Epidemiologists: B.1.1.7 a threat to ‘back to school’ plans

BOSTON — Epidemiologist Michael Osterholm once strongly supported the idea of kids returning to the classroom full-time.

“You know the epidemiology here is compelling that there’s just very little transmission to kids, from kids, by kids and that we could open schools,” Osterholm recalled his previous position during a March 19 press briefing sponsored by the American Association for the Advancement of Science.

But late last fall, the U.S. began seeing its first cases of B.1.1.7, the so-called British variant of COVID-19. Now Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, has done a 180 on the subject.

“It’s a totally different virus in the sense of what it’s doing epidemiologically,” he said. “I think school openings today are going to greatly enhance transmission of B.1.1.7 in our communities, and I predict that within weeks we will be revisiting this issue, unfortunately, after we’ve had substantial transmission.”

In Massachusetts, that substantial transmission has yet to be seen but may already be happening.

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On Monday, April 5, elementary school students go back to five-day-a-week in-person learning by order of the state’s Department of Elementary and Secondary Education [DESE]. Middle and high school students go back later in the month.

Those orders have not changed, despite the fact COVID-19 cases among students and staff in Massachusetts schools have steadily risen for weeks. At the beginning of March, student and staff infections numbered 476 total. Last week, DESE reported 1,045 infections: 801 students and 244 staff.

Massachusetts only performs variant checks on a small number of positive COVID-19 tests, so it’s hard to say whether B.1.1.7 is dominant here. Thus far, the state Department of Public Health has reported to the CDC finding 712 cases of B.1.1.7 and more cases of the P.1 variant than any other state: 58.

But in Osterholm’s native Minnesota, health officials said B.1.1.7 rapidly gained ground last month, such that it’s now probably responsible for more than half of all infections there.

“We’re certainly seeing outbreaks in youth sports,” said Dr. Beth Thielen, a virologist and specialist in pediatric infectious diseases at the University of Minnesota. “School-based outbreaks are sort of cropping up, and I do think that that is quite worrisome.”

Also worrisome to Thielen, aside from the increased transmissibility of B.1.1.7, it seems to cause worse disease.

“Working in the hospital, and I can speak from personal experience, that I’ve seen some more severe cases in younger individuals than I have at prior points in the pandemic,” Thielen said. “I think there are some worrying trends that have been reported in multiple locations that suggest there may, in fact, be more severe disease and more transmissibility.”

What also concerns both Osterholm and Thielen is that the CDC school reopening guidance issued in mid-March seems to be based on safety data from what amounts to a different COVID-19 era, that is, the pre-B.1.1.7 time.

At that time, two things seemed to be true: the COVID-19 circulating at the time seemed less infectious to children, and Massachusetts school districts were largely operating under modified conditions with the primary goal of de-densifying classrooms so as to minimize possible exposure to the virus.

New CDC ‘back-to-school’ guidelines ease up on classroom distancing from six feet apart to at least three feet, which is what will allow for all students to return to in-person learning in Massachusetts and elsewhere.

“If we are making recommendations based on the safety under a prior situation, where the variants weren’t circulating so widely, that may not be the most up-to-date information to guide our policies,” Thielen said.

“So here we are now putting out new guidance today, based on the conditions of four or five months ago, when, in fact, I think today the ability to transmit this virus in our communities is greatly enhanced in schools,” Osterholm said.

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