番茄社区

A group of physicians and scientists has called for all schools and children's activities to return to pre-pandemic norms by the middle of next month, but their published earlier this week, are drawing the ire of others in the field.

As the U.S. grapples with yet another surge in COVID-19 cases and hospitalizations, the group -- viral immunologist Scott Balsitis, PhD, as well as physicians Lucy McBride, MD; Monica Gandhi, MD; Tracy Beth Høeg, MD; Jeanne Noble, MD; and Kwadwo Kyeremanteng, MD, as well as a number of pediatricians -- is steadfast in their belief that children are being harmed by mitigation measures.

The primary goal of the group -- known as "Urgency of Normal" -- is to empower administrators, teachers, parents, and students to have a full understanding of the current situation and to make the best decisions they can for themselves, Balsitis told 番茄社区.

The group's recommendations include maintaining in-person learning regardless of COVID case counts; de-escalating fear around getting COVID; applying focused protection measures for individuals who remain at high risk; changing the focus to supporting kids' mental, emotional, and social health; and making masks optional in schools.

"We believe the data point to restoring full normalcy for children," said Balsitis, who confirmed the group feels this should happen by February 15. "We really mean the full normal."

Nearly 400 medical professionals have already co-signed in support of what the group calls its advocacy toolkit via its website, but their recommendations have also been met with swift criticism from peers.

"Proselytizing for a predetermined conclusion under the guise of objective, evidence-based analysis is not junk science, it's just junk," Mark Kline, MD, of Children's Hospital New Orleans, in response to the group. "With the health, well-being and lives of children at stake, we have every right to expect much more of our physicians."

In an interview with 番茄社区, Kline, who is also a professor of pediatrics at Tulane University and LSU New Orleans, said that he believes the toolkit was put forth as something people can use to argue against school closures, the general use of masks in schools, and other mitigation measures. He added that he was especially disappointed to see that a number of pediatricians had signed on to the document.

"It's not an evidence-based discussion of the pros and cons," he said. "It's just simply, here is the conclusion we've come to, and here is the argument we would use in favor of this conclusion. And I think it's flawed ... start to finish."

"I think if we were to do as they are proposing, which is to basically do away with mitigation measures where the schools are concerned, and basically throw in the towel and just focus our efforts on a subset of children that are high risk ... that it's bound to lead to more cases of COVID ... more hospitalizations among children, and probably more deaths," Kline noted.

He pointed out that even with mitigation measures, more than 1,000 children have died as a result of COVID-19 over the past 2 years.

Kline disputes the idea that there is no risk to children and that mitigation measures are all risk and no benefit, as suggested in the toolkit, in part because he's seen many children who have been hospitalized with COVID-19 in his own hospital.

Vaccination uptake in children ages 5 to 11 has been "abysmal," and younger kids don't yet have the option, he added.

The toolkit also doesn't take into account the disparities that exist when it comes to access to safe schools and healthcare, among other areas, he noted.

"We are not a homogeneous population, and some children and some families and some communities are at greater risk of this disease than others," Kline said. "That is not accounted for in the document, at all."

Lakshmi Ganapathi, MBBS, a pediatric infectious disease physician at Boston Children's Hospital and Harvard Medical School, concurred, pointing out that many policy proposals are being shaped by opinions of the privileged.

"They really silence the realities of communities of color," she said.

Ganapathi further took issue with the group's recommendations placing the burden of protection on the vulnerable. "We do need to act collectively," she said. "That's a core public health principle."

The Urgency of Normal is also receiving pushback on the data it cited in its toolkit.

A by Tyler Black, MD, a child and adolescent psychiatrist and suicidologist in Vancouver, noted that a line in the toolkit "about 'deaths from child suicide vastly outnumbering deaths from COVID and are increasing' is about as awful as it gets. I consider it ghoulish to wield child suicide statistics inaccurately to make advocacy points." (The line has since been removed from the toolkit.)

However, Balsitis maintained that the idea behind the recommendations in the toolkit are simple.

COVID-19 has never been extremely high risk for children, even for unvaccinated children, he said. Vaccines are available to make the risk even lower, and current data on children's mental health are "increasingly alarming."

"We think it makes sense to shift our focus away from taking action that may or may not have any efficacy against mild COVID infection [and instead focus on] whole person health," Balsitis explained.

He said that the group originated from his desire to empower his family's and community's schools, especially when so much of the strategy had focused on preventing transmission altogether. It became clear that Omicron was going to change that strategy, he noted, and communities have continued to live with a high level of fear, school closures, and "highly disruptive measures" imposed on kids.

"Everywhere else in medicine, it is necessary to carefully quantify the benefit of an intervention and thoroughly screen for any unintentional downsides," he said.

The burden of proof shouldn't be on parents who feel that mitigation measures are hurting their child, but instead should lie with those who want to apply the intervention, he added. "If someone is more comfortable making one choice than the other, they should have the option to make that choice."

However, Kline disagreed. "They're basically saying the mitigation measures that we've been using are unnecessary, so let's get rid of them. But imagine where we'd be if we hadn't used the mitigation measures that we have," he said.

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