Children, Schools and the Delta Variant: Parents' and Caregivers' Questions Answered

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• What is proper COVID protocol in schools?
• Do vaccines work against the delta variant?
• How worried should I be for kids about breakthrough infections?
• How does COVID affect kids?
• What if I have an unvaccinated child in my house?

As children in the Bay Area begin in-person learning this fall, and with new evidence that the COVID-19 delta variant is highly contagious and spreads as easily as chickenpox, questions and concerns about the safety of children under 12 not yet eligible for the vaccine have arisen. So what do parents and caregivers need to know about their children’s safety in school?

KQED Forum's Mina Kim spoke to Dr. Yvonne Maldonado, professor of pediatrics and of epidemiology and chief of the Division of Pediatric Infectious Diseases at the Stanford University School of Medicine, to answer audience questions around schools, the delta variant and how to reduce risk to unvaccinated children.

What is proper COVID protocol in schools?

Transmission of COVID-19 can often begin with unvaccinated teachers and staff. So “at the very minimum, adults need to be vaccinated,” says Maldonado. “Anyone who can be vaccinated should be vaccinated, especially the teachers and staff.”

On Wednesday, Gov. Gavin Newsom issued a mandate that all California teachers and school employees be vaccinated for COVID-19 or be tested weekly. The mandate includes staffers working on school campuses, and it’s the first such statewide mandate in the nation.

Maldonado also urges masking, citing the American Academy of Pediatrics’s recent guidance that “everyone at schools should mask.” As far as distancing goes, she said, three feet should do the trick: Maldonado notes that the medical and scientific fields have found that three feet of distancing is actually as sufficient as the previously recommended six feet — an update that would allow for more space for indoor activities in schools. And of course, Maldonado also stresses the continued importance of handwashing and sanitizing in school spaces.

Day care centers have been a really great example of the efficacy of proper COVID-19 precautions, Maldonado said. Although masks are not recommended for children under 2 years of age, if the adults in day care centers continue to mask, the children who are not yet vaccinated will be kept safer from COVID.

How is delta worse? And is the vaccine effective against it?

The COVID-19 delta variant produces a viral load that is much higher than other variants, said Maldonado. Among the vaccinated, the infection rate is low — however, vaccinated people who are infected with the delta variant still carry the same amount of the virus in their nose and throat compared to people who are unvaccinated and infected with the delta variant. What this means is that those who are vaccinated “don’t tend to be as sick as the unvaccinated,” explains Maldonado. “But they could potentially spread [COVID] more.”

Maldonado stresses that this does not mean that the COVID-19 vaccine is ineffective — or that it doesn’t work against the delta variant. “Vaccines are still highly effective and highly critical,” she said, and even if a vaccinated person has a breakthrough infection, their risk of hospitalization and death is very low.

As she notes, “over 99.7% to 99.8% of the people who are hospitalized and are dying, unfortunately, are unvaccinated people.”

How worried should we be about breakthrough infections?

As far as breakthrough infections go, “the good news is it appears that among vaccinated people, the virus drops off rapidly as the immune system kicks in,” said Maldonado.

We don’t know much about breakthrough infections as far as tracking goes, explains Maldonado, because the CDC halted tracking of breakthroughs unless they were severe cases. But Maldonado herself is now involved in a nation-wide five-site sentinel surveillance project. (The CDC defines "sentinel surveillance" as when "a network of healthcare providers or hospitals are recruited by the health department to regularly report specified health events.")

This project will begin tracking all breakthrough infections within the populations surrounding each site. And because Stanford is one of the five sites involved, this means that the breakthrough cases in the Bay Area will now be monitored.

Although the CDC is not able to track every breakthrough infection, they are continuing to monitor breakthrough infections of those who have been hospitalized or have died from their infections. Along with this tracking, the CDC is also tracking the genetic makeup of that virus, says Maldonado.

How are children affected by COVID? What can adults do?

Again, the greatest protection against COVID-19 and the delta variant for children who are not yet eligible for the vaccine is for adults to be vaccinated, urges Maldonado.

Over 4 million infections have been reported in children, which makes up for 14% to 15% of all cases in the U.S. A particularly difficult statistic: Between 380 and 700 children have died due to the disease, “based on data that’s reported from most of the states and some modeling data that accounts for underreporting of deaths,” says Maldonado.

As Maldonado states, "this is a very big deal" when looked at relative to the usual number of yearly deaths among children under 18. This means that at this moment, COVID-19 falls within the top 10 most common causes of death for those under 18 years of age, excluding newborns.

To parents and caregivers who might be wondering about the possibility of signing a medical waiver to grant vaccine access to a child under 12 years of age, the FDA is not allowing that to happen, and these actions would be in direct violation of federal regulations. Remember, stresses Maldonado, the best way to protect unvaccinated children as an adult is to get vaccinated, mask up and practice good hand hygiene.

Continuing to vaccinate children 12 to 18 who are eligible for vaccination is also key. Only 50% of teens 16 to 17 years old are vaccinated, notes Maldonado — and only 38% of teens 12 to 15 years old have gotten their shots.

Any parents or caregivers or those concerned overall with the safety of children during COVID-19 can visit the American Academy of Pediatrics website to find state-by-state vaccination data. Read more information about keeping children safe from the delta variant.

What if I have an unvaccinated child in my home?

When it comes to an adult in the household testing positive for COVID-19, how concerned should you be about unvaccinated children?

Maldonado advises that the infected adult "stay separate from the rest of those in the household as much as possible." She again encourages masking inside the home, and to take meals separately from those not infected and those who may be unvaccinated.

The good news is that 80% of vaccinated people who test positive for breakthrough cases of COVID-19 do not experience symptoms at all, said Maldonado. There is also, she added, a newly FDA-approved treatment available within a 96-hour timeframe after diagnosis. This treatment consists of a small injection of a monoclonal antibody, which will result in an 80% reduction in the risk of infection in those who are in contact with the person who has tested positive. Maldonado advises that adults who test positive for COVID-19 contact a health care provider to ask more about this treatment.