Go back to school and ditch weekly testing: The advice from one children's hospital

The kids aren't alright and are saying so publicly. Last week, an anonymous Reddit post went viral after a New York City high schooler chronicled a day at school. Highlights of the post included students and teachers being absent from classrooms, nose swabbing in bathrooms, and declaring study hall periods super-spreader events.

The latest level of pandemic fatigue has renewed the debate on whether schools should go back to remote learning or how they can continue in-person safely.

Dr. David Rubin is a primary care pediatrician and director of the PolicyLab at the Children's Hospital of Philadelphia.

As schools, teachers and parents in Philadelphia were scrambling for a plan after the holiday break, the PolicyLab put out its official advice: stay the course and open back up for full in-person schooling.

"We no longer can tailor our school safety policy to the decisions of those who've opted not to get vaccinated," Rubin said.

The guidance was based largely on the availability of vaccines now, and on data showing omicron generally resulted in milder cases.

"The spectrum of illness is very consistent with what we take care of each year, and we're actually seeing fewer kids in the ICU proportionally this phase," Rubin said.

Rubin spoke with NPR's All Things Considered about hospital capacities and the types of cases he's seeing, the PolicyLab's guidance to discontinue weekly testing for asymptomatic students and staff, and why he believes people should try to get back to "normal" at this point in the pandemic.

This interview has been edited for length and clarity.

Interview Highlights

You say hospital capacity is consistent with what you see each year, and yet the hospitals are more full than they were prior to the pandemic, right?

You know, we were facing a fairly significant capacity even before the pandemic.

If you were to walk across the Children's Hospital [of Philadelphia] today, what you would see is the kids who were convalescing with COVID or with other respiratory illnesses related to wintertime viruses. But we have a significant number of children with medical complexity that have been centralized in the children's hospitals.

And then we have a behavioral health epidemic, if you will, that's been exacerbated by the pandemic. And so we have a tremendous demand for services, particularly inpatient services for psychiatric needs.

The student who wrote the Reddit post was not a fan of remote schooling but said there's almost no real learning happening because so many teachers are out with COVID and students are unable to focus on their work. Is there a point at which a school campus just stops being a safe, effective learning environment?

I think the biggest challenge that we've seen across the region has been related to staff, obviously. And I think what the student was speaking about was just because this hit all at once. We had estimates of more than 20% of individuals in our region having detectable virus in the week between Christmas and New Year's. With so many people exposed or infected, we had so many staff out, but already in our own testing data ... we're seeing rates really drop this week.

Some of PolicyLab's guidance is intuitive: full vaccination, masks indoors, staying home if you have symptoms. But some of it is more surprising, including the recommendation to discontinue required weekly testing. Why do you suggest that?

You have to think about this in the context of where we were last year. Last year, we were facing a novel coronavirus that was very virulent in an entirely unvaccinated public. And so the goal was to eliminate any exposure risk to buy time for vaccinations to arrive.

This year, with a variant that on average is milder in most individuals, particularly in children, and at a time when people have been offered vaccination ... it no longer makes sense in terms of trying to prevent mild illness at a time when people have been vaccinated. And it's no longer feasible or practical, particularly for most schools.

We had discovered early on that not many schools can even achieve the kind of testing cadence to do the type of asymptomatic testing that schools are doing in some places, and you're starting to develop the haves and the have-nots. And at a time now when we have widespread transmission, even the schools that had been doing well were really challenged.

So we recognize that really simplifying the approach to school safety plans was probably the best way to keep kids in school, recognize that the pandemic has changed with regards to the moment that we're in and just make it simple.

It's interesting that you say the goal used to be to eliminate the risk of exposure and that that's no longer the goal. How would you describe what the goal right now is if that has changed?

The intervention is vaccinations and boosters for those who are eligible. And to me, that has shown even in this phase to greatly reduce the risk of severe disease and outcomes. And you know, we're learning to live with this virus now akin to other seasonal viruses.

But if you were just forget the last couple of years and just look at the situation now with the widespread transmission of the virus, that on average is milder for most people, particularly those who are vaccinated, you'd recognize that we have to start getting back to the types of things we were doing before the COVID pandemic, which is just asking sick people to stay home and and really not chasing mild disease with tests. It's no longer practical or feasible.

Other public health experts have said even if you're vaccinated and boosted, you can't just blithely go through the world assuming it'll be fine if you catch the omicron variant. It sounds like your message is slightly different.

Well, I think you can go with confidence. I don't think right now I would walk into a crowded venue of the week that we were at 20% of individuals who are infected with COVID. But besides that, I think you need to live your lives.

I think even during a typical influenza season we have breakthrough infections among those who are vaccinated. We don't always have a perfect match for the flu vaccine, and we've never really tracked seasonal viruses in terms of the rates of transmission during a bad year of influenza or just the common cold.

For kids now, depriving them of educational access, continuing social isolation, continuing this reflexive anxiety to stay away from others, that's really detrimental at this point. I would argue that the risks of that now far outweigh the risks of the disease itself.

How have these recommendations been received?

I think we recognized there was a level of panic and hysteria, particularly with regards to testing, not just in schools but across individuals. Emergency departments surge with individuals who either had mild disease or no disease at all or just were nervous and wanted that test. And we have to start recalibrating everyone's response now to recognize that you wouldn't normally be testing yourself over and over and over again during routine winter season where you're facing lots of different viruses. And to try to get people to understand that sometimes less is more. That really, all you need to identify is that I'm starting to get sick and I need to remove myself and isolate myself, and it's a very simple intervention. And I think we have to start moving back in that direction.

I think it's been really well received. I think people are sort of saying, "Oh, that makes sense." And I know there's some anxiety about doing that. But the reality is trying to eliminate exposure risk now is like putting a finger up to a waterfall and thinking that you could down the water.

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