Earlier this week I wrote a column which raised an alarm around whether it was worth sending our children into school when we know that more transmissible and possibly more lethal SARS-CoV-2 variants are circulating. Now, new reports from Italy of a spike in cases among the very young have those alarm bells ringing even louder.
The B.1.1.7 variant — first identified in the UK late last year — was reported to be circulating in Italy in early February. By February 18, the variant accounted for more than half of all infections in the European country. This week, Italy’s health minister confirmed the alarming uptick in new cases but shared even more worrisome news: the new infections were especially pervasive “among the youngest age group”. In response, Italy has tightened restrictions around schools, forcing elementary and daycares closed in red zones across the country, where infections are peaking.
There are a few lessons that the rest of the world should absorb from Italy’s current crisis. Covid-19 has long been thought to be a worry for the old, not for the young among us, especially not elementary and nursery school age children. But Italy’s experience is proving us all wrong — the incidence of new cases among young people has now eclipsed cases among the old.
Since the start of the pandemic, scientists have wondered why children have accounted for such a small percentage of identified cases. Over time, studies have suggested that part of the reason why children may be less susceptible to infection is that they have fewer ACE2 receptors than adults, which is the critical entry point into our bodies for Covid-19. But many of the emerging variants, including the B.1.1.7 variant, have mutations that increase the virus’ ability to bind to our ACE2 receptors — tighter receptor binding means that even with fewer ACE2 receptors, children now have a higher likelihood of becoming infected when they encounter the virus.
Compounding the problem is the fact that children are a relatively naive population — not in terms of education or intelligence, but in terms of immunity. Having no widespread immunity conferred from previous infections, our youngest generations are more susceptible to infection today. This is why we must all take special note of the warnings from Italy.
In the United States, the relatively low rate of severe illness and death among children has been used as the rationale for reopening schools and has fed into the current CDC school guidelines. Those guidelines note that children are less susceptible to infection than adults and suggest they may be less infectious, even though other studies have shown that Americans living with a child attending school in-person are at an increased risk of Covid-19, especially when schools don’t employ comprehensive mitigation measures.
It was nearly a year ago that Europe unwillingly became the epicenter of the epidemic, before passing that title on to those of us in the United States. Now, once more, their unfortunate experience risks being passed on to those of us here if we don’t heed the alarm and pay greater attention to the possibility of widespread infections in our schools. Already, we are seeing tragic ripple effects of the pandemic on the health of our youngest, on their mental health, routine vaccinations, and even on their ability to access lifesaving services like cancer care. We cannot stand by and watch another tragedy unfold.
Decisions on school reopening should be based on data — what is the prevalence in all school populations, children, adults, students, teachers and support staff? When new data emerges, like the data coming out of Italy, we must keep a close eye on it. The situation can change quickly, particularly with the variants. We must act on real, transparent, actionable data to protect our youngest, not on our perceptions. With this disease, the past is not prologue.