Parents will do anything to keep their kids safe, but some of our policies in pursuit of safety are harming children. In particular, as long as omicron or a similarly lethal strain is dominant, testing asymptomatic school-age kids, a policy currently widely in use in many school districts, is ineffective at best and damaging at worst.
Vaccinated or not, healthy children face very low serious long-term risk from COVID. An analysis from Germany shows that among infected kids, the risk of going to the ICU was 8 per 100,000, and the risk of death was 3 in a million, with no deaths from ages 5 to 17. These were the risks before vaccination and before omicron, both of which are likely to further reduce these numbers. Moreover, these probabilities are lower than risks kids face in a typical year from automobile accidents or drowning.
Most importantly: The vaccine is unable to stop breakthrough infections, and omicron is highly transmissive. For these reasons, Anthony Fauci says omicron will eventually infect us all. Its spread may be slowing in many parts of the country, but it’s still out there. If you haven’t been infected with it yet, you likely will—and the immunity you get from it will be valuable. New variants that successfully outcompete omicron in the future will almost certainly share its ability to evade vaccines, so even those who somehow manage to escape the current wave will not be protected from infection forever.
Best-case scenario, routine testing and quarantining of kids may slow the spread among these ages, but it will not avoid it entirely. One of the common arguments in favor of testing kids is that it will protect teachers. But testing kids without symptoms and then isolating those who test positive is unlikely to meaningfully bend the trajectory of the pandemic. Simply put, it means that all this testing won’t significantly delay when students, teachers, staff, or parents get sick, unless all of us stay home entirely and indefinitely, which very few people are willing to do nearly two years into the pandemic. In fact, modeling suggests that omicron is so transmissive that even aggressive mitigation across all of society will barely slow its spread.
The short-term health benefits of asymptomatic testing also depend on what kids do when some of them are inevitably pushed out of school for testing positive and who watches them during these hours. Recently, Chicago Public Schools preemptively closed due to teacher union demands. When kids were out of school, cases among students increased as the omicron wave hit the city. This further suggests that keeping a kid out of school is not enough to halt spread; what kids do when they’re out of school matters at least as much. In fact, asymptomatic testing might actually fuel community spread. Given the heavy reliance on informal child care arrangements among working parents, sending infected students home could cause them to spread the virus to older, higher-risk adults instead.
The tests themselves may not even be fit for the task. Although PCR tests provide the gold standard, they take too long to be much use for omicron. And there is considerable disagreement about the performance of rapid tests, particularly in kids at young ages and particularly for detecting asymptomatic, early disease. Some analyses find that rapid tests miss one-third of kids with the coronavirus. Testing isn’t as accurate when the person is less willing to cooperate with sampling, if the sampler is less aggressive in swabbing, and if instructions are not followed exactly—all of which can happen with kids.
Given the learning losses kids have already suffered, our focus now must be on making up lost ground. Aggressive testing policies that send a substantial number of students home are compounding the losses instead. Disrupting kids’ routines—particularly keeping them out of school—has potential to worsen their mental health, and has been shown to lead to learning losses, a potent predictor of life course outcomes. Indeed, regardless of one’s view about specific mitigation strategies, few serious people would dispute that missing school harms kids. Further learning interruptions are also disruptive for parents, particularly for working mothers who bear the brunt of child care. And unlike in early months of the pandemic, when other social safety net programs stepped in to fill the gaps, keeping kids home today creates additional hardships unrelated to learning. For example, most states are no longer providing food stamp benefits to families of children who are eligible for free lunch at school but who cannot access these meals due to quarantines and isolation.
For much of the pandemic, our well-meaning efforts to protect children from the virus ultimately ended up doing more harm than good and remained in place far too long even in the face of new evidence. In many places, schools stayed closed long after it was clear that doing so did not meaningfully slow disease spread and that children themselves faced low risks. The Centers for Disease Control and Prevention and many school districts insisted on maintaining an impractical 6 feet of social distancing in the classroom late into last spring, forcing many students to stay home half of the week, even as emerging evidence showed that much closer spacing worked just as well. At the start of this academic year, many districts adopted aggressive quarantining policies even as randomized data from Britain showed that using post-exposure testing allowed most affected kids to stay at school, minimizing lost learning time. Testing exposed students may have made sense with earlier variants of the virus, but it doesn’t work with the new omicron reality—again, aggressive mitigation efforts are unlikely to slow the spread of disease. On Jan. 14, nearly 1 million people in the U.S. tested positive. Many more tested positive on home kits. Many more were sick and did not test.
With explosive spread like that, a child who participates in the world is assured to have exposure in the course of day-to-day life. Punishing students who happen to have their exposure at school by sending them home is unlikely to make much difference. Documenting a very specific classroom exposure is like using a magic eight ball to decide when to test: It’s a random occurrence that does not capture the cumulative risk of exposure. Moreover, when we truly accept Fauci’s message that we will all be exposed, the price of disruption so quickly overwhelms the price of delaying exposure—particularly when it’s unclear how much delay such testing actually buys us.
Massachusetts is the first state to adjust policy in response to this reality. Earlier this month, policymakers there gave districts the opportunity to end their “test-to-stay” programs, replacing them with optional at-home tests instead. It’s time for other states and districts to follow their lead.
Testing has always seduced the American public. The idea that any information is always good information fuels American ideas about health care. We market direct-to-consumer genetic testing. We have rapidly adopted new cancer screening tests. But in recent decades, we have learned, often painfully, that more testing does not always lead to better outcomes. When it comes to testing kids routinely, repeatedly, we are embarking on an unproven intervention whose odds are against us.