How to approach back-to-school this year

Oster sees two ways that make this current back-to-school season different than last year. In 2020, back-to-school “felt so much more fraught because there were no vaccines,” she says. The questions we were asking were more about exposing high-risk adults. “That was really scary,” she says, and, in some instances, it felt “wrong.”

This year we don’t have that hard choice to face — many teachers are vaccinated, sometimes even if they don’t want to be. What is different is “we’re seeing a more contagious variant, and, therefore, more cases in kids.” Even though the “vast majority of cases are going to be mild or asymptomatic,” says Oster, “it is really scary for parents to face up to this and say ‘Actually the chance my kid gets COVID is higher than it was last year.’ ”

“it is really scary for parents to face up to this and say ‘Actually the chance my kid gets COVID is higher than it was last year.’ ”

In terms of data that backs up how much risk kids are taking on, “the severity of infection looks really similar.” One thing that’s complicating the situation is that we’re seeing more non-COVID respiratory viruses — for example, Louisiana and Mississippi both saw an RSV surge at the same time as their COVID surges.

“It’s a hard message to communicate to parents,” Dr. Greene adds. “If you live in a community where there is not an ICU bed, one child getting sick from COVID is too many, especially if there’s ways to mitigate risk.” But in communities that are highly vaccinated, measuring risk becomes harder to parse out. It might be that only one percent of the kids at school are infected, but every text message and email about a new case can be panic-inducing.

Each state has different ways of reporting the numbers of how many kids are infected or in the hospital. “That’s not super helpful,” says Oster. “It’s really hard because we’ve ramped up the fear much more in the U.S. than elsewhere.” We need to look at the approach of the U.K. or other European countries, where, when a case comes up, the response is more: “‘Yes, that’s going to keep happening.’ As it happens more [here] and things go okay, it will dial down people’s fear,” says Oster. “I think that’s all we can hope for.”

How to frame decision-making for things like extracurriculars and childcare

Oster thinks about decision-making through the framework of a risk budget. “Everything you do that is leaving your house, in principle, entails some COVID risk, and you’re going to need to choose what things you spend your risk points on,” she explains. For her family, most of their risk points are spent on sending the kids to school. For things like extracurriculars or play dates, you have to ask how important those activities are. Maybe the answer ends up being that no one really enjoyed that activity and it’s not worth spending points on it. Or maybe the social-emotional benefits outweigh the risk.

For Oster, her daughter’s music class ended up having a big benefit, even though it’s a riskier activity. “It’s inside with other kids who are not in our pod,” explains Oster. “It’s a lot of risk points in my mind — not like outdoor soccer — but it’s really important to her.”

“Everything you do that is leaving your house, in principle, entails some COVID risk, and you’re going to need to choose what things you spend your risk points on,”

As Dr. Greene points out, saying no to something doesn’t mean there is no risk. In her family, not sending kids to an afterschool program meant exposing them to a babysitter at home, who they’d likely be spending time with, un-masked. The question is “not just: should we do the afterschool program? It was more, ‘Well, what else are we comparing it to?’ ” she notes.

When to reevaluate your behavior

In her book, The Family Firm, Oster encourages couples to stick to a set framework for certain activities or events — things like play dates, or what to do when your kid is symptomatic. But with a constantly changing environment, these decisions may inherently need to change. “Some of these kinds of decisions are contingent on the disease environment,” Oster explains. If there’s a high case rate, you probably aren’t going to send your kid on a play date, even if it’s outside.

Every few weeks you may need to reevaluate those kinds of decisions. But it’s better to have that framework ahead of time rather than having to make them last-minute — like if you wake up with a sick kid and have to figure out who will stay home with them. “You’re not avoiding those conflicts by not airing them,” Oster says. “You’re just airing them at 7:15 in the morning rather than at a more convenient time.”

Testing strategies

Oster admits that the value of rapid testing has gotten confused. “The value is that you can do it right now,” she says. “It is easy, it is available, and it will pick up a good share of cases — well over half, or more for symptomatic cases.” As long as it’s backed up with a PCR test, it is a good screening method that should be used more in schools or at events.

It’s especially useful for symptomatic kids, notes Dr. Greene: “We’re seeing a lot of non-COVID illnesses now that kids are back in school and it’s really helpful to know earlier that a kid has COVID.” The PCR test will confirm the case 24 to 48 hours later.

According to Oster, the pitch is: “Is [a rapid test] going to detect every single case of COVID? No. Is it going to detect some of them? Yes. Is it going to detect the most infectious ones? Yes. Can we pull those people out of the circulation? Is that going to help? Yes.”

Continuing to weigh risks and benefits

One quote from Oster’s book that stood out to Dr. Greene was: “Don’t worry about making the right decision, but ask yourself, are we making this decision well?”

Often there’s not a right or wrong decision. One example Oster gives is last year’s Thanksgiving where they had to choose between a sad holiday (having a smaller Thanksgiving away from extended family), or an anxious one (gathering with extended family but worrying about exposing her vulnerable mother). “It was almost impossible to move forward on that decision until we recognized, ‘We are going to make this decision in the best way we can, but we are going to feel like crap about it afterwards, no matter what it is,’ ” she says.

The what-ifs of the pandemic can be maddening. “People want certainty, they want more data than there is,” explains Oster. When weighing the risks of long COVID or whether or not to get vaccinated, for example, “We can’t just be like, ‘Well, I wish there was no COVID.’ That actually isn’t an available option to us.” We just “have to move forward.”

Next time, we’ll be talking about the gut-immune connection with author and physician, Dr. Emeran Mayer. Subscribe below.