Quique Bassat (Barcelona, 47 years old) is an epidemiologist, pediatrician and researcher at the Barcelona Institute for Global Health. He is a member of the committee of the Spanish Pediatric Association that has advised the Government in the development of health protocols in educational centers, and has closely followed the evolution of infections among students. The school, which last year withstood the virus much better than expected, emitted some alarming signals in December, with a progressive increase in outbreaks and groups in quarantine. The concern of families and teachers is now focused on the impact that the explosive contagion capacity of the omicron variant may have on school activity in January.
The Government has convened on January 4 in La Moncloa an intersectoral meeting of the Ministers of Health, Education and Universities with the counselors of the respective portfolios of the autonomous communities with a view to analyzing the return to classes.
Ask. What health context do you foresee when classes resume?
Answer. Possibly worse than now. No one knows for sure, but mathematical models suggest that growth may continue with the peak seen around January 15. It may be that things improve sooner or that the effect of some measures that the communities are taking will begin to be seen, but it does not look good.
P. The schools ended the first term with enough problems, how do you expect January to be?
R. It depends on how seriously the measurements are taken. We know that if things are done well, the risk is lower than what we saw at the end of last quarter. We will begin to have a still small but significant number of students who have received the first dose. It’s doubtful that that’s going to protect them, but it could start to have a small impact. Both of these should start to show. Of course, everyone will be much more aware that things have to be done better.
P. Can the effect of the vaccine be trusted to save the school? Children will not have the full guideline until late February or early March.
R. Yes, but it is not ruled out that the eight-week period between the first and second doses will be shortened if more vaccines arrive. The decision to space them was made, in my opinion, because it was thought that there might not be enough. If we have more, the period could be reduced to three weeks, as in the rest of the age groups. Until this happens, we must assume that until March most of them will not be protected, although we have gone through other waves in which there were no children vaccinated and schools have remained open doing things well.
P. With the omicron the picture seems more complicated.
R. If the situation continues to be just as bad, we may have to take more drastic measures at the population level, that is clear. But we have always advocated that schools should not be the first to close, but probably the last.
P. Should the health protocol of educational centers be toughened?
R. It is an option, I think it is not necessary, it should simply be applied very strictly what we have, which is what I suspect was not done so well in the last weeks of the course. The only big change from last year has been the increase in the number of children per bubble group, from around 20 to more like the normal class size, almost to 30. This would be difficult to change right now, because it implies hiring many people and was the main reason this restriction was removed. The rest remains basically the same, but I think it has been applied less rigorously. What should be done is to return to the controls that were in the beginning. Check again that sick children do not enter school, even with measures as simple as taking their temperature, as was done in some places and then progressively stopped. Let families know that a sick child should not go to school, even if it is simply because they have snot. This was applied very rigorously when we were all aware of what happened in 2020 and were very aware that there was no need to break any rules.
P. The institutes have endured this first part of the course better than the schools, which has been attributed to the high vaccination of adolescents from the summer. But the data show that the infections between them also grow rapidly.
R. We’re seeing infections in all age groups, presumably because the effectiveness of the second dose is starting to wane, and that includes teens and young adults. The exception is the elderly, especially from the age of 70, who are the ones who most recently have the third doses. If schools and institutes reopen, they will have to do so following the strictest possible measures, as we did in the back to school in September 2020 and in September this year.
P. Infections among teachers, who were one of the first professional groups to be immunized, have also increased. Should they be vaccinated again now?
R. Yes, totally. They should be vaccinated with the third dose as essential workers, as was done last year.
P. How has the reappearance of other respiratory viruses, absent in 2020, influenced the behavior of families?
R. They have made people trust themselves. In September it was reported that only about 1% or 2% of children with snot had covid, and that the rest were due to other typical childhood respiratory viruses, which this year have circulated abundantly again. And that message helped parents send them snotty to school. But it was a time when the rate of positivity in covid tests in pediatric groups was very low and in the general population it was also low. Now we are in a totally different situation. If children have snot, it is time to suspect that it is covid, although it could be something else.
P. What should parents do?
R. Pay close attention to the appearance of symptoms. If the child has symptoms, he should not go to school. Use quick tests, which have their problems, but can be useful. And comply with the confinement if there are positives at home, both from adults and children.
P. If the incidence continues to increase, in January school activity can be very difficult due to the chain of quarantines. Should we review the rule that envisages confining the entire bubble group if there is a positive?
R. It’s a posibility. What interests me is the well-being of the children. The physical, of course, that they do not get sick, and for now we remain calm because it seems that the omicron variant does not cause different disease in children, which is still mild or asymptomatic. And their psychological well-being and mental health, which we see greatly affected when we confine them at home. That is why I believe that schools should remain open. And maybe exploring other methods if we continue to see bubble group confinement as high as we saw at the end of the quarter.
P. Like, for example, confining only positive students from a bubble group?
R. Yes, confirmed positives and those with symptoms. Epidemiologically it is incorrect, but we are in a period of such complexity that we could consider measures like this.
#Pediatrician #epidemiologist #Quique #Bassat #children #snot #time #suspect #covid