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COVID-19: It’s Time

By Mary O’Brien, M.D.

Are you caught up in the back-to-school debate?  It’s stunning that anyone is arguing about this.  There was never a medically valid reason for closing schools and colleges in the first place.  As far back as February, we know who the vulnerable people have been.  They were older individuals with multiple, significant underlying illnesses.  This pattern was observed everywhere from China to the European countries.

The panic-stricken rush to close schools and colleges was precisely that — a panic.  Experience over the centuries should have taught us that quarantining a healthy population is ineffective.  The sound, medically sensible approach is to isolate and protect the vulnerable people as quickly as possible.

Consider a few facts:

  • In the U.S. since February 2020, approximately 40,000 deaths attributed to COVID-19 have occurred in people age 85 and older.  Approximately 32,000 COVID-related deaths occurred in people aged 75 to 84.
  • Between the ages of 5 to 14, there have been 14 COVID-19 deaths.  Over 120 children have died from the flu.
  • Children are not vectors for COVID-19.  This illness does not mimic transmission patterns seen with cold and flu viruses in kids.  Young children do not bring COVID-19 home to grandma and grandpa.  There are several medically documented cases of adults transmitting the virus to children (out of millions of cases), but not the other way around.
  • The main reason for this curious fact appears to involve receptor sites in the nasal passages. ACE2 receptors (angiotensin-converting enzyme) in the nose seem to function like docking stations for COVID-19. (Most people are familiar with a class of blood-pressure medications called ACE inhibitors.) Children under the age of 10 have very low levels of ACE2 receptors.  Children between the ages of 10 and 17 have slightly higher levels of these receptors.  Adults gradually develop greater concentrations of these receptor sites as they age.

What does this mean?  It means that there is no medically valid reason for normal, healthy children to wear masks.  Masks can trap bacteria, spores, allergens, pollen, particulate matter, and even increase carbon dioxide retention in certain patients.  Socially and psychologically, there may be a price to pay one day.

Children should go back to school.  Colleges should reopen.  Teachers will be exposed to colds and flu as they are each year.  But COVID-19 is not a massive threat to faculty unless they are already old and sick.

According to the CDC website on “COVID-19 and Children” updated, July 23, 2020:

The best available evidence indicates that COVID-19 poses relatively low risks to school-aged children.  Children appear to be at lower risk for contracting COVID-19 compared to adults.  To put this in perspective, according to the Centers for Disease Control and Prevention (CDC), as of July 17, 2020, the United States reported that children and adolescents under 18 years old account for under 7 percent of COVID-19 cases and less than 0.1 percent of COVID-19-related deaths.[5]  Although relatively rare, flu-related deaths in children occur every year. From 2004-2005 to 2018-2019, flu-related deaths in children reported to CDC during regular flu seasons ranged from 37 to 187 deaths.  During the H1N1pandemic (April 15, 2009 to October 2, 2010), 358 pediatric deaths were reported to CDC. So far in this pandemic, deaths of children are less than in each of the last five flu seasons, with only 64. Additionally, some children with certain underlying medical conditions, however, are at increased risk of severe illness from COVID-19.*

Scientific studies suggest that COVID-19 transmission among children in schools may be low.  International studies that have assessed how readily COVID-19 spreads in schools also reveal low rates of transmission when community transmission is low.  Based on current data, the rate of infection among younger school children, and from students to teachers, has been low, especially if proper precautions are followed.  There have also been few reports of children being the primary source of COVID-19 transmission among family members.[6],[7],[8]  This is consistent with data from both virus and antibody testing, suggesting that children are not the primary drivers of COVID-19 spread in schools or in the community.[9],[10],[11]  No studies are conclusive, but the available evidence provides reason to believe that in-person schooling is in the best interest of students, particularly in the context of appropriate mitigation measures similar to those implemented at essential workplaces.

Wash your hands.  Don’t touch your face.  Stay home if you feel poorly.  Keep surfaces clean.  Avoid crowds.

It’s time for kids to go back to school and for adults to go back to work.