Can Schools Reopen Without COVID-19 Restrictions?

[MUSIC PLAYING] Welcome, everyone. I'm Dr. John Whyte, the Chief Medical Officer at WebMD, and you're watching Coronavirus in Context. Where are we with masks? Where are we with physical distancing? Do we still need to be doing any of that? And more importantly, how is this all impacting our children and how do we keep our children safe?

So to help provide some guidance, I've asked Dr. Lucy McBride. She is a practicing physician in the Washington, DC area and a frequent commentator on various media outlets. Dr. McBride, thanks for joining me.

John, thanks for having me. I'm glad to be here.

You wrote this fascinating piece in The Atlantic and also one in The Washington Post, which is all about masks and kids outside, but really, it's about framing risk. Have we done it all wrong in not explaining people how to calculate their risk?

So I love that question because my day job is seeing patients one at a time as an internal medicine physician, and my job with patients is to help them understand the various risks that they face every single day without necessarily even knowing it.

Being a human involves risk. There's risk everywhere we look, and so my job is to help people understand the risks of actions and the risks of infections. So when we are looking at a global threat like COVID-19, it's really important to understand that everything we do to mitigate risk against this horrible disease has a cost.

And we have to understand too that as the public health landscape changes and as vaccines go into arms all across the country and we are safer every day, we need to also shift the way we think about risk to make sure we are not only preventing disease, but preventing despair that can come from overestimating risk when it's not as threatening as it once was.

So let's talk about that in kids, because that's what you've been talking about, that's what everyone's focused on right now, and we kind of plop all kids in one group, but we know it varies. I want to break it down just for our discussion. You know, those kids that are 12 to 15 who can be vaccinated and then those kids under 12, which are primarily elementary school.

And we know that risk is much lower in elementary school. We know that they're not as much transmitters as we maybe once thought. So for parents that have kids 12 to 15, what should they do, and then what about for parents who have kids under 12 who aren't going to be able to get vaccinated this summer because they're not eligible?

So for my patients who have 12 to 15-year-olds and, by the way, I see 15-year-olds as patients myself and I have a 15-year-old daughter, I'm recommending that they get vaccinated. These vaccines are safe, they're effective, there's no sort of medically plausible reason as to why they wouldn't be safe. Of course, we need to continue to study long term safety effects. But right now, the biggest threat to kids is not being vaccinated and then being able to realize their broader human needs.

For the kids who are 11 and under who aren't yet eligible for the COVID vaccines, I tell my patients who are parenting those kids, look, I understand absolutely your fears and vulnerabilities when you have a child who is unvaccinated. But let me reassure you with the facts.

Kids age 11 and under and kids in general are at very low risk for severe complications of COVID-19. Have they gotten sick? Have some died? Tragically, yes, but not in enough numbers that warrant ongoing restrictions on kids.

Secondly, as we vaccinate more Americans, kids are indirectly protected by the immune protection for the vaccine in adults. So we have seen in the last couple of weeks in the United States, as case rates and hospitalizations drop in adults, case rates and hospitalizations are dropping in kids as well.

Lastly, we need to also realize when we have a low risk virus in general for kids, of course, there are kids who are higher risk, and the benefits of releasing them into normalcy and realizing not only the broad expression on their friends' faces, but also just the safety and security of being back in school, because it's not just about mask. It's about the whole restriction on them. When we are able to allow kids to be back in their normal habitat, that's when we are really providing them the opportunity to be healthy.

Let's get real practical. So you advise parents that it's OK for kids not to wear masks outside irrespective of age. Is that correct?

That's right.

Unless they have some underlying health condition--

Sure.

--immunocompromised, et cetera. What about indoors? What's your recommendation there?

So let's talk about outdoors for a second. First of all, people can mask at will as much as they want to. If you have an underlying condition, or you are vulnerable, or you have a child who lives with a high risk adult, mask if you want to. But for a mask a mandate to persist is not rooted in science.

So indoors, again, this is where I hope I will always have a job because I'm counseling parents and patients one at a time depending on their unique medical vulnerabilities. But inside, it depends. So I anticipate in the fall, when schools reopen, that the case rates will be so low in most parts of the country that it won't make sense to mask, distance, and restrict kids from their normal lives in school.

Let me interrupt you for a second. Let's take it back. So what's your metrics? That's what I've been trying to get people to focus on. I know you have too. Is it the number of new cases? Is it positivity rate? Is it deaths? I mean, that's where I think we have a challenge. No one is saying what the matrices are to remove risk mitigation strategies, so what's that metrics? Is it--

So in my opinion piece on The Washington Post with my co-authors Allison Krug, Monica Gandhi, and Tracy Beth Hoeg, we argue that the CDC, because they want metrics, to follow the UK's lead and use a metric like this where we have somewhere between two and four hospitalizations per 100,000 people in a day.

The problem is, tying a metric to school reopening is intrinsically problematic, so that's not the hill I'm going to die on. At the same time, because we live in the world we live in and because CDC generally wants to see metrics, that's what we have chosen because it makes sense. At the same time, we need to have some flexibility to understand that kids should really be in school in many ways regardless of the case rates because kids need school for their emotional, social, and mental health.

Is that for all schools? Because remember, elementary school, they still won't be eligible. There's not going to be a vaccine for kids under 11. That's why--

[INTERPOSING VOICES]

--in the fall. But then-- or do you expect there will be mandates for kids that are older?

So I wish I knew. I don't know. What I'm telling you is I'm following the science and seeing the very low risk that COVID-19 poses to kids, and it's lower and lower every day. And then we also see that kids are really protected by the vaccination status of the staff, and faculty, and teachers at the schools. And so by the time fall rolls around, of course, depending on the local situation of COVID in the particular region we're talking about, it just isn't going to make sense for most schools to restrict kids.

Now, there's lots of nuance here, right? Because I don't have a crystal ball and because could things change? Could case rates go up? They could. It's just very, very unlikely. Again, if you look at the UK and Israel as the seniors and we're the sophomores, we're going to be in so much better shape even next week than we are today, and in the fall, it should be a lot different. So I'm hoping--

We need the matrices to help guide us rather than just opinion.

That's exactly right. We need to make sure that our public health policies and that our internal narratives as parents are rooted in fact and science because, again, there is so much hope here. There is so much to be excited about and for kids to look forward to a normal fall would be really wonderful.

And be able to see people's faces and their loss of teeth maybe as well in elementary school age. Talk to me about boosters. Do you anticipate there will be boosters? Or from a communication perspective, are we spending too much time talking about this?

So I love that question. So my patients ask me this all the time. What about the variance? What about booster shots? I tell them, look, the vaccines that we currently have are so stunningly effective against all of the circulating variants.

Of course we need to keep an eye on this, but let's also just face the reality that Pfizer and Moderna have every motivation to get boosters ready and they are being made right this minute. Should we need them, they're in the freezer next to the mint chip. So let's not worry about boosters. Let's not worry about boosters and the need for them when that is a potential eventuality and the real threat right now--

Maybe. Maybe.

It's a big maybe, and worst case scenario, we need boosters and Pfizer and Moderna will crank them out. Let's worry about the immediate threats right now, which are, in my world as a medical doctor, are the emotional and physical health fallout from the pandemic.

And so let's worry less about things that are possible potentially and worry more about what's actually happening in our lives every day, where we are distressed, and anxious, and sleepless, and so many people are suffering emotionally and physically as a result of living through a collective trauma.

Dr. McBride, I want to thank you for taking the time to share your insights. I mentioned you're on Twitter. Tell us about your newsletter.

So my newsletter was started in March 2020 just as a way to tell my friends, and family, and patients about what to do, what test, how to quarantine, where should I go. And so I started writing it to dispense real time, fact-based, agenda-free information to whoever wanted to listen and it's gone, if you will, viral.

Now, I'm reaching, I think it's up to 15,000 people, to try to help people make sense of the news, to replace fear with facts, and to be able to live their lives without feeling like they have to either have COVID or be distressed. You can actually protect yourself from disease and despair together.

As you point out, if we give them better information, they're going to have better health. Dr. McBride, I want to thank you again for taking the time.

Thanks so much for having me.

And if you have questions about COVID, drop us a line. You can email me at [email protected]. Thanks for watching.