The last time I talked to Dr. Michael Osterholm, the Delta variant of coronavirus was surging in the United States, just as kids and teachers were preparing to go back to school. Children under 12 were not yet eligible for vaccines. And early data about the Delta variant indicated that it was more likely to infect children than previous variants.
Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota, didn’t mince words when he told me schools should prepare for a difficult fall. And his grim predictions came true. In Minnesota, COVID-19 cases remained high, sending many students into lengthy quarantines and straining teachers and staff. Statewide, 11 school staff members and two students died this fall due to COVID-19 exposures in school, according to data from the Minnesota Department of Health.
Now, students and teachers are back in school after winter break. Another new COVID-19 variant is surging: Omicron, which appears to be both milder than Delta and much more contagious. Children under 5 are still not eligible for vaccines. And early data show an increase in hospitalizations for unvaccinated kids.
So I felt a bit of déjà vu when I called Dr. Osterholm again to discuss how schools and families should be preparing for this new variant. It’s been a busy time for Osterholm, who worked as state epidemiologist for 15 years and more recently served on President Joe Biden’s transition team. When I reached him, he had just gotten off the phone with the Centers for Disease Control and Prevention.
“How are you?” I asked him.
“Ask me in a month,” he replied.
The good news: Unlike Delta, which kept the virus at high levels in Minnesota for months, Omicron is expected to move through quickly. Osterholm described it as a “viral blizzard.”
The bad news: The next few weeks could be tough. Osterholm warns that many schools will have no choice but to temporarily move to distance learning because so many people–teachers, students, bus drivers, and school support staff–will be sick.
Our conversation, below, has been edited for length and clarity.
How does Omicron change the picture of how schools should be responding to COVID?
First of all, we have to realize we’re in this viral blizzard of COVID that is going to last for another three to five weeks in this country. We have to plan for that in a very different way than we planned for the other surges, because they were much more regionally or geographically located. In some cases, they stayed persistently high like in the upper Midwest and the Northeast through the fall. Some places went up quickly and down, such as southern sunbelt states last summer with Delta.
The key feature that is really going to change schools is the fact that the transmissibility, or the infectiousness, of this virus is remarkable. We are going to continue to see large numbers of people become infected—even if it’s minor, minor illness. But that means that they’re out of work for, at minimum, seven to 14 days. Workforce-wise, this is a challenge.
We’re seeing schools right now reporting hundreds of teachers who are out sick. It’s pretty hard to run a school when you don’t have faculty, support staff, and bus drivers, et cetera.
So it’s not even about wanting to shut down, or not wanting to shut down, or distance learning. It’s about, I don’t even have enough teachers to safely have kids in the school building.
Yeah. Is there anything schools can do to help prevent that? Are there any measures they can put in place quickly that could help slow the spread?
Well, one thing they are doing which is absolutely not helpful is testing everyone before they go back. That is an absolutely flawed approach. That’s like buying a house and the first day the smoke alarm works, but doesn’t work anytime after that. I mean, what good is that smoke alarm?
Testing one day before you go to school doesn’t mean you don’t get infected that next night or the next day, and then have the same thing.
If you’re not testing routinely, almost daily, you’re not going to really reduce transmission in school. It’s a feel-good activity. It’s what administrators do to feel good.
Is there anything else that can help, like better masks or air filters?
Again, we need high-quality masking: N95s for adults and KN95s for kids clearly are going to be much more helpful.
The other key feature, which of course, is not going to have much impact in this surge, is going to be [new] vaccinations. We know that vaccination can greatly reduce one’s risk of serious illness, hospitalizations, and deaths. You see the number of cases increasing right now with kids and hospitalization. It’s a huge challenge. The problem is, it takes time to acquire that immunity after vaccination.
Back to your metaphor of a blizzard. If schools and teachers and families are starting to prepare for this blizzard, they want to make sure they’re as prepared as possible: say, making a grocery-store run for eggs and milk right before the storm. What are the things that people can be doing right now to prepare for this Omicron blizzard?
Think of it the same way as a snow blizzard. You know, if I’m not going to leave home for a while, what does that mean? If I want to minimize my risk for the next few weeks, I would limit the number of contacts I have, even if I’m fully vaccinated and with the booster. Which means I’ll have a much, much lower risk of having serious illness and hospitalizations.
The bottom line is that minimizing contact right now is going to slow this down. This is basically widespread, dynamic transmissions occurring right now.
The big thing psychologically: We’ve just got to get through the next three or four weeks. I think things will be much better at the end of that. This is not another year. This is not another semester.
We can say school buildings are a safe place for people to be. I mean, I think that’s always a dangerous term, because I don’t know what safe means.
If a Category Five hurricane is headed to your town, would you want to keep kids in school because it’s a safe place to be? No. For the very short term, you’re going to suspend school; you’re going to make sure that people are as protected as they can be. That’s what we’re in right now.
Minnesota’s largest school district, Anoka–Hennepin, recently announced that it would be eliminating its mask mandate for elementary students in mid-January, since they’re now eligible for vaccination. Do you think it makes sense to be scrapping mask mandates right now?
I would not be doing that at all right now. I think the challenge Anoka–Hennepin is going to have in the next three weeks is, Are they going to have enough teachers? Even if they’re fully vaccinated and have a third dose, they still have the chance to get infected. They are going to be protected substantially from severe illness, hospitalizations and deaths.
But an infected schoolteacher is an infected schoolteacher. They’ll be out.
Have we made any progress in COVID school safety since we last talked? Do you have any examples of schools or…
I don’t. I wish we did. Ventilation, which is huge, has been largely ignored. And good school-based testing programs—not one where you test one time before you come back, which again is like that smoke alarm thing—we need much more to do with that.
I’ve seen the pendulum swing from, “close schools, keep kids out” to “we’ve got to get kids back, it’s really important,” all the way to the other side again. There’s somewhere in the middle, that we can do more to protect kids without shutting schools down.
Beyond staffing shortages, at what point should schools be talking about moving to distance learning?
I think right now they have to be planning for it, so if it does happen, it can be a smooth transition. I think that’s up to each school district. How can you safely supervise kids given the number of faculty and staff you have? And what are the benefits of being in the school if they are largely absent of teachers?
How well can the at-home rapid tests detect Omicron?
These tests have been notably unreliable in the early days of infection, and we have many examples of people who have been tested multiple times with these lateral flow/antigen tests and are negative.
At this point, I think it’s very difficult to trust a negative. Positives are likely truly positive. But that’s the challenge.
Soon they won’t be available. I mean, the volume of tests coming into our community versus the desire to get tested: It’s just going to far outstrip any testing we have. It’s going to be very hard for a parent to find a test in the days ahead.
COVID vaccination rates for children remain pretty low.
Why do you think that is? Is that contributing significantly to the outbreak?
I think there’s been a misconception that kids don’t get sick with this, which is not true. There’s also a lot of misinformation, actual disinformation, about safety issues with kids, which is just absolutely not true either. Part of it is just the educational process for parents to protect their kids.
Hospitalization rates have jumped dramatically in the last week in the United States in kids. I mean, look at the American Academy of Pediatrics report for this past week. Numbers are just skyrocketing. That’s a huge challenge.
What do we know now about how Omicron affects kids? Why are those hospitalizations up?
We’re still learning a lot. For example, one of the things I’ve been very concerned about is what is the incidence of long COVID in kids? We are getting a better handle on adults, but we still have a long way to go to understand kids.
What’s your pitch to parents who are worried about vaccinating their kids?
If they have a health care provider, talk to them, seek out information from public health agencies. The bottom line is that these are highly effective vaccines in reducing serious illness, hospitalizations, and deaths. And they’re very safe. They’re not perfect tools. But they’re remarkable. The millions of people’s lives that have been saved because of taking these vaccines are remarkable.
The other day, I saw someone in a store who was not wearing a mask. Then I saw him get in his car and put on hand sanitizer. What do you think people are missing about how to prioritize COVID interventions?
The hands play very little role in transmission of this virus. We did so much hygiene theater with this early on. All these plexiglass things make no difference at all. It’s unfortunate. This is not an environmental contamination; it’s in the air.
Think of this as if you’re breathing somebody’s cigarette smoke. If you’re in a small room with them, and they’re smoking, you think you’d smell it? Sure you would. Where can you smell it? How often can you smell it? And that’s what an aerosol is. The virus just floats out. When I’m talking here right now, if I were infected, this whole room would be completely contaminated with the virus in the air. It’s not the surfaces that I worry about.
I think it’s safe to say at this point that pretty much everyone is tired of COVID and wishes it would magically disappear. Some people have given up on masks and social distancing because they’re tired of it. Other people just feel totally helpless, like there’s nothing they can do. How can public health messaging break through that exhaustion?
Well, I think it’s a challenge. I mean, we have to acknowledge that everything you just laid out is absolutely right. People are tired, frustrated. They’re challenging what the data means or at least the recommendations.
The only message I can give you is, if you’re not protected against this virus, it will find you. You cannot run out the clock on this one. It will find you.
In Minnesota, as you mentioned, we just weathered a four-month Delta wave. Now we’re bracing for an Omicron blizzard. Is there any light at the end of this tunnel? What do you think happens after Omicron?
Well, as I said, I think in three to four weeks, this surge will be on the downside. Very much so. And I think it’s still a question as to what’s going to happen. There’s no reason that we couldn’t see another variant emerge. That would be really challenging. It could evade immune protection, including the current vaccines and previous infection with Omicron or Delta.
I hope that doesn’t happen, but hope’s not a strategy. We’ve got to plan for it.