Children must wear them. Teachers must wear them. They are effective enough to act as a vaccine-replacement if worn correctly. Recent analyses shows that well-fitted cheap surgical masks tied to create a seal (see this video on how to make it fit correctly) or double-masking (putting a comfortable cloth mask over the surgical one) reduces transmission by 95% if BOTH the people in the interaction wear them. But schools need to fit-check children as they enter and supply disposable masks to those who do not have a good fit in their home mask. Teachers need to enforce masks up and over the nose. Nothing should happen indoors where children remove their masks — eating, sport, anything where the masks come down, need to be outdoors, in open air with spacing. It is doable; it just requires the will to make it happen.
  2. Other countries have invested in classroom and central air filters which help. Simply keep the windows and doors open at all times. The open windows suck any infected particles outside and disperse them where they cannot harm. Luckily, we have beautiful weather. If cold, the children can dress warmly in the classroom. When it gets warm, add fans for increased air circulation. In any very bad weather, cancel school for the day. We should also use our outdoor spaces. Eat ONLY outdoors. Sport ONLY outdoors. Recess ONLY outdoors. Set up hand washing stations with soap outdoors if possible. Teacher’s break room: shaded area with tables and coffee outdoors.
  1. Physical distancing. Where other countries have succeeded in staggered capsule classes, I am not even suggesting this much. Simply separate the desks by 1m (2m would be nice but impractical in our over-packed small classrooms), and do not allow the teacher to circulate through the room. Teachers must stand in front of the class (remain 2m distant). When outdoors, relax. The children can all play as they usually do, with the help of continued enforced masking and the natural ventilation. All of this is not what we are used to. But it is such a small price to pay for the protection of our children.
  2. Test, track, and trace cases at school. On the public health level, we need to implement the system which so many other countries use, and genetically sequence any coronavirus which is found in schools. This method allows us to track who gave it to whom, and if it is variant or mutation, and ultimately understand exactly what is happening at schools so we can create better policy.

The reason I am angry is because, as you may have noticed, none of these protections even mention the vaccine. The vaccine will save millions of lives and enable us to return to a more normal life, but we did not and do not need to wait for a vaccine to be safe. All we need is the will to make changes and clear leadership for how, and this is what we lack.

I cannot tell you whether to send your child back, because this is very personal decision for every family. But I can tell you that this terrible choice never had to be. Instead of doing the hard work of enforcing masking, building robust track and tracing mechanisms, investing in school facilities and teachers, and providing professional transparent messaging, the government has sold us a story about necessary lockdowns and the silver-bullet vaccine success. Of course, these both played an important role, but there are other, simpler ways to protect ourselves from corona. For our children, who are neither vaccinated nor to be socially distanced, those other measures MUST be put into place to protect them as much as possible.

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About the Author
Dr Roth is a US-trained family physician with specialties in research and global health. She made aliyah five years ago to Ra'anana, and is mother to four young children. Dr Roth currently practices both in Israel and to the US via telemedicine, and directs the Clinical Reasoning Course at Sackler Medical School (Tel Aviv University).
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