Thread by @dwallacewells

Yesterday, I published a long piece on the still-under-appreciated age skew of COVID-19, which has helped vaccination already eliminate most of America's mortality risk. I didn't discuss detailed policy implications for kids and schools. A thread (1/x). nymag.com/intelligencer/…

To start: the age skew. The coronavirus is dramatically more deadly in the very old than the somewhat old, dramatically more deadly in the middle-aged than in young adults, for whom it is dramatically more deadly than in teenagers and children.

Even among those who are familiar with this pattern, the data is startling, since the risk divergence is so large. An 8-year-old, sick with COVID-19, has about one-ten-thousandth the risk of dying as an 88-year-old.

The risk doubles every five years, more or less, which means even the difference between the risk faced by a 70-year-old and a 90-year-old are very large indeed, and dwarf the added risk of other factors and comorbidities.

This means that, while younger people are not immune or perfectly protected, the vast majority of mortality risk lies among the country's old, who are now, according to the White House, 90% fully vaccinated.

90% is not the same as 100%, and as a result there remain some vulnerable seniors, but many fewer than there were six or nine months ago, which means that the country's risk profile, as a whole, looks very very different.

How scared should we be for our kids, especially those younger children who remain unvaccinated? There remain real risks—of infection and illness, of some number of severe sickness and hospitalization, and of both "long covid" and deaths. These risks are real and nonzero.

They are vanishingly small compared to the risks faced by the elderly—especially the risk of death, severe illness and hospitalization. But how small? Perhaps more to the point, how small a risk is comfortable for us, as a society?

According to the CDC, "For young children, especially children younger than 5 years old, the risk of serious complications is higher for flu compared with COVID-19." cdc.gov/flu/symptoms/f…

The same fact-sheet notes, "for adolescents, the risk of serious COVID-19 illness is less than in children younger than 5."

But as @jeremyfaust pointed out in this piece from Scientific American, these comparisons are harder to make than they may appear, since the data is messier and less reliable than it can seem at first. blogs.scientificamerican.com/observations/c…

And of course given both the "novelty" of the disease and its transmissibility, especially its Delta variant, a low-rate of seriousness is not all that comforting—there are so many who can get sick that, even at very low rates, the number of scary cases could be tragically large.

Hundreds of American kids have died from COVID-19, and it is possible that hundreds more will die from it, especially in the fall and winter. Each of these deaths is horrifying, especially given how much life is lost in each instance.

To this point, according to the CDC, 331 Americans under the age of 18 have died from the disease during the 18 months of the pandemic, roughly half as many as the agency says have died of pneumonia.

As we head into winter and fall, that ratio could conceivably reverse, with COVID-19 becoming deadlier, if the disease spreads all the way through the under-18 population.

But to stop that from happening, we do have tools we can use, ones we may be able to use much more effectively and efficiently than we have to this point in the pandemic.

Rapid antigen tests are quite cheap and quite useful, and could be deployed at mass scale in schools.

In places where classes have been held outside, over the past year, or could be, given weather conditions, that is an option.

Ventilation systems in schools across the country are in dire need of upgrades.

Mask-wearing could be useful, too, especially in areas where and at times when there has been some amount of local transmission—though perhaps, especially for older kids, more often or always.

And of course there are vaccines to give, as well, though they have not yet been authorized for use in the very young.

There are other tools, too, short of large-scale school closures which I hope — and expect — will be unnecessary this fall and winter.

As I wrote yesterday, "Risk is a tricky thing, the spread of the Delta variant and the complications of 'long COVID' both real concerns, and all parents should assess their own comfort, and those of their children, in making plans and taking precautions."

But I hope, from the perspective of policy, we can do what we can to limit transmission among kids — and in so doing, limit the number of cases of severe disease, tragic death, and long covid — without losing sight of how much safer children are than their grandparents...

...or how far we've come, in changing the shape of the pandemic, that we are now worrying about how to protect those least vulnerable to the disease. (x/x)