Is it possible to achieve herd immunity without vaccinating children? Probably not, said Dr. Jody Terranova, a pediatrician at Connecticut Children’s Hospital.
Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, has estimated that herd immunity for the coronavirus would be reached when between 70 and 90 percent of the population are vaccinated.
But Terranova, who is also a member of the Vaccine Advisory Council’s Science Subcommittee, said that given that children made up about 20 to 25 percent of the population, nearly all adults would need to be vaccinated in order to achieve herd immunity without the children receiving a vaccine.
To date, the Pfizer vaccine has only been authorized for use in individuals ages 16 and older, while the Moderna and Janssen vaccines are authorized for individuals ages 18 and older. Clinical trials are currently underway at Pfizer and Moderna for children ages 12 and up.
That said, Terranova still believes that children should go back to in-person school as soon as possible, both for their mental well-being and their academic development.
“The American Association of Pediatrics stance is that we want kids to be back in safe school environments as soon as possible,” said Terranova.
Dr. Richard Martinello, Medical Director of Infection Prevention for Yale New Haven Hospital and Yale New Haven Health, said that the data shows that young kids are much less likely to spread the virus, and that few clustered outbreaks were taking place in classrooms.
Instead, coronavirus transmission in schools has mainly been traced back to adults. Martinello, who is also a member of the Vaccine Advisory Committee, said he’d heard recently of some clusters in schools stemming from groups of teachers having lunch together without masks on.
Terranova and Martinello both said precautions like masks, social distancing and cohorting should continue to be used even after all the school staff are vaccinated.
Although Terranova believes schools are safe places for children, she said she understands parent’s concerns about sending their children back, and she does not believe that children should be required to return to in-person learning before they are vaccinated.
Dr. Anthony Fauci has said that vaccines for elementary school children should be available around the start of 2022.
Looking at the data
According to data from the Connecticut Department of Public Health, there have been a total of 15,369 cases of COVID among children between the ages of 0-9, and 30,311 cases in adolescents between the ages of 11 and 19.
But Terranova said she believed the data on children might undercount infections — she said that many times, entire families would get the virus, but only the parents would be tested. Terranova also said it’s tricky to know whether or not children play a role in community spread, because they often present as asymptomatic or with mild symptoms.
A small number of children have been diagnosed with multi-system inflammatory syndrome, or MIS-C, a serious inflammation of various organ systems that requires hospitalization. Terranova estimated that there have been more than 20 children with MIS-C at the Children’s Hospital since the summer. At Yale-New Haven Health, 26 of the 121 children who have tested positive for COVID since the pandemic began were diagnosed with MIS-C.
A question of priorities
Ultimately, Martinello said decisions around reopening are a question of priorities. He said that while he sees opening schools as a necessity, returning to after-school activities and sports, which have been sources of spread, should perhaps be postponed.
CDC guidelines appear more stringent. According to an article in the New York Times, only four percent of counties nationwide have low enough levels of cases and community transmission for elementary schools to reopen in-person – and none of them are in Connecticut. Middle and high schools in Connecticut, according to CDC recommendations, fall within the remote learning category.
CDC officials have said, however, that each school should be evaluated separately based on community transmission, the number of cases in the school and the efforts being made in the school to stop the virus from spreading.
“K–12 schools should be the last settings to close after all other mitigation measures in the community have been employed, and the first to reopen when they can do so safely,” read the CDC guidelines.
Terranova said that community spread needed to be factored in when considering which schools should open for in-person learning, and both she and Martinello cautioned against opening schools and other venues, like restaurants and businesses, simultaneously.
“[We] have to think about priorities,” said Martinello. “For me, reopening those schools, getting them back [in-person], is a top priority.”