Schools’ efforts to curb absenteeism this fall could be hamstrung by a worse-than-expected season of respiratory bugs and other childhood illnesses—driven in part by the ongoing COVID pandemic.
As early as this week, the Food and Drug Administration and Centers for Disease Control and Prevention are expected to greenlight COVID-19 boosters for children to vaccinate against both the original pandemic coronavirus and more recent omicron variants, which have become the dominant strains in the United States.
Yet so far, the vast majority of schoolchildren haven’t received the existing vaccines. Little more than 30 percent of children ages 5-11 and about 60 percent of those ages 12-17 have completed their initial series of COVID-19 immunizations, according to CDC data. And only 17 percent of teenagers and 4 percent of younger children have gotten the first booster, made available earlier this year.
While booster authorization may help, it will be emergency use rather than full FDA authorization, and “a lot of parents will draw a hard line at, you know, if it’s not fully FDA approved, then I won’t let my kid get it,” said Dr. Andrew Noymer, a demographer and associate professor of public health at the University of California, Irvine.
While children typically have less-severe cases of COVID, “kids can be the engine of COVID transmission in the community, because they bring it back to their households. So, I don’t think just letting kids get sick in school is a better solution,” Noyer said.
That low booster coverage significantly reduces protection even for students who had a prior strain of COVID or who took the full course of the original vaccines, which studies find less than half as effective against catching newer omicron variants without a third shot. And prior studies have found even mild cases of COVID-19 can suppress the immune system, putting patients at risk of developing secondary illnesses such as shingles or respiratory syncytial virus (RSV).
Moreover, social distancing and changes in seasonal respiratory and stomach viruses may mean more outbreaks, particularly among the youngest students, said Dr. C. Buddy Creech, chair and professor of pediatric infectious diseases at Vanderbilt University and director of the Vanderbilt Vaccine Research Program.
“The unintended consequence of some of the social distancing and risk mitigation factors that we used for COVID is that kids weren’t being exposed to some of the common respiratory viruses of childhood,” Creech said. For an infant who delayed getting a respiratory virus like RSV, that meant reduced risk of being hospitalized or developing later asthma.
By contrast, a child who turned 3 or 4 in 2020 may have been socially isolated during a window in which children typically get a dozen or more minor colds and other bugs every year. Those children, now starting kindergarten, Creech said, “may have more missed school days because they haven’t been primed with all these respiratory viruses of childhood that tend to give us the ability to stave them off when we’re in school.”
“If I were an administrator, I would not be surprised, and I would actually plan ahead for situations in which it feels like even the most unremarkable respiratory illness—that’s not flu, that’s not COVID—comes through and just annihilates a classroom,” Creech said.
“They just need to recognize that rather than in years past, when a child in a classroom gets human metapneumovirus or enterovirus [common cold and stomach bugs] instead of having one or two kids get sick, it might be most of the kids in that classroom,” he said.
That doesn’t mean schools should return to intensive quarantining regimes, he said, but it does mean administrators should be prepared to adapt protocols developed during the pandemic to control other disease outbreaks. Schools likely won’t return to remote instruction, but could, for example, ask students and staff to wear masks for a few weeks during a flu outbreak or beef up cleaning protocols to curtail the spread of a stomach bug.
Awareness needed for other childhood illnesses
Experts also warned that parents’ vaccine hesitancy in many communities also has spilled over from COVID-19 to other, established vaccines against childhood illnesses like measles, pertussis (whooping cough), and polio.
The CDC’s school vaccination data have not been updated for the current school year, but full immunization rates against a slew of childhood diseases—including measles, mumps, chicken pox, polio, tetanus, and whooping cough—all declined from 2019-20 to 2020-21.
“If you were to ask the average American, ‘Are you at risk for polio?’ all of ‘em would say, ‘Of course not.’ We’ve lost the memory of how substantial polio was. And yet now we can find polio virus in waste water in certain communities in New York,” Creech said, pointing to polio outbreaks this summer.
“So we’ve just got to be really mindful that we can’t be complacent vaccinating against what we are prone to think of as older diseases,” like polio and measles, he said.