Emergence of Delta Variant Means a Back-to-School Like No Other

by Ari Robin McKenna

With the return to Seattle Public Schools (SPS) only days away and the COVID-19 vaccine for children under 12 years old still months away, there sits a cloud of uncertainty looming over the return to school — especially for unvaccinated students in grades K—6. Making matters more complicated, "trusting science" has become less straightforward as the delta variant has become predominant, yet less is known about this more contagious COVID-19 variant.

The American Academy of Pediatrics and the Children's Hospital Association released an Aug. 18 State-Level Data Report using data from 49 states and focusing on the 23 that posted data on children. The report noted that there has been a 7% increase in child COVID-19 cases from Aug. 5 to Aug. 19. Of these children's cases — the vast majority of which were the delta variant — 0.2%—1.9% required hospitalization and 0.0%—0.03% resulted in death. While comparisons to the flu 18 months ago were both misguided and dangerous, it would appear based on current data that even with the increased transmission of the delta virus being experienced right now, the risk it poses to younger students is in fact similiar to the flu.

However, as the report acknowledges, "There is an urgent need to collect more data on longer-term impacts of the pandemic on children, including ways the virus may harm the long-term physical health of infected children, as well as its emotional and mental health effects." Additionally, uncertainty remains about how a full-fledged return to in-person learning will impact these numbers and whether SPS' mitigation strategy will prevent outbreaks.

While there are cautionary tales from places like Alabama and Florida where school started earlier, there are a number of factors that make a comparison strained — especially considering that in Florida the governor effectively banned mask mandates, and in Alabama their mask mandate expired April 19. In Pike County, Alabama, where schools were closed due to an outbreak, only 29% of their residents are fully vaccinated, and in Hillsbourough County, Florida, where large numbers of students and educators had to isolate or quarantine, the vaccination rate is 50%. King County recently announced that over 70% of people, across every demographic group and in every age bracket except those under 12, have had at least one shot. Additionally, Washington State requires all school staff to be vaccinated by mid-October. Although also a strained comparison, Great Britain sent students back to school during their delta spike and — perhaps surprisingly — school did not prove to be the COVID-19 breeding ground many fear it to be.

It should be noted, however, that the delta variant caused infection rates in King County to approach their December 2020 highs until beginning to subside mid-August, and hospitalized cases were also alarmingly high. Deaths did not increase from previous months, but it is troubling that case rates are highest in southwest King County.

In order to inform communities of color hardest hit by the novel coronavirus during this period of tremendous uncertainty, Families of Color Seattle (FOCS) organized a well-attended virtual panel and community dialogue last week. FOCS Executive Director Christine Tang spent much of the informative hour-and-a-half-long event sharing the many questions FOCS had received with three female physicians of color.

Dr. Helen Y. Chu, a University of Washington (UW) professor of Medicine and Public Health and an expert on respiratory viruses and vaccines, was able to clarify the delay in impending availability of the Pfizer vaccine for kids — initially expected to be available in early September. Chu said Pfizer, who has "gotten the furthest in the 5—12 vaccine trial," was asked by the FDA "to increase the number of children enrolled in their studies" over concerns about heart inflammation which she expects to be resolved. Chu commented that as a mother of school age children, "It's hard for me to watch the delay because of that." Dr. Leslie Walker-Harding, the chair of the UW Department of Pediatrics and the chief academic officer of Seattle Children's Hospital, said parents can now expect a children's vaccine "later fall … sometime later in the year."

During the panel, Chu also said that while kids can transmit COVID-19, "there's a lot of other measures being taken to keep kids safe. The distance is important, masking is important, the ventilation, the regular testing. I think with all of the things we [in Seattle] are doing, and all of these other measures that we have, schools will not be the place that drives transmission. They have never been, and I don't think they will be."

Dr. Aisha Reuler, a UW Pediatrician at the Neighborhood Shoreline Clinic, didn't disagree but noted areas of concern during the school day. "It's true that the eating — and even choir and band and all of these other activities where they're taking their masks off — are definitely the higher risk situations." She later added,

"We are all under so much stress and distress … it's an important thing to acknowledge."

On Wednesday, Aug. 24, SPS held a thirty minute Virtual Town Hall, and Superintendent Brent Jones reported that SPS has added "additional mitigation in rooms with high transmission risk, including the designated health care room, band, and choir."

Carrie Nicholson, the interim director of Health Policy, Practices and Procedures laid out the components that constitute SPS' "layered mitigation" strategy: "Vaccinations, wearing face coverings, staying home when ill, physical distancing, cleaning and disinfecting, hand-washing, ventilation and air quality, as well as responding to cases of COVID-19 in the school setting." She stressed the proper use of multilayered masks, saying SPS will have extra masks available for staff and students at all schools. For the 2021—2022 school year SPS has done away with daily attestations but has added COVID testing. Nicholson says, "We are excited that we will be offering COVID testing in collaboration with the Washington State Department of Health and the Health Commons Project. We're starting with testing when symptoms arise or following known exposure." Dr. Sarah Pritchett, the assistant deputy superintendent at SPS, added that all parent-staff meetings will take place on Microsoft Teams.

During the Virtual Town Hall, parents filled both the Microsoft Teams and Facebook Live chat with hundreds of questions, many about why there is no virtual option. One parent has distributed a survey with close to 400 respondents — the majority from schools in the north of the city. Another petition that arose in the South End seeks to encourage SPS to move lunch outside en masse and has over 1,000 signatures. SPS' lunch policy involves principals of individual schools making judgement calls based on the physical layout of their building and outdoor space. Building leaders can request funds from the district should they need tents or other physical necessities to enable their students to eat outdoors. Earlier this week, it was announced in nearby Portland that their public schools will be eating outdoors for the first six weeks of school. Their safety plan details, however, will be released two days before school starts.

While many teachers are worried about students remaining three feet apart in classes and how to teach effectively when students are separated from one another, it should be noted that the Seattle Education Association (SEA) and SPS' bargaining has been remarkably less volatile than it was last spring, when SEA leaders questioned SPS' implementation of safety measures — especially in regards to air quality. While the SEA did come out with a statement questioning the lack of a remote option Aug. 5, they came to a tentative agreement with SPS on Aug. 14. SEA President Jennifer Matter recently told the Emerald, "We were pleased that the District took our request for a third-party industrial firm to assess air quality and HVAC systems for the district. The third party spot checking demonstrates their commitment to do right."

In a recent press release from UW Medicine called "COVID-19 guidance for parents of schoolkids," Dr. Amanda Kost, the clinical director of the Family Medicine Clinic at Harborview, said, "The start of the school year is aligning with another surge in COVID-19 infections, and it's bringing renewed uncertainty for families in back-to-school mode." The release referenced Washington State's current plan which mandates masks for all students, educators and staff. Kost cites a recent study concluding that young children are capable of wearing masks in school but suggests parents have their kids practice wearing a mask in different settings before they're asked to at school.

"Being prepared for knowing that you don't know what's going to happen is helpful," says Kost.

Editor's Note: This article was updated after publication to clarify that "the delta variant caused infection rates to approach their December 2020 highs" specifically in King County.

📸 Featured Image: South Seattle swing set closed off with caution tape to prevent spread of COVID-19, March 29, 2020. (photo: Sharon Ho Chang)