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Back to school shouldn’t mean a field trip to the hospital

Kids wear masks outside school
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This August, school will begin for millions of students across the U.S. — on Aug.10 in Atlanta, Aug.16 in Los Angeles and Aug. 23 in Raleigh and Houston. The rise we have seen in cases of COVID-19 from the Delta variant is scary, resulting in hospitals that are overfull in Missouri, Arkansas and many small towns around the country. Unfortunately, it will get worse if school boards and health departments do not take actions now to protect their communities. New research from me and my students at North Carolina State University reflect this.

Our operations research model yielded troubling results. Specifically, we found a typical elementary school without testing should expect 70 percent of its students to become infected within three months. For middle and high schools, this was 40 percent. Masks and frequent testing more than halved these numbers, however, giving school officials and local policymakers valuable options in ensuring this upcoming schoolyear goes as smoothly as possible.

The importance of masks in school can be understood through CDC guidance. In May, CDC and others recommended youths 12 and over should get vaccinated against COVID-19. While 65 percent of all people age 12 and older are vaccinated, the vaccination rate among youths ages 12 to15 is approximately 25 percent.  No COVID-19 vaccines have been approved or recommended for children 11 and under yet, so the only existing protection can be for those who have already had COVID-19 — or widespread mask usage to help mitigate spread.

For those who have dismissed the risk for kids, consider: COVID-19 has appeared as one of the top 10 causes of death in kids.

What happens every year when schools begin again? As the parent of two and a university professor, I can tell you. Kids gather joyfully with their friends and classmates, and then they bring home fevers and stomach viruses and coughs. It is natural — bring people together in a new setting, and they will share. Unfortunately, that also means they will share the Delta variant of the virus that causes COVID-19 – and tragically, this Delta variant is more deadly, contagious and already impacting kids across the United States.

This shows up in the data: For the original SARS-CoV-2 virus circulating, the CDC best estimate was that a single person could infect two to three others without other mitigation in place. Summaries report that the Delta variant is 50 percent more transmissible than the Alpha variant, which was 50 percent more transmissible than the original strain in the United States. Conservatively, one person could infect five others during the infectious time period without mitigation.  With a virus like that, the math shows the pandemic wouldn’t begin to slow down until at least 80 percent of the students are protected (likely higher, given that cases can continue to import).

So, imagine that school when only 25 percent of the students have protection. Perhaps 25 percent of those in elementary school already had COVID-19 and have lasting immunity. The protection in the high schools may be higher, but the schools are larger and have greater circulation. The Delta variant will spread like wildfire in a dry forest without mitigation like vaccination and masks.

Here’s the thing — children and youths generally live with someone else. They are going to bring home the Delta variant to parents and grandparents and aunts and uncles and neighbors and soccer coaches, infecting even more vulnerable people. Viruses can transmit even more easily in shared living quarters where people breathe the same air.

It is clear that our children need to be in school. Mine do, too. I am not advocating that all school systems should close. For places where it works for students and the system, hybrid offerings of in-person and virtual can reduce the number of people sharing a small space. Giving risk-averse families the mere option of this would reduce transmission in schools and give families the security from this variant they deserve.  Even more important though, is that schools need to continue to require masks. For everyone, regardless of vaccination status. In classrooms and on buses. This should continue until the COVID-19 vaccine has been approved for children below age 12 and there has been sufficient access to the doses with time for immunity to form.

Right now, children and their caregivers can’t make the choice of vaccination. That means millions of lives are at stake.  Not just theirs, but their parents, grandparents, neighbors and family friends with compromised immunity. As our data modeling suggests, schools need to continue to require masks.  Do it for the children. Keep it for the adults.

Julie Swann, Ph.D., is an Allision distinguished professor and department head of Industrial and Systems Engineering at NC State University. In 2009, she was on loan as a science advisor for the H1N1 pandemic response at the Centers for Disease Control and Prevention. Swann’s recent collaborations have been to quantify the return on public investments to improve pediatric asthma, plan for infectious disease outbreaks, analyze administrative claims data from Medicaid patients across the U.S., and design systems with decentralized decision-makers.

Tags COVID-19 Education Healthcare Julie Swann Masks Public health schools

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