Part of the Series
Despair and Disparity: The Uneven Burdens of COVID-19
When epidemiologist and parent Rebecca Fielding-Miller heard that California was going to allow asymptomatic, COVID-19-positive students to attend school without quarantining, she was stunned.
Under California’s new policy, students (and school workers) can return to the classroom “as long as they are asymptomatic and are improving” and have been free of fever for 24 hours without medication. The previously required five-day quarantine after testing positive, followed by 10 days of masking when in public spaces, is no longer in effect. The policy mirrors a similar plan implemented by the Oregon Department of Education in May 2023.
These changes, officials argue, support COVID-19’s transition from a public health emergency to an endemic public health concern, putting it in the same category as bronchitis, flu, respiratory syncytial virus (RSV), rhinovirus and the common cold.
Unsurprisingly, reaction to the change has been mixed. Some parents, for example, saw the previous requirement to keep a seemingly healthy, asymptomatic child at home burdensome, forcing them to take time off from work or scramble to arrange child care. But others, including Fielding-Miller, see the change as risky since adequate mechanisms to protect public health are rarely in place in either schools or work sites.
“The science is clear about the importance of ventilation and cleaning the air,” Fielding-Miller, a professor at California’s Herbert Wertheim School of Public Health and Human Longevity Science, told Truthout. “Administrators need to make sure that there is enough ventilation in every classroom to keep everyone healthy.”
Every room, she explains, should have a working air filter, and while many schools used COVID relief money to purchase them, she says that they are routinely turned off because the sound generated can interfere with instruction. Furthermore, other forms of ventilation are also often unavailable. “In a lot of schools, windows do not open and teachers are told to keep classroom doors shut,” Fielding-Miller said. “I understand that everyone wants to return to normal, but for some of us, this means facing serious burdens. The law says that students should always be placed in the least restrictive environment possible, but children with respiratory or heart issues, or living in a multigenerational household with infants or the elderly — people who are at a higher risk of experiencing acute, life-threatening symptoms if they get the virus — are being forced to bear the brunt of this policy.”
For its part, the Centers for Disease Control and Prevention (CDC) seems to agree, noting that children with underlying health conditions including asthma and other chronic lung ailments, autoimmune disorders, congenital heart defects, diabetes, obesity and sickle cell anemia are at an elevated risk of becoming extremely sick if they contract COVID.
And, while the agency also makes clear that most children will eventually make a complete recovery from the virus, it acknowledges that a small number will develop a rare condition called multisystem inflammatory syndrome in children (MIS-C). MIS-C typically shows up between two and six weeks after the initial COVID infection and can cause inflammation in the brain, eyes, gastrointestinal tract, heart, lungs, kidneys or skin. As of January 29, 2024, the CDC reports that in the four years since the pandemic began, 9,645 U.S. children under 18 have developed MIS-C; 79 have died.
It’s further noteworthy that other children have developed different (but still serious and sometimes debilitating) disorders including long COVID, in which persistent symptoms linger for months (and in some cases, years) after the infection was first diagnosed. What’s more, the American Academy of Pediatrics reports that at least 200,00 people under 18 have been hospitalized with COVID since August 2020; 1,289 have died, making the virus the leading cause of death in this age cohort for those with infectious and respiratory diseases.
Vaccines and boosters, of course, usually mitigate the severity of infection, but they do not stop people from contracting the fast-spreading disease.
“People who are at the greatest disadvantage in our society should not have to bear harm for the convenience of others.”
In fact, as the CDC noted in early January, 2024 began with a significant viral surge. “Infection levels measured using wastewater and test positivity, which captures both symptomatic and asymptomatic infections, are higher than the year before,” the agency reported. “Wastewater viral levels, in particular, have increased rapidly.”
This finding has alarmed California public health advocates who say that the state’s loosening of COVID-19 attendance policies, which took effect on January 9, is particularly ill-timed. They fear that the change will put the state’s nearly 6 million students and 319,000 teachers at risk. Oregon public health advocates are similarly concerned about that state’s 571,000 students and nearly 30,000 teachers.
So why did California and Oregon make this change?
Follow the Money
Educational consultant and brain science specialist Liesl McConchie, a San Diego-based mother of three elementary school-aged kids, is the PTA president at her children’s public charter school. “Schools are desperate for funds,” she told Truthout, “and are feeling the financial pressure because California funds schools based on daily attendance rates.”
Although progressive educators and lawmakers have pushed for the state to use average annual enrollment figures to calculate allocations, California is currently one of six states — the others are Idaho, Kentucky, Mississippi, Missouri and Texas — that use daily attendance counts to decide how much each school district receives.
ABC10 News in San Diego estimates that the city loses $32 a day for each absent student, causing cities and neighborhoods with high absenteeism rates to struggle to make ends meet. (Oregon does not use the same funding formula as California; nonetheless, many of the state’s public schools also face financial shortfalls. Peter Rudy of the Oregon Department of Education told Truthout by email that approximately 80 percent of education revenue comes from the State School Fund, a combination of state and local monies, but that anti-taxation voter referendums passed in 1990 and 1991 limit local contributions.)
McConchie told Truthout that she understands the drive to fill seats, but still believes the new policy is ill-advised. “The change came during the second-largest COVID surge since the pandemic began,” she said. “We have the tools to combat the virus — masks, vaccinations and indoor air quality monitoring — but vaccination rates for children are very low, between 5 and 6 percent.”
Moreover, McConchie says vaccine clinics and child-sized N95 masks should be available at schools. “Right now, N95 masks for kids are not sold in the U.S. so only families with the financial resources to import them are able to protect their children,” she said. “Then there’s the issue of medication. Paxlovid is not recommended for children under 12, but that’s not to say we have no tools at our disposal.”
Carbon dioxide monitors, she continues, should be installed in every classroom since high levels indicate that ventilation systems are not working well. “The CDC recommends five air changes per hour in indoor spaces, but in many schools, there are maybe two. This is troubling, but it’s a question of priorities,” McConchie said. “Students and teachers should not have to spend six or seven hours a day inhaling someone else’s breath. It makes me angry that schools have cherry-picked which public health guidelines to follow and which to ignore.”
McConchie is not alone in her frustration. Disabled Oregonian PJ Jones, whose sister is a public school teacher in that state, told Truthout that the situation facing Oregon students is equally appalling. She says that since the federal government ended the COVID public health emergency in May, life for disabled people of all ages has become increasingly difficult.
“Everything has gotten worse since the emergency was declared over,” she said. In addition to allowing asymptomatic students with the virus to attend school, “previously accepted accommodations, from curbside and contactless food and pharmacy deliveries, to people being masked in public, to being able to stay in my car while waiting for a medical appointment” have fallen by the wayside.
“Layers of protection have peeled away,” Jones said. “The government wants to go back to normal and the focus has been on vaccines as the way to beat back against COVID, but vaccines are not always affordable or available. Masks and tests are no longer free, and while I get that some people think that having to wear a mask or get a shot infringes on their personal freedom, I don’t understand why their rights are more important than other people’s rights to access public spaces. People see kids returning to school as a ‘return to normal,’ but are schools helping people access vaccines? Are they providing and making sure that people take COVID tests? Are they even offering information about the virus or the risk of Long COVID in children?”
Furthermore, while Jones is pleased that online schooling is available in Oregon — during the 2021-2022 academic year, the most recent year for which statistics are available, 25,029 students from every corner of the state were enrolled in virtual learning — she nonetheless questions whether the instruction is coming from the student’s local district or from another part of the state. Instruction from outside the district, she argues, deprives enrolled students of a chance to engage in periodic outdoor and in-person activities with other remote learners. “It’s simply not equitable,” she said.
That said, Jones knows that as COVID evolves, and new treatments become available, the public health and advocacy response will also need to evolve. But like McConchie and Fielding-Miller, she hopes that for the time being, school districts throughout the country — especially in states that are considering whether to adopt school attendance policies like those promulgated by California and Oregon — will simultaneously ramp up their provision of free testing, free vaccines and free face coverings. Jones also hopes that these states will recommend the resumption of regular testing since she recognizes that most people have eliminated this form of infection monitoring.
“COVID is airborne so no one is okay unless everyone is okay,” Fielding-Miller concludes. “Even when folks can go to school from home, the impact will still be there for disabled people, low-income people and people living in multigenerational households — the millions of people who are already bearing the costs of disparities in health care access. People who are at the greatest disadvantage in our society should not have to bear harm for the convenience of others.”