ARI SHAPIRO, HOST:
An anonymous New York City high schooler's Reddit post went viral last week. It chronicles a day at school during this coronavirus surge, and the student describes short-staffed classrooms, absent students, bathrooms full of classmates swabbing their noses. The post calls study hall a super-spreader event. Many schools across the country are once again debating whether to go remote or how to safely continue teaching in person.
Earlier today, the White House said it will give schools 10 million free coronavirus tests per month to help keep kids in schools. But testing in schools, says Dr. David Rubin, might not be the best strategy. He is director of PolicyLab at Children's Hospital of Philadelphia, and he advises Philadelphia schools.
Welcome to ALL THINGS CONSIDERED.
DAVID RUBIN: Thanks for having me.
SHAPIRO: Hospitals are reaching capacity because of COVID cases again, many of them children's hospitals. And yet your latest guidance supports in-person education right now. Explain why.
RUBIN: Well, it's not just our guidance. Our leadership at Children's Hospital of Philadelphia came together in a consensus statement last week having reviewed the data from across the pandemic and particularly during this omicron wave and concluded that, you know, No. 1, at a time when all adults have been offered vaccination and most children have been offered vaccination, we're seeing a variant moving across the region that certainly has moved very rapidly with very high, quick peaks in terms of transmission, but that the spectrum of illness that we're seeing, particularly in our children's hospital - and we're seeing some of the highest rates in the country in Pennsylvania. But the spectrum of illness is very consistent with what we take care of each year. And we're actually seeing fewer kids in the ICU proportionally this phase.
SHAPIRO: Some of your guidance is intuitive. You recommend full vaccination and masks indoors, for example. You advise people with symptoms to stay home. Other guidance is more surprising. You recommend discontinuing required weekly testing. Why do you suggest that?
RUBIN: Well, you have to think about this in the context of where we were last year. Last year, we were facing a novel coronavirus that was very virulent in an entirely unvaccinated public. And so the goal was to eliminate any exposure risk to buy time for vaccination to arrive.
This year, with a variant that, on average, is milder in most individuals, particularly in children, and at a time when people been offered vaccination, it no longer makes sense, you know, in terms of trying to prevent mild illness at a time when people have been vaccinated. And it's no longer feasible or practical.
And so we recognize that really simplifying the approach to school safety plans was probably the best way to keep kids in school, recognize that the pandemic has changed with regards to the moment that we're in, and just make it simple. At least during the worst of this, ask your students to mask and your staff to mask. If you're sick, stay home. And we're all exposed. So if you're exposed but asymptomatic, come to school with that mask on. We no longer require testing for asymptomatic individuals, but, you know, if you're an individual who has a chronic health condition or a family member at home that having that weekly test has been helpful to you, I think schools should provide that level of access and - whether it's for weekly screening or following an exposure.
SHAPIRO: I think it's really interesting that you say the goal used to be to eliminate risk of exposure and that that's no longer the goal. How would you describe what the goal right now is if that has changed?
RUBIN: Well, the intervention is vaccinations and boosters for those who are eligible. And to me, that has shown, even in this phase, to greatly reduce the risk of severe disease. And look; there was a lot of anxiety when our recommendations came out last week. And we certainly have a lot of empathy for, you know, our school staff. They're the backbone of our nation's education system. But to help them recognize - we've all been traumatized by COVID over the last couple of years, but if you were just to kind of just look at the situation now with a widespread transmission of a virus that, on average, is milder for most people, particularly those who were vaccinated, you'd recognize that we have to start getting back to the types of things we were doing before the COVID pandemic, which is just asking sick people to stay home and really not chasing mild diseases with tests. It's no longer practical or feasible.
SHAPIRO: We've certainly had other public health experts on the program say even if you're vaccinated and boosted, you can't just blithely go through the world assuming it'll be fine if you catch the omicron variant or the coronavirus. It sounds like your message is slightly different, like you disagree with that.
RUBIN: Well, I think you can go with confidence. I don't think right now I would walk into a crowded venue the week that we were at 20% of individuals who were infected with COVID. But besides that, I think you need to live your lives. I think even during a typical influenza season, we have breakthrough infections among those who are vaccinated. We don't always have a perfect match for the flu vaccine.
So I think we've learned how to individually adjust our routines based on what we think is the risk to ourselves or our family. But, you know, it's time to resume our lives and to recognize now that the competing costs both to adults but particularly for kids, who are asked to shoulder a burden during a time when kids never really had the same level of risk as adults - that for kids now, depriving them of educational access, continuing social isolation, continuing this reflexive anxiety to stay away from others, you know, that's really detrimental at this point. I would argue that the risks of that are now - far outweigh the risks of the disease itself.
SHAPIRO: It sounds like you're saying it's not just the risk of catching the coronavirus in a vacuum. It's that weighed against the mental health costs of not being in school, the learning loss, the relative mildness of coronavirus cases among children - all of that factored into the equation.
RUBIN: Yes, and the fact that the teachers and the staff themselves have been offered vaccination and have been offered boosters and people have made their choices. And we no longer can tailor our school safety policy to the decisions of those who've opted not to get vaccinated.
SHAPIRO: I know that there are going to be parents, students, teachers and others listening who say, all well and good for you, but I don't want to get COVID. What do you say to those people?
RUBIN: Well, I would say to those people that I would be careful to conclude that schools are the source of transmission at this moment in the pandemic. Exposure is everywhere. And for families over the holiday season, you know, when the counterfactual occurred, the kids were out of school. And that's when transmission risk increased the most. This is still principally happening in locations away from the school. In fact, I would still maintain that schools are probably a safer environment than most of our community settings.
SHAPIRO: Dr. David Rubin - he's a primary care physician and director of PolicyLab at Children's Hospital of Philadelphia - thank you for the conversation.
RUBIN: You're welcome.
(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.
