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Q&A: What will back-to-school look like in the delta surge?

Students line up for the first day of the 2021-2022 school year at Salnave Elementary School on Wednesday. Students are masked and in-person for classroom learning in the Cheney Public School District.  (Libby Kamrowski/THE SPOKESMAN-REVIEW)
By Arielle Dreher and Laurel Demkovich The Spokesman-Review

Kids are returning to classrooms at the height of the delta surge in the Inland Northwest.

Health officials are expecting to see cases in classrooms again, so it’s wise to be prepared to potentially quarantine your child or teen at home at some point in the coming school year.

“With high case rates as we have now, one of the concerns is we could see an increased number of students becoming positive and developing disease with the delta variant or any of the other variants in the community,” Interim Health Officer Dr. Francisco Velázquez said Wednesday. “That’s one of the concerns, and that’s one of the reasons we encourage wearing masks, and getting vaccinated while you can.”

There are vaccines for teenagers as well as a host of other safety measures schools can put in place.

Here’s a breakdown of what being back in school means for students who are vaccinated, unvaccinated or not even eligible for the vaccine by answering some questions from readers:

What does the data say about how safe vaccines are for teens?

The Advisory Committee on Immunization Practices has granted emergency use authorization for three COVID-19 vaccines, including the Pfizer-BioNTech two-dose mRNA vaccine, which is the only one approved for use in 12 to 17-year-olds.

The Centers for Disease Control and Prevention fully approved the Pfizer vaccine for people 16 years old and older in August, and once more clinical data is available, Pfizer will ask the CDC to fully approve the vaccine for everyone 12 years old and older.

The CDC and the ACIP have assessed the data multiple times throughout the pandemic and found the risk of COVID-19 and the potential subsequent conditions resulting from the virus are greater than the risks associated with vaccine side effects, even in young adults.

Serious side effects from the mRNA vaccines are very rare, and hundreds of millions of people in the country have received at least one dose and experienced no severe side effects.

How dangerous is COVID-19 for young people?

More children and teens are being infected with COVID-19 now than previously in the pandemic thanks to the delta variant, and children’s hospitals throughout the state are reporting an uptick in children and teens with COVID-19 needing hospitalization. These hospitalization numbers remain low and rare, but the fact that they are increasing at all has hospital and health officials concerned.

Even if a child doesn’t need to be hospitalized for COVID-19, they could still suffer other consequences.

Children and teens are at risk of developing MIS-C, or multisystem inflammatory syndrome in children, if they are diagnosed with COVID-19.

The risk of this is low, but more cases of MIS-C have been detected in children who test positive for the virus than cases of myocarditis following full COVID-19 vaccination.

As of mid-August, 4,573 cases of MIS-C have been detected in children who contract COVID-19 nationwide, according to the CDC.

Children are also at-risk for developing ongoing symptoms should they test positive for COVID-19, just like adults who get long COVID symptoms that don’t go away. Some preliminary studies show even if a child or teen is asymptomatic, they could still experience long COVID symptoms later on.

The CDC, ACIP and the American Academy of Pediatrics all recommend vaccines for children 12 and older to protect them and loved ones against COVID-19 and possible complications that come with that.

What’s the risk of my teenager getting myocarditis or side effects from vaccine? Is it worth getting the vaccine?

Out of one million vaccine doses administered among 16 and 17-year-olds, health officials estimate they would see eight myocarditis cases in teenage girls and 73 myocarditis cases among teenage boys.

In other words, the chances of myocarditis post-vaccination are still very low.

The rare yet much-discussed side effect is seen in predominantly young male adults after receiving their second dose of the Pfizer vaccine.

Myocarditis or pericarditis, which is inflammation of the heart or the tissues around it, is treatable, and this side effect is not life-threatening.

No one has died from myocarditis or pericarditis as a result of getting their COVID-19 vaccine, Dr. Gretchen LaSalle, MultiCare family physician, said.

As of Aug. 18, 2,754 cases of myopericarditis and pericarditis following full vaccination have been reported in all age groups to the nationwide Vaccine Adverse Events Reporting System.

Out of more than 17 million second Pfizer-BioNTech vaccine doses administered in young people ages 16-29 years old, there have been 327 confirmed myocarditis cases in VAERS as of Aug. 18 in that age group.

The risk of developing COVID, being hospitalized, developing MIS-C or long COVID symptoms are all outweighed by the benefit of the COVID-19 vaccine for young people.

“If we look at the risk-benefit ratio, the risk is so much higher with COVID than with the vaccines,” LaSalle said.

What’s the best guess for when my child under 12 will be allowed to get a vaccine?

This fall, Pfizer is expected to request emergency use authorization for use of their vaccine in 5- to 12-year-olds. This could happen in September.

Then the Food and Drug Administration as well as ACIP will have to evaluate the data submitted by Pfizer and make a decision on whether or not to approve the vaccine for emergency use in children, likely by late fall.

For children younger than 5 years old, those vaccine trials are ongoing, but Pfizer is expected to ask for emergency use authorization in that age group sometime after the vaccine is authorized in 5- to 12-year-olds, maybe this winter or in early 2022.

How likely are the other kids in my child’s middle or high school to be vaccinated? How likely is my child’s teacher to be vaccinated?

Kids and teens have the lowest vaccination rate in Spokane County. As of Aug. 18, about one in four Spokane County young people ages 12 to 17 are fully vaccinated, according to Department of Health data, and just 34.7% of this age group has received at least one dose, according to state data.

Children younger than 12 are not eligible to be vaccinated yet, so any classrooms or grades with younger children will be predominantly unvaccinated except for adults in the room.

What happens in the classroom is impacted by what happens in the county. Currently the incidence rate for COVID-19 is quite high at a rate of 777 cases per 100,000 people in the past two weeks. There will be cases in schools as a result.

Different parts of the county have different vaccination rates, however.

The South Hill, Moran Prairie and Cliff Cannon neighborhoods have the highest vaccination rates in the county at 60% or more of eligible people in those zip codes receiving at least one dose.

By mid-October, all K-12 teachers and staff, in public, private or charter schools, will be vaccinated against COVID-19, as required by a statewide mandate.

There are some exemptions for religious or medical reasons. The Office of the Superintendent for Public Instruction has outlined the exemption process. School districts’ human resource departments are responsible for reviewing and approving exemptions, which should be, but are not required, to be submitted in writing. The state has a template that districts can use for exemptions.

OSPI will be asking school districts to report numbers and percentages of their staff that have shown proof of vaccination or taken an exemption, spokesperson Katy Payne wrote in an email. That survey will likely go out closer to the October deadline.

Districts can share their school-wide vaccination rates with their students and families, Payne said, but districts should not disclose individual teacher’s vaccine status as it is personal medical information.

Are there any conditions that should make parents think twice before sending their child with underlying health conditions back to school in-person?

Children with underlying health conditions are at higher risk for contracting COVID-19 and being hospitalized with it.

CDC data from March 2020 to January 2021 show that 61% of hospitalized 12- to 17-year-olds with the virus had an underlying health condition like obesity, asthma or other chronic diseases.

LaSalle encouraged families with children with underlying health conditions or family members who are at-risk to talk to their primary care providers about what decision makes the most sense for sending a child to school if you are concerned about their health and your family’s safety.

Even if you can’t get an appointment, many doctors are answering emails or questions through patient electronic health record systems about the safety of vaccines as well as whether or not your child should return to school.

What does science say about how effective masks are in school, particularly if all students are all back in classrooms at the same time?

While vaccinations among kids remains low, masks are the next best thing at preventing the spread of COVID-19.

Returning to full in-person instruction is safe when masking is in place, a study by the ABC Science Collective at Duke University found. Researchers looked at 100 school districts operating in person with masking and minimal social distancing last spring. During that time, only one in 3,000 students who were in the building became infected. That’s out of more than 1.2 million students and 160,000 staff members.

Masks are not the only tools districts should rely on this year.

The American Academy of Pediatrics, along with the CDC guidance recommends using masking, 3 feet of social distancing when possible, good ventilation, frequent testing, quarantining when exposed and sanitizing.

The Washington Office of the Superintendent of Public Instruction’s guidance includes universal masking and social distancing. It also recommends schools keep their windows open, offer more time outside and adjust HVAC systems to improve air quality and ventilation.

To prevent the spread of COVID-19 in schools, officials are looking to all those 12 and up who are eligible to get their dose.

Because vaccines are not going to do the trick themselves, requiring masks is “a great starting point,” said Alex Perkins, associate professor of biological sciences at Notre Dame.

In Washington, all kids and teachers will have to wear masks in classrooms. Is there any science showing the mental health effects of wearing masks?

The short answer is not really, according to Dr. Kira Mauseth, co-leader of the state’s COVID-19 behavioral health strike team.

Research has shown that wearing a mask for students who are older than 7 years old does not impact their ability to perceive emotion, despite half of someone’s face being covered.

For children with learning disabilities or those younger than that age, masks could impair some recognition of emotional states, and adapting environments where this can be a barrier will have to be addressed by educators.

Any “adverse experiences” reported due to masks were typically related to irritability and discomfort, Mauseth said, and also involved young children who experienced frustration over wearing the mask or being asked to wear it properly.

There is a difference between discomfort and trauma.

“To date, to our knowledge, no peer-reviewed research has been published that indicates a relationship between mask wearing (for children) and the experience of psychological trauma in the context of COVID-19,” Mauseth wrote in an email to the Spokesman-Review.

Is there any science or data that show how the pandemic and kids not being in school full-time last year impacted their mental health?

The pandemic has impacted the mental health of both kids and adults alike. Gov. Jay Inslee declared an emergency earlier this year for youth mental health.

There are not enough resources and not enough beds in hospitals for youth experiencing mental health crises.

These trends have continued into the summer, Mauseth said, despite there typically being a decline in need for services during typical summers before the pandemic. Many children and teens have experienced symptoms of depression, and data in Washington show that emergency departments for suicidal ideation and attempts may be increasing.

The Department of Health is continuing to monitor this data and working to increase supports and systems that provide mental health care.

I live in Idaho. Is it safe for my child to go back to class when few students are likely to be wearing masks?

Masks are deemed by experts at being effective at reducing the spread of COVID-19 and other viruses. In other parts of the country where school districts attempted to open with no mask mandates in place, they became quickly overwhelmed with COVID-19 cases and exposures.

One school district where masks were optional in Mississippi was forced to go entirely virtual after 40% of the student body was quarantined in just one week, the Mississippi Free Press reported.

With disease transmission high in the Inland Northwest, school districts are poised to see cases of COVID-19, but without prevention measures in place, physicians and health officials are concerned about the spread of the virus among students.

“I do have some concern about lack of masking in schools,” LaSalle said.

LaSalle is worried about what flu season will bring, in addition to COVID and other respiratory viruses.

On the flip side , LaSalle also said if your child is vaccinated that the vaccines are still very good at protecting against serious, scary outcomes for children and teens should they test positive anyway.

“If (vaccinated kids) get sick, the likelihood is that they’d weather that storm well,” LaSalle said.

Is participating in athletics after school unmasked risky for my kids and teens?

The jury is still out on how much transmission of the delta variant can occur outdoors, which is part of why the state mask mandate does not apply outside.

Health officials are still recommending masks at large outdoor gatherings, however, which calls some student athletics into question.

LaSalle said she’s still fairly confident about kids participating in outdoor activities unmasked, but how close of contact the activity is might matter.

Tennis is different than basketball. For spaced out sports like soccer or cross country, there’s more distance, while other sports might have closer contact.

LaSalle said you’re never wrong to default to doing what you feel like is safest for you and your family, even if that means wearing a mask for contact sports outdoors.

Arielle Dreher's reporting for The Spokesman-Review is primarily funded by the Smith-Barbieri Progressive Fund, with additional support from Report for America and members of the Spokane community. These stories can be republished by other organizations for free under a Creative Commons license. For more information on this, please contact our newspaper’s managing editor.

Laurel Demkovich's reporting for The Spokesman-Review is funded in part by Report for America and by members of the Spokane community. This story can be republished by other organizations for free under a Creative Commons license. For more information on this, please contact our newspaper’s managing editor.