Dr. Farber’s COVID-19 Update 34

I had hoped not to have to keep writing these, but circumstances have mandated a further update.

In pediatrics, we are used to the concept of rewarding children for good behaviour.  For example, telling your children when you go on a trip in the car, that if they behave, they can get a treat later.  However, if they don’t behave, and squabble in the back seat, then you are not going to figure out who was responsible, the ruling will be that nobody gets a treat.

The same situation applies to adults being vaccinated.  If everybody who could get vaccinated did, then we would all receive a treat:  no more mask wearing.  However, too many adults didn’t go along, COVID returned with a vengeance (although still not as bad as at its peak in most places), and we lost our treat:  back to mask wearing, even if vaccinated, in many, if not all situations.

Moving on to a subject that has nothing whatsoever to do with adults acting liked spoiled children, I turn to Florida, and Governor DeSantis.   He has declared that no school system in the state can mandate mask wearing. This is despite his state having more new cases and hospitalizations than at any previous period during the entire pandemic.  Public health issues, and the safety of children, are unimportant compared to the right to infect as many people as one wants.  This is not just a Florida issue, however; it impacts on us as well, since it is the underimmunized and maskless states that have fueled the resurgence of COVID-19 in this country, including in Virginia.

How do I feel about going back to school in light of the upsurge in cases?  Schools are vitally important, not just for academic learning but for social learning as well.  On-line learning doesn’t cut it; one does best with an in-person teacher (so I am also comfortable with home schooling, especially if one can find a co-op where all the parents have been vaccinated).  I want children back in school, and if that means wearing a mask for now, so be it.  There will of course be breakthrough infections, but one thing we have learned is that children generally have done well during the pandemic.  They tend not to get very ill.  Furthermore, when there are cases in a classroom, there have rarely been other children infected, and when children do get infected, it is most often from family members.  We also know, contrary to when the pandemic first hit, that the virus is transmitted from people, not objects, so your children are not going to catch it from sitting at a desk someone else used before them.

Cafeteria eating is a concern in schools.  As above, I am not concerned about picking up COVID-19 from a table.  However, masks are off when eating, and social distancing is a problem. I would prefer that children eat in their classrooms with prepackaged meals such as sandwiches, but that is not always doable.  Cohorting children (not mixing classes) as much as possible is preferred.   Enforced handwashing/ hand sanitizing before and after meals should be done.  As the lesser of two evils, I still vote for school with cafeteria eating rather than no school.

Of course, if your child is eligible for a vaccine (12 years and up for now, hopefully expanding to younger children soon). I recommend they get it, even at the risk of side effects, which are much less than those of the disease itself.

For example, consider the risk of Guillain-Barre syndrome from the vaccine, and assume that risk is 1 in 100,000 (it appears to be lower), and furthermore assume that everyone who gets it dies (although almost nobody does).  If we vaccinated every adult in the US, we would expect almost 3000 deaths from this, which sounds terrible, until you compare it with the 600,000+ deaths so far from COVID-19 itself –   a reduction in death of 99.5%.  The vaccine is of course not 100% at preventing infection, but it is highly effective at preventing hospitalization and death, which is why more deaths are now occurring in younger (unvaccinated) adults, rather than in sicker, older, but vaccinated, ones.

People sometimes wonder if they can trust the CDC, since it changes its recommendations often.  This is not flip-flopping.  Medical science adjusts as knowledge and conditions change, and what was true at one point may not be true at another.  Thus, we used to use penicillin for ear infections, for many years, but no longer, as it is ineffective.  This is not because we were wrong in using it 50 years ago, but because the germs have mutated, and we had to adjust our approach accordingly. Similarly, when COVID-19 cases were dropping, it was reasonable to ease up on mask wearing (although I personally never stopped wearing them in stores), but with the resurgence masks again have become an essential component to handling the pandemic.  One thing science can do well, when it is functioning properly, is to acknowledge change, rather than digging in its heels and refusing to face facts, as new facts emerge.

Hopefully, my next blog will be with good news about the pandemic, which has gone on for much longer than it needed to.

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