June 20, 2020

Good afternoon... Today's Deep Dive is a close look at coronavirus and kids — and what that means for parents, school districts, even pediatricians.

Smart Brevity count: 1,531 words, or a 5 1/2-minute read.

1 big thing: High stakes for parents and schools

Illustration: Eniola Odetunde/Axios

Schools, day care, camps and other children's programming present some of the hardest challenges as the U.S. tries to figure out its coronavirus response.

  • Scientific unknowns, social and socioeconomic factors, and sheer logistics all make this complex health issue even thornier, Axios' Caitlin Owens writes.

"It's tough with schools because if you close down schools, that means the parents who rely on the schools to take care of children during the day have a difficulty," said Anthony Fauci, the director of the infectious diseases center at the National Institutes of Health.

  • "It's not a simple issue of opening and closing the schools. You want to balance nicely to make sure the most important thing is safety … but there [are] also social considerations that make the issue complicated," Fauci said.

The big picture: We don’t know how risky reopening schools is because we don’t have much data on how likely kids are to get infected or to transmit the virus.

  • So many experts want to keep schools, camps and other kids' programs closed out of an abundance of caution.
  • “If you put people together in a mixed environment, if you have essentially a daily mass gathering of children with teachers, you’re providing opportunities for transmission of the virus,” said Jeffrey Shaman, a professor at Columbia University.

But that's a problem for parents who can't keep working from home (and a significant headache even for those who can).

Between the lines: This dilemma is particularly acute for minority families, who are more at risk of severe illness from the coronavirus — and also more likely to have to return to work.

  • Bringing the virus into the home could be deadly; minorities are more likely to live in multigenerational households, where an infected child could infect a grandparent, and age increases the risk of a fatal infection.
  • But continuing to stay home to care for children who aren’t in school may simply be impossible.

“What may happen, unfortunately, is natural experiments, where certain jurisdictions are just going to bowl ahead … and others are going to have an attitude [of], ‘No, we're going to prioritize the health and safety of our population,’” Shaman said.

Go deeper.

2. Summer leaves poor kids disconnected

Illustration: Aïda Amer/Axios

As the academic year ends across the country, millions of students are facing a summer with no laptops, tablets or WiFi access, Axios Cities editor Kim Hart writes.

The big picture: Many school districts are collecting the laptops, Chromebooks, iPads and WiFi hotspots they distributed to students in March, when virtual learning replaced in-person classes.

Why it matters: Without access to school-issued technology during the summer, low-income and minority students, who are less likely to have reliable access to technology tools at home, are at higher risk of experiencing a greater "summer slide."

"For schools who issued devices to fill the gaps, by taking it away, they're recreating those gaps," said Jeff Mao, CEO of Edmoxie, which works with school districts on educational technology issues.

Some school districts — including Washington, D.C. as well as San Francisco, Stockton, Calif., and Seattle — are allowing students to hang on to their loaner devices through the summer.

  • But budget constraints, a lack of devices and difficulties in contacting families are getting in the way in other areas. Comcast has extended free internet service for 60 days to eligible customers.
  • But many low-income students will rely on a parent's smartphone for any connection.

3. Vaccination rates are plummeting

Adapted from CDC; Non-flu vaccines include all pediatric vaccines recommended by the Advisory Committee on Immunization Practices; Graphic: Naema Ahmed/Axios
Adapted from CDC; Non-flu vaccines include all pediatric vaccines recommended by the Advisory Committee on Immunization Practices; Graphic: Naema Ahmed/Axios

The general decline in pediatric care during the pandemic has put a lot of children behind the curve on routine vaccinations, Axios' Marisa Fernandez reports.

By the numbers: Non-influenza vaccine doses decreased by an estimated 21.5% from January through April, according to the Centers for Disease Control and Prevention.

  • Publicly purchased non-flu vaccines, including hepatitis, meningitis, polio and rotavirus, were also sharply down in April, compared to this time last year.
  • In New York City, vaccinations plummeted 63% overall, and 91% for kids older than 2, compared to the same time last year.
  • In California, shots for children are down 40%.
  • In Detroit, less than half of children younger than 2 are now up to date on their vaccinations, per a CDC case study.

"The last thing we want during a COVID pandemic is another epidemic of measles and pertussis and diphtheria here in the U.S.," said Gary Kirkilas, pediatrician and professor at the University of Arizona College of Medicine in Phoenix.

4. Keeping schools open worked in Sweden

Illustration: Sarah Grillo/Axios

UNESCO estimated in March that 91.3% of the world’s students were out of school. But Swedes under 16 were not among them.

Sweden’s iconoclastic approach was based on the belief that students faced little risk from coronavirus and far more from missing months of school, Axios World editor David Lawler writes.

Anders Tegnell, Sweden’s chief epidemiologist, admits there were flaws in the country’s permissive approach to the virus — Sweden has a high death rate, particularly in nursing homes — but says there’s little evidence schools exacerbated the outbreak.

  • The risk to teachers was also lower than many feared.
  • While Sweden’s no-lockdown approach was shunned by its Nordic neighbors, health officials in Denmark and Norway came around to Sweden's stance on schools.
  • Both made reopening them one of their first steps out of lockdown. Neither has seen a resurgence since.

What it looks like: Denmark has placed elementary school students in pods of around 12. They eat lunch together, play together at recess, and are taught by one teacher in one socially distanced classroom.

  • Spacing restrictions often mean staggering arrival times or even the days on which students attend.
  • Some parents were unconvinced. The Danish Facebook group "My Child Will Not Be a Guinea Pig for COVID-19" grew to 40,000 members after schools reopened in April.

5. Pediatricians wait for the kids to come back

Illustration: Aïda Amer/Axios

It's not just vaccinations: The pandemic has dried up pediatric care more generally, Axios' Bob Herman writes.

  • "We're missing things because kids aren't coming in," said Sara Goza, a practicing pediatrician and president of the American Academy of Pediatrics.

What's next: Pediatricians have changed how they care for kids, with dwindling cash reserves.

  • Most offices pivoted immediately to virtual visits, like other specialties.
  • As they've begun to reopen, they're now better stocked on personal protective equipment, and in-person visits are often staggered. For example, wellness checks could be in the mornings, while sick visits (including potential coronavirus cases) can be reserved for afternoons.
  • Some pediatricians got federal Paycheck Protection Program loans, which has provided some financial stability since they were shut out of the initial health care bailout payments.

"Our patient volumes are slowly increasing, but it's certainly not anywhere close to where it used to be," said Daniel Summers, a private practice pediatrician in the northern suburbs of Boston.

6. What we know — and what we don't

Illustration: Sarah Grillo/Axios

We know kids rarely get severely ill from COVID-19, but scientists aren't sure why.

Why it matters: A strong scientific understanding of the virus' effect on children, and of children's ability to spread it, is vitally important for school districts and policymakers — and for grandparents who long to reunite with their grandchildren.

What we know, via the Axios Science team of Alison Snyder and Eileen Drage O'Reilly:

  • Children are 35%–60% less likely to become infected, compared with people older than 20, according to a study published this week in Nature Medicine.
  • Just 5.7% of pediatric cases in a CDC survey were hospitalized (versus 10% of adults 18–64 years old), and three children died.

Yes, but: Some kids do experience severe complications.

  • COVID-19 is linked to a rare but severe condition in which the heart, lungs and other organs become inflamed. Scientists don't know why.

The unknowns:

  • Whether children are resistant to infection in the first place, are less likely to develop symptoms if they become infected, or both.
  • What is protecting children.
  • Their role in spreading the virus. Children may make up a small percentage of reported COVID-19 cases, but it is unclear whether they are significant spreaders of the virus, even if they don't have symptoms.
  • The long-term effects. It's too soon to know how COVID-19 affects children and others in the long run.

What's next: The NIH is enrolling thousands of kids and their families in a six-month study to better understand the infection in kids.

7. COVID crashes college

Illustration: Aïda Amer/Axios

Today's college students won't have a normal college experience — one with classes, graduations, internships and campus love.

Where it stands: Colleges' decisions about openings and closing are just as inconsistent as school districts', but with different stakes and a lot more money on the line, Axios managing editor Jennifer Kingson notes.

The big picture: Some students get to go back to campus in the fall, and some don't. And it could all change at any time.

  • New York Gov. Andrew Cuomo on Friday released complex guidelines that largely leave it up to schools whether to open their campuses.
  • Some schools are splitting the baby: Check out Boston University, where "arriving freshmen and returning undergraduate students will have a choice of attending in-person classes or taking classes remotely under a new hybrid teaching format the University is calling Learn from Anywhere (LfA)." 

Between the lines: There are all kinds of thorny issues at play here — from the complicated relationship between U.S. universities and foreign students, to the sad fact that black kids are more likely to suffer if campuses are closed.

For young people in particular, it's important for us to focus on a "sense of the future, and to remind ourselves that we’re in this with other people," says Joshua Morganstein of the American Psychiatric Association.