Delta variant spreads worry as school reopenings near

Two students look are separated by a plastic barrier.
Jackson Hulke (left) and Milagros Larios Tulujan look at each other through a plastic divider at their table in Mrs. Powell's kindergarten class at South Elementary in St. Peter, Minn. Schools across Minnesota opened classrooms back up to students for in-person learning on Tuesday, Jan. 19, 2021. Principal Doreen Oelke said that students and teachers have had many different emotions returning to school, from being scared and nervous to being happy and excited.
Jackson Forderer for MPR News

The COVID-19 delta variant is leading a new surge of infections nationwide leaving families and school officials to face a complicated reopening of classrooms. 

As schools ready for in-person instruction, Minnesota is recommending —  though not requiring — all students, teachers and staff, as well as visitors, wear masks indoors, regardless of vaccination status. 

The highly contagious variant is responsible for 75 percent of new cases and officials are urging those who are eligible to get vaccinated. 

The American Academy of Pediatrics, for its part, recommends universal masking for all students 2 years of age and older and advises schools to prepare for “building ventilation, testing, quarantining, cleaning and disinfection” to help to prevent transmission.

Last week, the Centers for Disease Control and Prevention issued revised masking guidelines after a Massachusetts study found the delta variant had high rates of transmissibility among fully vaccinated people.

Wednesday, host Kerri Miller was joined by two pediatric specialists to discuss mask and vaccine mandates, what the delta variant means for children and the state of vaccines for children under 12. 

Guests:

  • Dr. Madeleine Gagnon is the associate medical director of pediatrics at Gillette Children’s Specialty Healthcare in St. Paul.

  • Dr. Paul Offit is a pediatrician and director of the Vaccine Education Center at Children's Hospital in Philadelphia.

The following is a transcript of the show, edited for clarity. Use the audio player above to listen to the full conversation.

Kerri Miller: Dr. Gagnon, I want to be clear on whether you agree with the other expert recommendations that in person learning is so necessary, the kids have to be back in school, even though this pandemic isn't over and the Delta variant is spreading. Is that the balancing act and you come down on the side of, Yes, in person learning is essential?

Dr. Gagnon: Yes, I agree our children has paid a significant price for this pandemic, between hybrid learning their mental health, their social health, and how their own health has been impacted. Children are often overlooked, but over 110,000 children in Minnesota alone has contracted COVID. And their family members certainly have also been impacted. So to your point, it's that delicate balance of recognizing the need for in person learning, but balancing the delicate resources that each district in a unique way is trying to bring that together with their resources and communication. And that brings for a difficult challenge. But yes, I of course, do agree with the American Academy of Pediatrics that in person learning is so important for our children across Minnesota.

Miller: Dr. Offit, you agree with that as well?

Dr. Offit: Completely. I think for all the reasons that the doctor just said. We need to get children back to school. I know just as one small point, I mean, are prominent or important point is that in Philadelphia last year, the rate of child abuse dropped to virtually zero. It's not because it actually dropped to zero, it's because child abuse as soon as he picked up in the schools. And because many kids didn't get back to school, we didn't get to see it. So that's just one of the many ways in which children have suffered this pandemic.

Miller: Dr. Offit, I read an interview that you did last month, and you said, this is a winter virus, kids are going to be going back to school, they're not likely to be masking. They're not likely to be social distancing. And I think you're going to see again, an outbreak of this virus come late fall and winter. Are you concerned that these layers of mitigation that schools did last spring and that they're planning to do again, this fall, are not going to be what followed or sufficient to protect kids? What's what's your view on that? What were you thinking about there?

Dr. Offit: So it's a confluence of three unfortunate events. You have the Delta variant, which is clearly more contagious. You have children less than 12, who at least right now can't be vaccinated. It's extremely unlikely that there's going to be a vaccine available at the start of school. And hopefully, we'll have it by late fall, early winter. We'll see. And, and you have winter, which is clearly the virus spreads more easily in drier, less humid, colder climates. So that's a bad combination of three things. Also, the you know, when you see, for example, that yesterday, there were 100,000 cases in the United States and 500 deaths. I mean, those are the numbers we saw last summer. Last summer when we had a fully susceptible population, and last summer when we didn't have a vaccine, why the Why is it so much worse? Or why is it Why is it that we haven't had significant advances? I think the reason is twofold. One is that delta variant is more contagious. So that's part of it. But the other thing is our behavior has changed. I mean, if you think about last summer. You know, we were appalled when there was a bikers convention in Sturgis, South Dakota. And you know, there were, you know, people didn't have weddings, they didn't have birthday parties. They didn't. They didn't, you didn't have 60,000 people watching a baseball game. That's not true now. I mean, we've definitely loosened our behavior. I think it's been so hard to get back there to be as stringent as we were last summer as compared to this summer. So I, I do worry about kids going back to school. But I think that the critical thing is if we don't have vaccines, and our only other choice at that point, is masking. And I think we need to be really good about that when we go back to school.

Miller: Okay, let me take some calls here from Mara in Hopkins. Hi, Mara, I really appreciate you calling. What are you thinking about this morning?

Mara: Well, I teach in high school, and I have multiple sclerosis. So I was told by my neurologist that my disease modifying therapy invalidates the vaccines that I received. My son is 10. He's in elementary school, and all summer, he's been in camp outside, wearing his mask, because he wants to protect his mom, which is very sweet. Now, I'm worried about both myself because I of course, need the health insurance for my job to treat my multiple sclerosis. But if I go into school, I'm putting myself at risk. And now I'm increasingly worried about my son at 10 not old enough to get the vaccine, which he keeps saying, Mom, mom, is there a trial? Can I go into trial to get the vaccine to protect you? This is 84% increase in cases in kids last week.

Miller: So Dr. Gagnon, this is what I alluded to about these these complicated situations where you have unvaccinated school-going kids, you might be mixing with family members who are particularly vulnerable. And in Mara's case here, she's also going to be in a school once, I guess, can you can you assess her risk level? And then some of the interventions that might be helpful?

Dr. Gagnon: Yeah, so Mara, thanks for calling. And I hear you and your concerns, it's important to remember that every family needs to make the unique decision that's best for them taking into context, their own social, mental and physical health challenges that may be faced both with their children and other adults in the household. And so working with your own medical team, who knows your health care best is a great place to start, I think, to Dr. Offit's point, it comes down to us as a community coming together both as local communities and school districts and putting in place mitigation that can help protect one another. This means vaccinating those that are 12 and over masking in school districts. And also, you've seen teachers also not only masking but also wearing face shields, for example, to protect their eyes, hand hygiene and social distancing. And so it's going to take that unified effort by a school district, for example, to help protect its teachers and students alike from helping decrease that transmission between students and teachers in the classroom and bringing that back into the home where there may be multi generational individuals living or individuals with various health care needs as Mara you're pointing out here. So again, it's that unified action together as a community to try to help decrease that transmission.

Kerri Miller: Dr. Gagnon, I want to ask you about something that I think if we've been following the transmission of the Delta variant, we're hearing about viral loads. Again, this is something that we were hearing about at the very beginning of the pandemic, which is that you may even if you're vaccinated, and you're exposed to the Delta variant, you may carry a higher viral load in your nose, is that something that you are going to be watching very carefully when you have even vaccinated people mixing with kids who are unvaccinated? And, you know, maybe they're doing this in the household? And nobody really knows whether they are transmitting the variant? How? Tell me what you're what you're seeing in the research on what that may mean, for back to school?

Dr. Gagnon: Certainly, you know, we're, you know, each day we're learning more and more about transmission. But I think, you know, that was a key point behind the CDC's most recent movement to encourage vaccinated people to wear masks and indoor public places just for that reason to protect themselves from you know, acquiring the same viral load that perhaps to be detected in unvaccinated because and transmitting it to other members in their household such as their unvaccinated children under the age of 12, for example, and so I think there is that concern, which was the impetus to encourage all to get back to masking to help stop that spread, recognizing that vaccinated people do appear to be able to transmit the Delta variants. Dr. Offit, I'm interested to hear Are your thoughts on this?

Dr. Offit: Why not? I think this is all based on an event that occurred in Provincetown, Massachusetts, celebrating July 4, when there were hundreds of people, mostly men who sort of gathered together in one area. Here's what I would take away from that. I think that it is expected that a vaccine like this meaning a vaccine to prevent a new cultural virus similar to the rotavirus, influenza virus is going to be very good at protecting you against moderate to severe the critical disease, but will not necessarily be great at protecting you against asymptomatic infection or mildly symptomatic infection, where you could still shed virus and be contagious. But that said, I think people who are vaccinated are still less likely to develop asymptomatic infection or bodily symptomatic infection, which would make them contagious than someone who who's unvaccinated. So I do think, you know, some of the messaging that came out of that outbreak wasn't perfect. And I do think that people should feel comfortable to even vaccinate, they're still less likely to transmit, but it doesn't mean that they're, it's impossible that they could transmit they should know that. And therefore for therefore mask.

Miller: Dr. Offit, just one more question here. Before we go back to the phones. I'm seeing reports of Louisiana children's hospitals filling with kids with the Delta variant and and children's hospitals in Missouri, also starting to hit close to capacity with kids. Is that a consequence of the higher infectiousness the higher transmissibility of the Delta variant? Or is it what you've both been saying about how we've kind of let down our guard and kids are mixing in areas where, you know, we're not using the usual interventions? What do you think?

Dr. Offit: No, I think it's both. I think it's a more contagious virus. And it's still in those areas like Missouri, Louisiana, you have a relatively under vaccinated population, and children are going to then catch this virus, often from adults. So again, the answer to the questions to be raised again and again, is always the same, almost independent of the question, which is that we need to vaccinate people who are unvaccinated. We have -- I think the Biden administration has called this a pandemic of the unvaccinated. It's always been a pandemic of the unvaccinated - what it is now is the pandemic of the willfully unvaccinated. and we can do something about that, and we need to do it and I think at some level mandates is part of doing something about it.

Miller: Two guests this morning, if you're just tuning in with a lot of expertise in pediatrics and infectious disease, Dr. Paul Offit, with us, a pediatrician, director of the Vaccine Education Center at children's hospitals in Philadelphia, and Dr. Madeline gagnant, Associate medical director of pediatrics and vice chief of staff at Gillette children's specialty health care. Here in St. Paul, what do you want to know about school and COVID? And the Delta vary? And are you getting communications from your school about how it's going to handle the return of in person learning? As a parent, as an educator, as somebody who may have an educator in the household? What are you most concerned about? 651227 6800 to for two to eight to eight hours want to add this? Are you hearing from your school that they will not be mandating masks and distancing? What are you thinking about that? Have you been in communication with your school about that? 651-227-6000 back to John in Minneapolis. Hi, john. Thanks so much for waiting. What do you thinking about this?

John: Yeah, what I wanted to say was the science or what we can draw, the conclusions that we can draw out of all of this are just really up in the air in the sense that, I mean, there's certain things we know, but it's a novel virus, you know, so there was anecdotal evidence that even children who had a subclinical infection, their chest x rays changed, so that was in Florida, and I'm a retired respiratory therapists, I would not send my child to school at this point, I'd try to arrange some kind of other instruction at home, I don't think it's really safe. And you know, with children, you want to eliminate all possibilities of them dying or getting sick or having, you know, getting a disease that possibly will change their life forever. Like with the long haulers. we really don't know much about this. You know, disease, but we do know that the most successful country was Taiwan still, only 750 deaths out of 25 million people. And they did things that we just never did. From the very beginning. They did it because they had SARS One, they were already primed for this type of virus. And unfortunately, where we were not prepared, and until we, you know, take care of the the infrastructure of schools, I really don't think it's safe.

Miller: John, I think I have the essence of what you're calling to say here. I appreciate your concern here, Dr. Gagnon. I want to take what john is saying, and then put this into the mix. I was reading studies from last spring, including in some rural schools in Wisconsin that showed that even if the virus was circulating in a classroom, masking and distancing, were keeping kids safe. So take what you hear john talking about with his expertise, and then take some of the research that was coming out last spring. Where are we in that?

Dr. Gagnon: I think John raises a good point. There are many anxious parents out there who worried to the extent that you're talking about about wanting to eliminate all risks for their children. And we don't know all the long term effects, we haven't had enough distance on this pandemic. I will say that roughly about .01% of children in Minnesota, ages zero to 19, who have contracted COVID have been hospitalized, which speaks against the fact that children are impacted. But often with asymptomatic or mild symptoms. Thankfully, you know, many, many are not requiring hospitalization, then we have had single digit deaths from the COVID pandemic virus, and well, no death is acceptable. It comes to a risk stratification of what each family and each parent is comfortable with. And so thankfully, the, you know, retrospective look of last year's data coming out of Minnesota Department of Health does show that children do remarkably well if they do encounter the virus. But I do think it speaks to John's concerns about the long term or lingering side effects that can come from COVID. And I think that's where it comes back to using that unified effort to control our behavior, masking, social distancing, giving the school districts enough resources to do that. And resources come that only intangible resources, but the support from you know, government officials and from school leaders and superintendents across the state to provide support, to unify in that masking effort to your point can be so effective in stopping the spread, because it's not only the health care risks that are at play, but also now going on 18 months plus here of looking at their educational and social and mental health needs as well.

Miller: Dr. Offit let me let me follow on this with - does the transmissibility of the Delta variant make some of that research that was coming out of you know, where they're testing schools, and they're looking at the the presence of a circulating virus and still kids were primarily safe? Does the does the Delta variant make that outdated? I guess?

Dr. Offit: That's right. I think it certainly alters the interpretation. To some extent, I agree. I mean, if you look at the the virus, we would eventually This is the third variant. I mean, the first, the virus that came up with Wuhan, was eventually replaced by the so called the 614 g bearing if that's the variant of trying to that's the bearings that swept through Europe, Asia, in the United States and killed in this country, more than 500,000 people that was replaced by the alphabet. And the reason it was replaced, is it if they looked at the quantity of virus that was shared from the nose and throat, the alphabet was basically 10 times more than that person, right? Now we have the third variant, the Delta variant, which again, is taken over and the reason it's taken, which should basically be 1000 times more virus than 100 times with an alpha 1000 times. I mean, that's why but that's why it's thinking over three, you're right. I mean, it's, I think, when you see a virus like Delta, which has shed at such a much greater quantity, you probably can assume that you don't need as long of a contact between one person to the next to get infected. And so I do think it does change a little bit. I mean this delta variant should scare people. And the reason more children are getting infected is because it's this is more contagious. The good news is it doesn't appear to be any more virulent, meaning more likely to cause severe disease. The only reason I think more children are suffering severely, or children are getting infected. I can tell you that in our hospital, Children's Hospital, Philadelphia, we have a handful of kids now that are in the hospital, which is more than we were seeing and a few of them are in the intensive care unit. So it's as Dr. Gagnon says, she's exactly right. I mean, it is it is not uncommon cause of very severe disease, but it can happen which is why, you know, we need a vaccine for children of all ages.

Miller: Well, I have a call about that. From Jasmine in Minneapolis. Hi, Jasmine, what's your question about the vaccination age?

Jasmine: So the vaccination ages 12 and I know that HPV vaccinations are actually given to kids at younger ages, like 10 In 11, my question is why can't we lower the vaccination age to 10, 9, 8, 7? If we're as parents, willing to cooperate with the medical community, and just why can't we lower the vaccination age, and if the parents are okay with it, I have a seven year old, a 10 year old and a four year old. And I would get my seven and 10 year old vaccinated in a heartbeat, because I'm high risk.

Miller: Dr Offit, back to you on the vaccines. The research is going on, right? The studies by the pharmaceutical companies on lowering the age, where are we?

Dr. Offit: Right, to get to the caller's point, when Pfizer did its original trial, it extended its dose its data down to 16 years of age. So you have several 100 children between the 16 and 17 years of age that you knew got the vaccine safely, effectively, when they then extended down to 12 years of age -- So they did their study of 12 to 17 year olds, which was a 2300 child study that either the children received either vaccine or placebo, it wasn't a leap to believe that it was going to be the same dose, 30 micrograms of messenger RNA and the same dosing interval three weeks. And in fact, the vaccine was as you would expect, safe and effective. Once you go down to six years of age, then you need to go back to the so called phase one studies with a dose ranging studies to make sure that the dose is right, you know, because a six year old isn't the same thing as a six same job as a 16 year old. And so they do 10 micrograms, 20, micrograms, 30 micrograms, to make sure that you have good the optimal dose, meaning a dose that is safe, and effective, you know, and exactly where you want to be that sweet spot. So those are ongoing trials, trials between 4000 and 7000 are big, depending on whether it's Moderna or Pfizer, but you really shouldn't wait for the results of those trials. I mean, I too wish that we have those results in hand right now on the FDA vaccine Advisory Committee. But I suspect we're probably not going to have a vaccine for at least fall early winter, which is too bad, because you'd like to have a vaccine before these kids go back to school, for all the reasons that we've talked about. But you didn't need to wait.

Miller: Dr. Gagnon, one of the things I I've wondered about is if and when the vaccine is available for kids 12 and under whether we are going to see kind of a repetition of what we're seeing right now areas of the country that are hesitant, skeptical, resistant to vaccines, and whether that's gonna happen in, you know, the kid population, too. Parents who don't believe it's necessary and what the consequences of that may be. Have you have you given some thought to that?

Dr. Gagnon: Certainly, I think as a pediatrician, we are always wanting to do prophylactic or preventative medicine. So working with our parents, in anticipation of this coming vaccine for those under the age of 12. And helping provide reassurance to their anxiety. It's only natural for parents to be anxious about putting anything in their child's body. So that questioning attitude is only inherent to good parenting. But then it is our job to help provide information around the study and help provide that reassurance. You know, 1000s upon 1000s of you know, 12 to 16 year olds have received this vaccine and been incredibly safe. And it's been incredibly effective in previous trials, as I'm sure Dr. Offit can speak to. And certainly I anticipate we'll see something similar for those under the age of 12. So again, vaccinating those when they have the opportunity will be incredibly important. So starting those discussions now, both in school and the medical community is so important. I think skepticism around science and the anti vaccine movement is incredibly difficult. There has been a powerful movement, putting out a lot of misinformation and misinformation in this particular case is incredibly dangerous. And so it's very important to get that education out there and correct that information.

Miller: Want to get a call in here before we go to news to Ellen in Apple Valley. Ellen, you're a teacher. Is that right?

Ellen: Yeah. So I'm a high school science teacher. And there's just a couple comments I want to make. First of all, I'm okay going back to school, largely because I'm vaccinated. But I think even your experts have an unrealistic view of what a high school classroom is really like. Because, you know, they they're quoted that in Wisconsin, the study showed that masking and social distancing kept the kids safe. For one thing, the classes didn't have as many students actually in school like last spring, I was teaching kids a small classes in front of me because half of the kids were, you know, zooming in via Google meet from home. So I didn't have that many kids in front of me. But I've already looked my class list for this year as some of my classes have 36 kids in them in classes that are designed at a 28 student capacity. So social distancing is impossible. And then also, with masking, I think, just with the teenage brain, you wouldn't believe how often you have to remind kids, they're just some kids are just defiant and do not want to keep that mask on over there, especially their nose. So those, I just think it's unrealistic to say, Oh, everything will be fine if there's masking and social distancing, because that isn't what a real high school classroom looks like today. And then one question I have for your experts is, I'm not too concerned about this. But this year, I'm, you know, we're planning to do actual live experiments. So there's a lot of shared materials, not just between all, you know, five of my sections of students, but also with my co workers that are doing the same experiments. You know, we're all sharing these materials, there's going to be hundreds of hands, maybe touching the same things.

Miller: So what will that mean, if you've got lots of people touching the same things for the spread of the virus? Okay. Dr. Gagnon, the first part of what Ellen was asking about, which is, you know, here's the reality, here's the recommendation, I have a big class, and we're going to be doing experiments. How do we manage what these recommendations say, and the reality of a classroom?

Dr. Gagnon: You know, I think Ellen makes an excellent point. And I know myself as a mother of second grade twins, the mother inside of me echoes those same fears and concerns about the reality check of the mitigation efforts we need to have in place to keep our kids safe. And that often requires accountability and ongoing surveillance, but each district which is which is exhausting. So first and foremost, we don't have district to district unification on mask mandates. We need to start there. We need to have the district you know, come strong with mask mandating so that teachers then are in a position to have surveillance and accountability of the students, which is not to underestimate just how exhausting that is for every teacher. The districts also need resources. As we saw in late June, Governor Walz announced that Minnesota will spend 132 million on federal education funding to help districts. and so I think, you know, putting those resources to good use that comes down to space; teacher and student ratios. You know, and ability to keep the classroom safe. And but it is no doubt that Elon is right that that to keep surveillance on this and to keep our students our parents and our districts accountable. is exhausting.

Miller: Lots of comments on Twitter here Mike says what about the damage to kids missing school socio-developmentally and education milestones, versus the very low risk for kids from COVID. Masks work. My three year old wore his mask daily without problems. Parker says I'm planning to send my kids under 12 to school with higher level masks will add additional protection for them. We know my fifth grader will be in a school with masking for all not sure about the first grader yet, I guess Dr. Offit, I'll just I'll ask about whether this is a time to get kids wearing those N95? Or isn't that really necessary?

Dr. Offit: It's a good question. I think you know, the key word here is mitigation, not elimination. In other words, we mitigate risk we lessen risk, but we don't eliminate it. So as Ellen said, the teacher high school teacher called earlier, the way it plays out in the real world is not perfect. You know, you're going to have people who aren't great at wearing masks, it's going to be difficult to social distance. It's going to be difficult when kids go to the cafeteria and eat. So you're trying to lessen but not eliminate risk and what you know, and there's always a price to pay for higher and higher sort of stringency in terms of masks and social distancing. N95 masks are not as easy to wear as say just the rectangular surgical mask that's a little easier to wear. So so it's it's really a balance. I I'm not sure there's a clear, easy answer to this. In some level, it comes down to what parents are comfortable with what the child is comfortable with. But I think that we can do a good I think certainly we all agree kids need to go back to school. And I think that because there's just too much of a price to pay for not doing that. Realizing that when we do that there is some risk and there are children who may get sick and there may be outbreaks in schools, and just do the best we can to try and get on top of that.

Miller: To Elle in Excelsior. Hi, l really appreciate your waiting. What are you thinking about as you hear our conversation?

Elle: Yeah, I'm a clinician and also parents of two Minnetonka school district children. And I believe that we should require vaccinations for teachers. And I think historically, Dr. Peterson has given us no confidence that he actually believes in the validity of the pandemic. He back in back in May was saying that it was no worse than the flu. Which, you know, does not inspire confidence among me and, you know, fellow clinicians that sent him send a letter To that effect, but But yeah, I think it should be required that teachers be vaccinated. And if they're not going to be vaccinated, then they can do e-learning or something, but you're not going to be around my child who is ineligible for a vaccine, when you can potentially give them a deadly virus.

Miller: Elle, is Dr. Peterson, the superintendent?

Elle: Yeah.

Miller: What was the reaction to the letter that you all sent?

Elle: Well, we have yet to find out. There were several clinicians that were a part of the letter, doctors, nurses, NPs like myself, that with concerns about, you know, right at the end of last school year, he said, Oh, well, we'll see about the masks when the kids returned, which I think was, you know, an unnecessary addition. And I think he was leaving the door open for, you know, to say, Oh, we won't we won't be masking when the kids return. Yeah. And based on that information and and his historical stance on this pandemic, several of us were concerned and helped, helped peGa a letter to him.

Miller: Dr. Gagnon, what about Elle's suggestion that teachers be required to get the vaccine. A delicate subject. We did a show on this recently. And boy, is it complicated?

Dr. Gagnon: It sure is yes, you know, the Delta variant has certainly put pressure across the nation. on this topic. Even here locally, we've seen Fairview and Elina[?], in the last week, make movements to require their staff at these health care systems here across the state of Minnesota implement a vaccine requirements for their staff. So certainly, we are moving in that direction. You can see the vaccine passport in New York City, for example. So I do think that the Delta variant and where we are beginning to climb here today, and the weeks to come has altered the course of conversation. Certainly myself being a healthcare provider and and mother of students, I can appreciate Elle's concern of wanting teachers to be vaccinated, it helps it greatly in helping decrease the transmission.

Miller:  Dr. Offit, I have to say I was pretty astonished to read how many people there are working in health care settings, who are not vaccinated yet. Can you tell me what the what the policy is at Children's Hospital in Philly?

Dr. Offit: Yes, we have a hard vaccine mandate that will be put in place by mid October. We're getting people who haven't been vaccinated yet who work in our hospital, the 10s of 1000s of people who work in a hospital, not just doctors, nurses, and nurse practitioners, but any dietary services, environmental services, anybody who can walk into the room has has to proceed with the mRNA vaccine three doses of vaccine by then. If they have not done it, they will not be able to work in a hospital. I mean, they you know, they will no longer be employed by our hospital. It's a hard mandate. And it's it's the right thing to do. Because if you're going to choose to be part of our community to work around a vulnerable population of hospitalized children, many who can't be vaccinated not only because of your age, because because of the illness, you have a responsibility. And I would extend that to society. I think if you were if you live in the society, you have a responsibility to those issues. You're surrounded by your earlier caller Mara who had multiple sclerosis, she is likely receiving a biological agent that decreases the ability of her B cells, which are cells that make antibodies to do that, therefore, she's much less likely to have a vaccine that works in her. She depends on those around her to protect her. Don't we have a responsibility to her? And I think we do what as far as the high school teacher who called earlier the science teacher, the good news is, we have a vaccine for high school students. We have a vaccine for 12 to 17 year olds, I think not only should we mandate a vaccine for the teachers, I think we should mandate a vaccine for the high school students.

Miller: All right. Glad I asked. Good to have your insight on that. To Jennifer, in International Falls. Hi, Jennifer. Thanks for waiting. Hi, Jennifer, are you there? You're a school board member. Is that right?

Jennifer: I am. Our school board unanimously decided last night to as part of the mitigation process. We were going to require masks for K through 12. Everybody in the building, starting in September. It was a unanimous decision. But it was difficult for everybody. I think all of us tried our best to educate ourselves in what was best. But my point is, so last year we were very successful in International Falls, we had elementary in place all students every day, the entire year because of the layered strategy. We had very little we had hybrid model in the sixth through 12th grade and except for a small time in the spring. We had that half 50% of our students present two to three days. It wasn't optimal. We want all of our kids there who want it to be in a safe way for our staff or our families or students and obviously our community because it affects everybody.

Miller: So how are you feeling about the fall?

Jennifer: Yeah, well, going into, you know... So we're also in a, in a district that's getting smaller. So we don't have we're losing students, just by population. But also we lose students by these tough decisions. And because families are concerned to send their kids or they just refuse to if we require masks, we know that this makes us vulnerable. And we don't have the same resources to keep we had last year we had the staff, we had extra staff to make those class sizes very small at the elementary school, so that we could keep the distance. And so we know we need to layered strategies. I hope we continue to do that. But my point is, I know we need we're doing the right thing. I hope that we'll continue to get support from the state and the federal government helping get more people vaccinated.

Kerri Miller: Jennifer, if I might, we have a lot of people who are also waiting, I really appreciate hearing the experience from the school board meeting. And wow, the valuable experience that you had last year. Thank you for the call. To Dustin in Southwest Minnesota. Dustin sounds like you're an educator. Yeah?

Dustin: Yes, I teach in a district in Southwest Minnesota. I teach high school. And as it was just previously stated, high school students can be vaccinated. But I teach in a county that is one of the lowest counties in the state of Minnesota for their vaccination rate. I think we're somewhere around 40%. And from teaching last year and getting feedback from students, just families not willing to get the vaccine, and at the same time not being willing to to mask. It being realistic to have your students mask when they when there's defiance about it. How do you function? How do you--How do you operate when your vaccination rates are low? When the students are masking? And at what point does it become a personal responsibility? So I'm vaccinated. And I know that if I get the virus, hopefully I'm not going to get super sick, because that's what the vaccines for. At what time does it become a personal responsibility that, hey, the vaccines there? It's your choice. You know, you know, the risk.

Miller: So Dustin, do you? Do you anticipate that there will be kids in your classroom who are not masking and aren't? Well, obviously aren't vaccinated but aren't masking?

Dustin: Oh, I'm certain, certain. Last year, our mass compliance towards the end of the year was was not great.

Miller: Right, Dr. Gagnon? I don't know if you have any advice on this. But boy, this this really presents a complex situation in a classroom, doesn't it?

Dr. Gagnon: It sure does. And it was really between the last two callers of Jennifer and Dustin here really highlight an interesting juxtaposition about everybody's community responsibility here. International Falls and Koochiching County has low transmission currently. And it also speaks to what it sounds like Jennifer's speaking to a school board who unanimously passed masking for K through 12. You know, it strikes me based on their transmission rate. And this information about their school board speaks to a community that wants to come together to make decisions that help keep each other safe. And I think what Dustin is highlighting on is a community that we've seen, you know, echoed and repeated across the country where there is a disagreement on this topic, and taking in, quote, individual choice compared to a community responsibility. And certainly myself and many others in the healthcare community, you know, want to support the obligation we have to one another to mask and get vaccinated and stop this transmission. But I think these two counties, for example, here in Minnesota, really highlight key key problems we're having and the reason for more universal support from governments, governors, district leaders at large to put in structures that can help implement this safety.

Miller: Dr. Offit, I wonder how important you think the FDA full authorization is because we're hearing from some Americans that they are still skeptical about the vaccine because the FDA hasn't fully authorized it. I guess I question whether they, you know, how acquainted they are with the science of what the FDA does and whether it matters but what do you think?

Dr. Offit: Right. So technically, when a when a product is it has approval to emergency use authorization, that would that literally means is that the company has the right to distribute an investigational new drug, that's what that means. But this is far from investigational. I mean, you already have more than 300 million doses of this vaccine, it's been out there, half of the American public has received this vaccine. You have an enormous safety, and immunogenicity and efficacy profile on this product, more than most licensed products out there. I mean, how many licensed products have been given to half of the American public? So you already so the notion of this, this is in any way investigational or experimental should drop out. The difference between this UA and a licensed product technically, is that when the FDA licensed as a product, they don't just license the product, they also licensed the manufacturing site, and they licensed the process. So you license three things, which means that you have to go through all these protocols, and validate all those protocols to see to prove that every step of the manufacturing process has been now validated via these protocols. That's really the only difference. So it's more of a psychological thing than anything else. But you're right. I mean, that's what I hear probably more than anything else. I don't want to use this. I may not have enough information at this point that this vaccine is what it's claimed to be.

Miller: That that really startles me that you are still hearing that. And your answer is look around. The safety of it has been validated and is validated every single day. Yeah?

Dr. Offit: Exactly. Exactly.

Miller: Oh, call from Nick in Minneapolis. Hi, Nick, thanks so much for waiting. What are you thinking about?

Nick: Hi. So my name is Nick. And I'm an oncology fellow at the University of Minnesota. And I was hoping that maybe we could address the actual breakdown of health care providers receiving the vaccine. I think it was the AMA American Medical Association said more than 95% of doctors that actually received the vaccine. But I was hoping if somebody had some more numbers showing that your doctors are really, really believe this is safe with that uptake. And it's not. It's not necessarily the doctors rejecting the vaccine, if that makes sense.

Miller: That's such a good point. Yeah, Dr. Gagnon, maybe more information out there that health care professionals, including the doctor you trust, believe in this vaccine and have it for themselves and their families.

Dr. Gagnon: No doubt I charge every health care professional out there in our communities to share their own story to help input that trust that I myself have received this vaccine, you should consider it as my patients. I've certainly heard many non primary care surgeons, pain[?] doctors and other specialists who vaccination is not their area of specialty, but recognize their influence as an important physician in their patient's lives and speak to them about their own experiences. And, you know, certainly we'd love to hear those stories where each day you know, even if it means one or two of your panels, patients change their mind because of your influence. So I think Nick raises a key point is the large majority of us physicians have gotten this vaccine and vouch for its efficacy and safety, and and encourage our patients to do so.

Kerri Miller: Dr. Offit, a question here about whether if the vaccination rates continue to hover about where they are, and we still have, I don't know, 25% of the country, adults that aren't vaccinated. Is it possible that these variants could ultimately mutate to become vaccine resistant? Or is that highly unlikely?

Dr. Offit: Well, depends how you define resistance. I mean, right now, if you look at the Delta there is compared to the previous two variants, it is somewhat more resistant to protection against mild illness or asymptomatic infection. So the good news is the Delta the chronic vaccines protect against severe critical disease caused by the Delta variant, that's good devise a vaccine can keep you out of the hospital, it can keep you out of the morgue. That's good. But is it possible that it could get to the point where the virus is completely resistant, which is to say that even if you've been vaccinated, you were still as likely to be hospitalized or killed? It's possible. I do think my sense is that it would be relatively unlikely just because I think that those mutations may be lethal mutations to the virus, not to the person to the virus. So I think it hasn't happened yet. But certainly, you're starting to see it move in the wrong direction, which is the Delta very new, somewhat more resistant to production against mild disease. So -- and the degree to which we continue to learn it spreads continues to be a problem. There was the earlier caller who talked about personal decision. This isn't a personal decision. This is not a decision you make for yourself on whether or not to get a vaccine. It's a decision you make for everyone with whom you come in contact. I mean, if I don't get a tetanus vaccine, after I cut my foot on a rusty nail. That's a personal decision. No one's gonna catch tetanus from me. It's not a contagious disease. This is. I think that it's um -- when people try and make a case for this sort of personal freedom, because we do that in America, because it's a country founded on the basis of individual rights and freedoms. This is a personal freedom we don't have. It is not your right as an American citizen to catch and transmit a potentially fatal infection. And watch the way that this plays out.

Kerri Miller: Dr. Gagnon, I'd love to hear you on that to this idea that well, it's my personal decision. And I get to make that decision, no matter how it affects the people around me, would you speak to that?

Dr. Gagnon: I completely support Dr. Offit's view on this, that this is a choice that impacts the community. And so you know, much like we don't have, you know, choice around drinking and driving or seatbelts or having car insurance, again, things to, you know, help protect and provide social fabric safety for the communities we live in. And so this vaccine against COVID is that that impacts all of us across the state of Minnesota, not just us, as individuals. Completely agree with Dr. Offit's point.

Miller: Dr. Offit. I've got about a minute left, though. Do you think that the vaccine will be available for kids under 12 by late October, November? Is it going to take longer than that?

Dr. Offit: We know that we'll know about two weeks before we're asked to have our committee meeting on this, and we will be meeting on this. So I'm hopeful like you that we can have it certainly before late fall.

Miller: I really appreciate both of your time. Thank you so much. Dr. Paul Offit is a pediatrician and director of the Vaccine Education Center at Children's Hospital in Philadelphia. Dr.  Madeleine Gagnon is the Associate medical director of pediatrics and vice chief of staff at Gillette Children's Specialty Healthcare here in St. Paul.

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