COVID-19 vaccines: Public health before personal liberty

Just when it seemed as if the public health issues regarding schools were becoming clearer, the equation changed because of the emergence and predominance of the delta variant. The variant’s increased spread makes the need for more precautions at schools even more important than before, especially now that there is more in-person learning. The solution isn’t state mandates or threats — it is local policy, compliance and wisdom.

Pre-delta, multiple studies showed that children were far more likely to spread COVID-19 outside of schools than in school, that mitigating measures (masks, distancing, ventilation) along with regular testing were factors in a very low rate of spread (less than 2 percent) in schools. Most importantly, there was increasing evidence that being out of school for a prolonged period of time affected nutrition, behavior, development, and led to the loss of proper health screenings, increased anxiety, depression, and substance abuse. It was clear that schools, a mainstay in everyone’s lives, needed to remain open. 

But delta has altered the COVID-19 terrain. For one thing, it appears to spread more easily (including among children) than earlier versions of the virus, and recent evidence shows that it is making non-immune people sicker (and children under the age of 12 are currently unable to be vaccinated) and in one disturbing case in California, an unvaccinated teacher spread COVID-19 to many young schoolchildren (26 according to the Centers for Disease Control and Prevention, CDC).

Recovery from COVID-19 and full vaccination both greatly decrease the risk of acquiring and spreading COVID, and both must be incorporated in a strategy intended to decrease spread at schools. 

Under these tense circumstances, we can ill afford the ongoing politicization surrounding schools and school openings. Mask wars make no sense because even though this virus can be aerosolized and escape masks, at the same time multiple studies have shown that regular mask use is associated with lower rates of transmission (pre-delta). With the far more transmissible delta variant, it makes complete sense to at least try masking in schools. More importantly, there is every reason for every teacher, staff member and eligible child to be vaccinated. Large-scale vaccination will create a lower risk level at schools. Schools may need to mandate this in the name of safety and public health. This must be accompanied by a return of rapid, regular testing — at least once weekly — so that COVID-19 positive teachers and students can be isolated and their contacts, in turn, tested.

Large outbreaks at schools in defiance of or in opposition to the above measures are likely to fuel school closures whether for purely medical reasons or because these outbreaks will feed the politics of fear and divisiveness. Either way, this would be a dreaded and potentially avoidable outcome. Schools have always been places that mandate certain vaccines, have dress and behavior codes that everyone follows. This culture can help us now with COVID-19 vaccines and masks. My son’s school hands out a comfortable yet substantial mask in the school’s colors with the school emblem on it, and it is now part of the school uniform. In my view, public health supersedes personal liberty when your behavior puts others at risk, such as with an infectious disease. All efforts must be taken to prevent that spread, especially when there are long-term negative outcomes of becoming infected (known as “long COVID”) beyond just the immediate and increasing risks of severe illness.

It is a diversionary political argument to question or deride the usefulness of masks, to cite the lack of double-blinded randomized trials, rather than to see them simply as part of an all-hands-on-deck approach to combat COVID-19 and its delta variant.

With schools closed, it is the economically disadvantaged communities that will suffer the most, as they did all last year. Our best hope to avoid this disabling scenario is to stick to pure public health and avoid politics as much as possible. Otherwise, it is our children who will suffer. We don’t need to defend their right to take off their mask or to refuse the vaccine on their behalf; we need to defend their need to be in school.

Marc Siegel, M.D., is a professor of medicine and medical director of Doctor Radio at NYU Langone Health. He is a Fox News medical correspondent and author of the new book, “COVID; the Politics of Fear and the Power of Science.”