Opinion | The Hard Covid-19 Questions We’re Not Asking

What if the stated goal is simply, “Kids need to be in school, period.” Considering the devastating costs of having children out of school last year, including dramatic and quantifiable learning loss in math and reading, this is a very reasonable and defensible goal. How might that then drive policy? Setting that goal would mean deploying more tools to keep children in school, like using rapid antigen tests and allowing kids who test negative to go to in-person class rather than mass quarantining hundreds or thousands of children who had close contact to people with the virus, as is happening now. Or, we accept that there will be more cases in children, recognizing that disease severity for a vast majority of kids is low.

Another hard question that is most likely also causing confusion and disagreement is how we define “severe” disease in children. Children can get Covid, but their death and hospitalization rates are much lower than for adults. The inflammatory syndrome MIS-C is rare. Long Covid has gained wide attention, but recent studies have shown that rates are low among children and not dissimilar to effects caused by other viral illnesses.

We’re not being cavalier by raising these points. Consider that in Britain the government doesn’t require masks for children in schools, and it’s not clear it will advise kids to get vaccinated, either. Britain has experts like we do, and they are looking at the same scientific data we are, they most assuredly care about children’s health the same way we do, and, yet, they have come to a different policy decision. Schools were prioritized over other activities and the risks of transmission without masks were considered acceptable.

This reveals the crux of the problem in the United States. It’s not just the C.D.C., but everyone — including us public health experts — who is not always connecting our advice or policy recommendations to clear goals. The conflict is not about masks or boosters, it’s about the often unstated objective and how a mask mandate or a “boosters for all” approach may or may not get us there.

We use schools as the example here, but much of the same applies to broader societal questions over mass gatherings, live entertainment and returning to offices. There are questions around how vaccinated people should live their lives if the vaccines reduce the likelihood of spread but don’t absolutely and completely prevent breakthrough infections and transmission, which was never going to be the case.

If the goal is zero spread, which we think is not realistic, then the country would need to keep many of the most restrictive measures in place — an approach that has serious public health consequences of its own. If the goal is to minimize severe disease, some states with high vaccination rates might already be there. Low-vaccination states would still have work to do before loosening restrictions. Treating the country as a whole just doesn’t make sense right now because of the widespread differences in vaccination rates.

The emergence of the Delta variant has, understandably, caused many Americans to step back and use caution. But the same questions will be there when we emerge from this Delta surge, whether in a few weeks or next spring. We shouldn’t let ourselves off the hook with “easy” decisions today. At some point, the country needs to have an honest conversation with itself about what our goals really are.

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