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Last week, in what was intended to be an internal document, the Centers for Disease Control and Prevention made a harsh admission: The highly contagious Delta variant has redrawn the battle lines of the coronavirus pandemic and required new public health measures like universal mask mandates. Or, as the agency noted in the document obtained by The New York Times, “war has changed”

The news came as the first school districts were preparing to reopen; Some kids in Atlanta and its suburbs are returning to class this week.

There have been contentious debates over the past year over how much schools have contributed to the spread of the virus, and whether and when schools should be closed. For some parents, teachers, and officials, keeping schools open as a new, poorly understood virus circulated seemed like an unacceptable risk. But for others, it was school closures that posed the greater danger – learning loss, growing educational inequalities and worsening mental health, not to mention the challenges for parents.

However, as the new school year begins, the CDC, the American Academy of Pediatrics, and many other experts agree that reopening schools should be a priority.

“We’re in a very different place than we were a year ago,” said epidemiologist Elizabeth Stuart of the Johns Hopkins Bloomberg School of Public Health. “We have very effective vaccines, we know a lot more about how to open schools safely, and I think we have more awareness of some of the challenges kids face when they don’t go to school face-to-face.”

Just a few months ago, the stage looked set for at least a partial return to normalcy, with vaccinations for those aged 12 and over advancing at a steady pace and new cases falling.

Delta questioned that. not much is known about variantincluding whether it affects children more seriously than previous forms of the virus. This variant, where vaccination rates are highly unstable and most decisions are left to local authorities, adds new uncertainty to the upcoming school year and makes it even more critical for schools to take safety precautions as schools reopen, scientists said.

D., medical director of the National Infectious Diseases Foundation and a vaccine expert at Vanderbilt University. “Delta raised the stakes because it was so contagious,” said William Schaffner. “It makes all those details even more important.”

Here are answers to some common questions.

What have we learned about the risk of transmission in schools?

Overall, research shows – in the past year at least – that intra-school transmission is generally low when schools take basic precautions.

He is a pediatric infectious disease specialist at Stanford Medicine and chair of the American Academy of Pediatrics Committee on Infectious. “When you have masks and even a meter distance, you will not see major outbreaks in schools,” said Yvonne Maldonado. Diseases. “There may be some transfers, but they will be relatively infrequent.”

Studies north carolina, Utah, Missouri and elsewhere, transmission rates in schools were even lower than in the surrounding area when schools implemented several kinds of safety measures (a combination of masking, symptom screening, distancing, improved ventilation, virus testing, hand washing, and dividing students into smaller groups). society.

A pediatric infectious disease specialist at Duke University, Dr. “It’s actually safer for kids at school than they are at home,” Daniel Benjamin Jr. said.

These low rates are partly due to children under 10 Older children and adults seem less likely to transmit the virus. But another contributing factor is that schools are – or can be – controlled environments and may have stricter safety measures than the surrounding community, said Dr. Benjamin.

However, outbreaks have occurred in schools that have reopened without good mitigation measures. Israel’s first major school-based epidemic, In the end, 260 people were infected.came during a heatwave as authorities temporarily lifted the requirement to wear masks and students were packed into air-conditioned classrooms.

How does delta complicate the equation?

Delta, which is roughly twice as contagious as the original version of the virus, has caused an increase in infections and hospitalizations, especially in areas of the country where vaccination rates are low. Recent data suggest that people infected with Delta can carry it. a thousand times more viruses – this can make them more contagious and longer lasting as those who catch the original version of the virus.

However, many questions remain unanswered about the variant, including the precise risk it poses in a school setting. But what is clear is that Delta is already causing outbreaks in many American communities, raising risks for local schools.

An infectious disease specialist at Harvard Medical School, Dr. “Schools are not islands, and so if there is a lot of community sprawl, some of that sprawl will also spread to schools,” Westyn Branch-Elliman said.

In A study done before delta became widespreadBritish researchers found that for every five additional cases per 100,000 people in a large community, the risk of school outbreaks increased by 72 percent.

The good news is that since the start of last school year, the United States has authorized three highly effective vaccines for emergency use, and they are widely available for those 12 years and older.

Vaccines are not perfect. Some fully vaccinated people breakthrough infectionsusually mild and rare. And vaccinated people infected with Delta can carry high levels of virus in their noses and throats, which means they can transmit it easily.

However, vaccines provide strong protection against the Delta variant. It reduces the possibility of virus transmission and protects against the worst consequences, including hospitalization and death.

Schools with high vaccination rates are likely to have far fewer people infected with the virus who carry or transmit it in the classroom.

“This is our best tool to control the virus,” said Justin Lessler, an epidemiologist at the University of North Carolina. “Even when it is defective, it has major implications for reducing transmission and protecting people’s health.”

What does the CDC recommend?

Initially, the CDC’s guidelines recommended that unvaccinated people aged 2 or older wear masks in schools. And they strongly implied that vaccinated students don’t need to be masked in the classroom.

But last week, due to concerns about CDC Delta revised its guidelinesrecommends everyone wear masks in schools this fall, regardless of vaccination status.

The agency proposes a layered approach to Covid measures, suggesting that schools combine various mitigation measures and encourage everyone who is eligible to get vaccinated.

But the guidelines also leave many decisions to local authorities, who are told when to tighten or relax restrictions based on data on local cases and vaccination rates.

What about states that ban mask mandates?

Currently some states, including some experiencing great fluctuations – including Florida, South Carolina and Texas – makes it difficult for schools to take protective measures. These three states and a handful of other states, or prohibited or severely restricted universal mask powers.

This does not mean that schools in these states will all have major outbreaks, and even schools that do may see mostly mild or asymptomatic cases. But neighborhoods that open without security measures take a real risk, said Dr. Benjamin.

“Here’s another way of saying it,” he said. “When I was growing up, I always got away with getting in the back of a pickup truck. But that doesn’t make kids riding in the back of pickup trucks a good national policy.”

Given the erratic vaccination rates and patchwork of policies across the country, experts said they wouldn’t be surprised if school safety changes drastically this fall. Dr. “I think there will be risks of infection when school districts decide not to follow any advice,” Maldonado said.

As the pandemic continues to evolve, schools and authorities will need to make complex decisions based on local conditions, including when to insist on certain measures and when it is safe to remove them.

Dr. “We need to make detailed decisions about what to do in schools,” Branch-Elliman said. “But it’s a much harder public health message than the polarized ‘Schools are safe’ or ‘Schools are unsafe’ messages.”

What about unvaccinated primary school students?

Vaccinations may be allowed before the end of the year for some children under the age of 12, although the exact timeline is uncertain. But until then, primary schools will open without any of their students being vaccinated. (Children participating in the trials may have received the shots.)

But research shows that the virus is much less likely to cause serious illness in children. They are not completely protected; rare in a small number of children, but serious inflammatory conditionand some children with mild infections may experience long-term symptoms.

There is no good, solid data yet on how Delta affects young children, but there is no evidence that Delta specifically targets them.

Still, children may account for an increasing proportion of Delta cases, as large numbers of adults have been vaccinated. The contagiousness of the variant may also mean that more children are infected with the virus. There is also some emerging evidence that the variant causes more severe disease in adults.

Given these observations, and very carefully, the experts said it’s particularly important that schools with young, unvaccinated students take other measures, including universal masking.

Dr. Maldonado said that in schools or districts where masks are not required, parents can provide some degree of protection by at least having their children wear masks at school.

And adults can help protect younger children by vaccinating themselves. Dr. “The most important thing any community can do to reduce risk in schools is to get the whole community vaccinated,” Schaffner said.