Tagged Youth

What Does a More Contagious Virus Mean for Schools?

What Does a More Contagious Virus Mean for Schools?

The coronavirus variant discovered in Britain is more easily spread among children, as it is among adults. Current safeguards should protect schools, experts said, but only if strictly enforced.

Children in Knutsford, England, returning to school this month following a Christmas break.
Children in Knutsford, England, returning to school this month following a Christmas break.Credit…Martin Rickett/PAMPC, via Associated Press
Apoorva Mandavilli

  • Jan. 14, 2021, 3:46 p.m. ET

It wasn’t until last fall that many parents started to breathe easier, as it became clear that elementary schools, at least, were not cesspools of infection with the coronavirus. But the alarming news of a more contagious version of the virus, first identified in Britain, revived those concerns.

Initial reports were tinged with worry that children might be just as susceptible as adults, fueling speculation that schools might need to pre-emptively close to limit the variant’s spread. But recent research from Public Health England may put those fears to rest.

Based on detailed contact-tracing of about 20,000 people infected with the new variant — including nearly 3,000 children under 10 — the report showed that young children were about half as likely as adults to transmit the variant to others. That was true of the previous iteration of the virus, as well.

“There was a lot of speculation at the beginning suggesting that children spread this variant more,” said Muge Cevik, an infectious disease expert at the University of St. Andrews in Scotland and a scientific adviser to the British government. “That’s really not the case.”

But the variant does spread more easily among children, just as it does among adults. The report estimated that the new variant is about 30 percent to 50 percent more contagious than its predecessors — less than the 70 percent researchers had initially estimated, but high enough that the variant is expected to pummel the United States and other countries, as it did Britain.

Prime Minister Boris Johnson of Britain had promised last year to do all he could to keep schools open. But he changed course in the face of soaring infections and buckling hospital systems, and ordered schools and colleges to move to remote learning. Other European countries put a premium on opening schools in September and have worked to keep them open, though the variant already has forced some to close.

In the United States, the mutant virus has been spotted only in a handful of states but is expected to spread swiftly, becoming the predominant source of infections by March. If community prevalence rises to unmanageable levels — a likely proposition, given the surge in most states — even elementary schools may be forced to close.

But that should be a last resort, after closures of indoor restaurants, bars, bowling alleys and malls, several experts said.

“I still say exactly what many people have said for the past few months — that schools should be the last thing to close,” said Helen Jenkins, an infectious disease expert at Boston University. Keeping schools open carries some risk, but “I think it can be reduced substantially with all the mitigations in place,” she said.

Reports of the new variant first surfaced in early December, and some researchers initially suggested that unlike with previous versions of the virus, children might be just as susceptible to the new variant as adults.

Researchers at P.H.E. looked at how efficiently people of various ages transmitted the variant to others. They found that children under 10 were roughly half as likely as adults to spread the variant.

Adolescents and teenagers between ages 10 and 19 were more likely than younger children to spread the variant, but not as likely as adults. (The range for the older group in the study is too broad to be useful for drawing conclusions, Dr. Cevik said. Biologically, a 10-year-old is very different from a 19-year-old.)

Over all, though, the variant was more contagious in each age group than previous versions of the virus. The mutant virus will result in more infections in children unless schools shore up their precautions, experts said.

“The variant is not necessarily affecting children particularly, but we know that it’s adding on more transmissibility to all age groups,” Dr. Cevik said. “We need to find ways to return these kids back to school as soon as possible; we need to use this time period to prepare.”

A schoolyard in Dortmund, Germany, this month. Fears of the new variant prompted Chancellor Angel Merkel to order schools closed.
A schoolyard in Dortmund, Germany, this month. Fears of the new variant prompted Chancellor Angel Merkel to order schools closed.Credit…Ina Fassbender/Agence France-Presse — Getty Images

In Germany, Chancellor Angela Merkel had vowed that schools would be the last thing to close during the second lockdown that began in November. Schools went to great lengths to keep in-person classes in session, requiring children to wear masks and opening windows to ensure better ventilation even as temperatures plummeted.

But fear of the variant’s spread prompted Ms. Merkel to keep schools closed following the holiday break at least through the end of January.

In France, where the new variant has not resulted in a surge of infections so far, schools reopened earlier this month after the winter break. France was not dealing with a particularly difficult epidemic, and health protocols put in place last September limited transmission in schools, Jean-Michel Blanquer, France’s education minister, has said.

The Italian government, too, has allowed not just elementary schools to open but also high schools, albeit at half capacity. Still, local leaders have implemented tighter restrictions, with some high schools slated to stay closed until the end of the month.

In the United States, the variant has only been spotted in a handful of states, and still accounts for less than 0.5 percent of infections. Schools remain open in New York City and many other parts of the country, but some have had to shut down because of rising virus infections in the community.

“Obviously, we don’t want to get to a point where it seems like we closed schools too late,” said Dr. Uché Blackstock, an urgent care physician in Brooklyn and founder of Advancing Health Equity, a health care advocacy group. “But at the same time, I think that we should try to keep our young children in school for as long as possible for in-person learning.”

It’s been clear for months what measures are necessary, Dr. Blackstock and other experts said: requiring masks for all children and staff; ensuring adequate ventilation in schools, even if just by opening windows or teaching outdoors; maintaining distance between students, perhaps by adopting hybrid schedules; and hand hygiene.

The new variant, while more contagious, is still thwarted by these measures. But only a few schools in Britain implemented them.

“When we look at what’s happened in the U.K. and think about this new variant, and we see all the case numbers going up, we have to remember it in the context of schools being open with virtually no modification at all,” Dr. Jenkins said. “I would like to see a real-life example of that kind of country or state or location, which has managed to control things in schools.”

There are some examples within the United States.

Erin Bromage, an immunologist at the University of Massachusetts Dartmouth, advised the governor of Rhode Island, as well as schools in southern Massachusetts, on preventive measures needed to turn back the coronavirus. The schools that closely adhered to the guidelines have not seen many infections, even when the virus was circulating at high levels in the community, Dr. Bromage said.

“When the system is designed correctly and we’re bringing children into school, they are as safe, if not safer, than they would be in a hybrid or remote system,” he said.

The school Dr. Bromage’s children attend took additional precautions. For example, administrators closed the school a few days before Thanksgiving to lower the risk at family gatherings, and operated remotely the week following the holiday.

Officials tested the nearly 300 students and staff at the end of that week, found only two cases, and decided to reopen.

“That gave us the confidence that our population was not representative of what we were seeing in the wider community,” he said. “We were using data to determine coming back together.”

The tests cost $61 per child, but schools that cannot afford it could consider testing only teachers, he added, because the data suggest the virus is “more likely to move from teacher to teacher than it is from student to teacher.”

In New York City, students and teachers are randomly tested, and have so far shown remarkably low rates of transmission within schools.

Dr. Blackstock has two children at an elementary school in Brooklyn, and said her son has not been tested all year. Even if the new variant brings a spike in cases, the city’s policy of closing a school if it has two unrelated infections is “too conservative,” she said.

If the number of cases skyrockets and the schools shut down more often, “then I would probably say, ‘This doesn’t feel right, let’s keep them home,’” she said. “But they’re going to be in school as long as I can possibly keep them.”

Emma Bubola contributed reporting from Milan, Melissa Eddy from Berlin, Constant Méheut from Paris and Benjamin Mueller from London.

How Teenagers Use Free Time Affects Mood

Adolescence

How Teens Use Downtime to Connect, Distract or Reflect

Different choices for how young people use free time lead to different kinds of relief.

Credit…Antonio Giovanni Pinna
Lisa Damour

By

  • Dec. 3, 2020, 5:00 a.m. ET

When pandemic-weary adolescents get to take a break, what should they do with themselves? The main aim, of course, should be to feel better after the break than before it. But different downtime choices lead to different kinds of relief. Adolescents (and adults) might want to reflect on the options for how they spend their free time — whether they’ve got 20 spare minutes today or can anticipate more unscheduled time in the weeks ahead.

Here’s a look at three ways teenagers tend to spend their downtime, and the particular benefits and challenges that come with each.

Connecting With the World Digitally

Young people often use their downtime to text with friends or check their social media accounts — and with good reason. Particularly under the restrictions of the coronavirus pandemic, teenagers rely on these platforms to connect with peers and to keep up with headlines. Spending time online might deliver the boost of an amusing exchange with a friend, a clever meme or good news about a favorite sports team. If it does, that makes for a restorative break.

But, of course, it can go another way.

Checking in on social media or the 24-hour news cycle is the psychological equivalent of sidling up to a slot machine. Hitting the jackpot — receiving digital love from a friend or finding an encouraging update about a vaccine — feels good. Pulling the lever and losing — whether that’s your messages being “left on read,” meaning the recipient doesn’t respond, or catching a depressing headline — is pretty much bound to happen from time to time.

For teenagers, especially in the context of the pandemic, turning to social media as a way to recharge can be a high-stakes gamble. Jill Walsh, a Boston University sociologist who studies technology use among adolescents, finds that having fewer in-person interactions has left many teenagers feeling “incredibly uncertain about their friendships.” Previously tolerable ambiguity in communications can now be highly distressing. Dr. Walsh notes that “getting a text that simply reads ‘k,’” — shorthand for OK that can be read as friendly, curt or angry — “can create a huge amount of emotional labor as a kid tries to figure out what it means.”

Before defaulting to downtime scrolling, teens might weigh the possibility of seeing a mood-lifting post against the chance that they’ll run into something distressing. A well-spent break should help to ease the mind; it shouldn’t open new tabs to worry over in our mental browsers.

Getting Lost in Distractions

There’s a lot to be said for taking occasional, all-consuming mental vacations, especially during a pandemic. Research on chronic stress shows that engrossing, happy distractions, such as competing in a sport or losing oneself in a movie or a book, can help young people weather persistently difficult circumstances.

Happy distractions may be a particularly apt choice when teenagers find themselves dogged by worries about school, peers, rising Covid-19 rates or anything else. Peggy Zoccola, an associate professor of psychology at Ohio University who studies the impact of stress and coping on the body, has found that ruminating over unpleasant events raises blood pressure and heart rate and triggers the ongoing release of stress hormones. Distraction, however, stops or attenuates the biological stress response. “It’s important,” she says, “to be able to recover and not always be pumping out these stress hormones.”

In fact, transporting diversions can be useful in two ways at once. According to Dr. Zoccola, they both draw our minds away from negative events that can trigger our biological stress response and at the same time pull them toward positive experiences that may prompt the release of natural mood-improving substances in the body that work much like opioids to help us feel better.

That said, it’s possible to have too much of a good thing. While pleasant distractions provide valuable mental and physiological breaks from stressful conditions, “my hesitation with recommending distraction,” Dr. Zoccola said, “is that while it can get people out of the moment, if it goes on too long, that might prevent folks from addressing an issue, or might create a new one.” Teenagers can run an easy check for themselves by asking, “Are my distractions getting in the way of what I need to do?”

Creating Space for the Mind to Wander

As a third option, young people sometimes use openings in their schedule for pursuits that are engaging, but only to a degree. Researchers use the term “soft fascination” in connection with activities that require attention but don’t entirely occupy the mind, such as spending time in nature or taking a long shower. More absorbing endeavors, such as playing a video game or solving a puzzle, recruit what’s known as “hard fascination.”

Compared to hard fascination, soft fascination uses less mental bandwidth and leaves more room for the mind to wander and reflect. Avik Basu, an environmental psychologist at the University of Michigan who researches soft fascination, explains that activities that “don’t swamp the mind” are more likely to be restorative because “a softly fascinating environment allows for reflection — and that’s when the problem-solving part of our brains can really get to work.”

In other words, soft fascination relieves stress by helping us close those mental browser tabs; unhurried reflection lets us sift through mental clutter, quiet internal noise and come up with fresh, useful solutions. According to Dr. Basu, “the ‘aha’ moments you have in your shower — that’s the problem-solving mechanism of the mind working. The answer just bubbles up!”

Unfortunately, for many young people, the pandemic has swept away previously routine occasions for soft fascination. Indeed, many of us have come to appreciate how much mental housekeeping we used to do as we made our daily commute or walked along a familiar route to work or school. Teenagers might now have to go out of their way to seek low-key activities when their minds feel cluttered. And they may need adults’ encouragement to do so, because simply going for a stroll or looking out a window can seem boring compared to the allure of online catching up or consuming distractions.

When it comes to self-restoration, we all have options — with connection, distraction and reflection being chief among them. Caring for our mental and emotional health matters now even more than usual, so it’s essential for people of all ages to take the breaks that best address the needs of the moment.

Swipe Right to Connect Young People to H.I.V. Testing

Photo

A screenshot of the Healthvana app.

A screenshot of the Healthvana app.Credit

Midway through her sophomore year of high school, my patient told her parents that she had missed two periods and was worried she might be pregnant.

Stunned to learn that she was sexually active, her parents took her to the pediatrician, who had another surprise: She wasn’t pregnant but she did have H.I.V.

I met her a few days later in my H.I.V. clinic, and watched her start crying as I told her that her H.I.V. was advanced and that she needed antiviral treatments really soon.

Sadly, her story of late diagnosis is far from uncommon. Ten thousand people ages 13 to 24 are given H.I.V. diagnoses every year in the United States, and epidemiologists estimate fully half of young people with H.I.V. do not know it. While the virus is no longer considered the death sentence it was decades ago, late diagnoses like my patient’s can undermine the life-saving benefits of antiviral medications, leading to greater risk of AIDS and death.

Part of the problem is the low rate of H.I.V. testing in young people, despite the recommendation by the Centers for Disease Control and Prevention that every sexually active person over the age of 13 get tested. Earlier this year, C.D.C. researchers reported in Pediatrics that pediatricians and parents are testing five times fewer young people for H.I.V. than recommended by national guidelines. Only 22 percent of sexually active high school students were ever tested for H.I.V., and, even worse, the likelihood that young women like my patient were tested for H.I.V. actually fell from 2011 to 2013.

Tio Pier, a Stanford University student who advocates for testing and sexual health education, says his high school teachers provided basic education about H.I.V. in a health class but, “they don’t follow up and say, ‘and if you feel like you need a testing resource you could go here…’ There was none of that.” Indeed, a 2015 survey showed that less than half of sexually active gay and bisexual adolescents even knew where they could get an H.I.V. test.

A number of groups are working on ways to improve access to H.I.V. testing for young people. Tim Kordic, a health educator with the Los Angeles Unified School District, is partnering with a company called Healthvana to place educational posters about H.I.V. in classrooms and provide students with a free iPhone app that harnesses GPS technology to locate nearby H.I.V. testing facilities.

Most public health departments and community health clinics offer free H.I.V. testing to people of all ages, and in New York and 30 other states, children under 18 have legal access to H.I.V. testing without parental notification. Kids who test positive can access life-saving H.I.V. therapy early, with drug costs often covered by the federally funded Ryan White HIV/AIDS Program. Kids who test negative leave the clinic better educated and probably with a pocketful of free condoms.

Ramin Bastani, the chief executive of Healthvana, says their app has delivered the results of over 200,000 H.I.V. and sexually transmitted infection tests to patients at participating health care providers across the country. The confidential service also gives users information on how to access treatment if a result is positive. Some young people post negative H.I.V. testing results on social media as a way of encouraging others to get tested, Mr. Bastani said.

Healthvana isn’t the only app seeking to connect youth to H.I.V. testing. The United States Department of Health and Human Services has its own locator app pointing out nearby testing services and a panoply of other resources like H.I.V. care, substance abuse services and housing assistance. Yet another app connects users to free condoms, and there is even a mobile game designed to sensitize youth to the risks of teenage pregnancy.

“It’s hard for teenagers to physically go places, and to know that they will be welcomed,” says Karen Rayne, a sexuality educator and author of the book “Breaking the Hush Factor: Ten Rules for Talking With Teenagers about Sex.” To Dr. Rayne, the privacy of a mobile app – including the ability to delete the app after use – is a great way to “draw teens out” and “give them the confidence to access a public physical space” like an H.I.V. testing clinic.

Mobile phone apps that connect youth to H.I.V. testing cannot supplant other proven H.I.V. prevention methods. Kids still need quality health education in school and optional school-based H.I.V. testing. Most important, kids need caring parents who support access to high-quality care.

My patient didn’t have access to any of these resources. Fearing fellow churchgoers would judge them for her diagnosis, her parents kicked her out of the house. She fought to finish high school while sleeping on a neighbor’s couch and struggled to take medications and keep her medical appointments. At 18 she moved to a new state, hoping to start a new life.

She and the 10,000 other young people in the United States given H.I.V. diagnoses every year deserve more. They need evidence-based sex education, supportive parenting and better access to the H.I.V. testing information that could save their lives.

Tim Lahey, M.D., M.M.Sc., is an H.I.V. physician, ethicist and director of education at the Dartmouth Institute for Health Policy & Clinical Practice in Dartmouth’s Geisel School of Medicine. He is a member of the Dartmouth Public Voices Fellowship.

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