Kids should stay in school, even amid new strain

The emergence of a new variant of coronavirus has the world’s attention - and rightly so. The new variant seems significantly more transmissible than earlier strains of viruses, leading some scientists - including those who discovered that the new strain spreads faster - to make a bold but shortsighted recommendation: Close the schools.

That’s the wrong answer. The right answer is enhanced controls in schools.

Calls for school closures do not factor in the alarming risks for kids: reports of hundreds of thousands of kids missing from the U.S. school system; drops in literacy gains; billions of missed meals, kids failing. These impacts are compounding over time, and we’re on the verge of some kids being out of school for a year or more.

While the extent to which this new variant is more transmissible in kids in still unknown, even if it ends up being more transmissible in school-age children, the evidence so far is that it won’t be deadlier for them. And there’s research suggesting a biological reason that this is so.

Before we get into that, let’s acknowledge that kids can get COVID-19 and that kids can die from COVID-19. But it’s extremely rare.

How rare? Literally one in a million for kids 14 and younger, according a new JAMA study.

For those ages 15 to 24, the risk of dying from COVID-19 is 1 in 100,000. To put this in context, the study reported that schoolage kids are 10 times more likely to die by suicide than COVID-19.

The biology of kids explains why this is so - and why this new variant likely won’t change the risk of dying. The novel coronavirus is dangerous only when it latches on to a part of a cell known as an ACE2 receptor. That’s the lock-and-key mechanism for how this virus gets into our cells. But new research published as a preprint found that the cells in an immature lung have fewer of these ACE2 receptors than those in adults do (the formal way of saying this is that the cells express less of the gene that produces the ACE2 receptor). The same is true in cells lining the inside of the nose. The virus is left holding a key to a door that is bolted shut and has no keyhole.

Even if kids do get infected, they have a second line of defense that might begin to explain why they have such a low risk of death: Infected lung cells in kids self-destruct faster than adult cells. This process - known as apoptosis, or programmed cell death - is a normal part of how the body defends itself. A cell that dies rapidly after being infected doesn’t produce as much virus that can infect additional cells.

So, we know the kids will be all right, but two issues remain: how to keep adults safe in schools and how to limit transmission in the community.

A set of controls must be used to limit how much withinschool transmission is happening. By now, this is well understood: masks, hand-washing and enhanced ventilation and filtration. This is what hospitals do, too. (It’s interesting that there is already a call for schools to be closed in the United Kingdom, where the variant was first detected and where controls in schools have been largely lax. Only recently did the country start requiring masks in schools, and, inexplicably, it limited mask-wearing to only secondary schools and only in corridors, not classrooms.)

As for limiting how much spread happens in the community, one of the best things we can do is get kids in school, where controls can be implemented and enforced. If schools were drivers of spread, we’d have seen this in the data already from Europe and the United States. In fact, it looks as though school transmission mirrors community transmission. A faulty assumption in the current approach to schools has been that hybrid models - which mix online and in-person teaching - reduce risk, but this might actually lead to kids having wider social networks with fewer controls.

The rise of the new variant is concerning, but we have learned enough from the early days of the pandemic that the answer is not widespread lockdowns of key aspects of our society. Will hospitals close? Pharmacies? Grocery stores? Of course not. These are essential. So are schools.

This does not mean letting the virus run rampant. The goal remains to keep community transmission low. At the same time, we should not ignore data showing that risk to kids is very low. The likelihood of kids getting COVID-19 depends not only on personal behavior - mask-wearing, avoiding high-risk activities - but also biology. And here, kids have defenses that adults don’t. Decisions on reopening activities, including schools and youth activities, must take this into account.