As a pulmonary and critical care doctor and the mother of three children too young to receive a COVID-19 vaccine, life has been harrowing. At the beginning of the summer, however, I was beginning to breathe a sigh of relief. My children had been in school last spring, and by the heroic efforts of their amazing teachers and staff, completed the school year free of sickness or quarantine from COVID-19. They wore masks like champions, ate lunch outdoors, were broken into smaller cohorts, and even treated us to a socially distanced outdoor play at the end of the year, with the parents masked and distanced on the sidewalk, and our highly spirited kiddos singing valiantly through their masks into the sunshine. It was definitely a glimmer of hope.
Darker clouds began to gather on the horizon as I continued to work over the summer in the ICU, particularly with the explosive spread of the delta variant and rising hospitalizations among adults and children. At one point, 80 to 100 percent of the patients in my ICU were there because of COVID-19. I had breathed a sigh of relief after our school teachers and coaches were vaccinated last spring, but became more nervous over the summer as the reality sank in that the vaccines, though highly effective at reducing hospitalizations and ICU stays, were not an iron barrier. My concern for my three unvaccinated children and their friends and teachers at school grew. I breathed another sigh of relief when a statewide mask mandate for schools was issued for my state. I hoped this meant that our children’s hospitals would not be overwhelmed, and the spread in the wider community would be lessened.
However, watching schools open and slam shut again already this year has exposed that we need to do more. That more involves the air itself, and how we ensure we clear it as best we can of the virus that would love to sneak under the masks of our kids or settle on their wide-open eyes. Fortunately, there are resources for this. The Johns Hopkins Center for Health Security has issued a report on how best to keep our kids safe. I spoke to Dr. Paula Olsiewski, one of their lead scientists and a biosecurity expert, on this important topic recently on the Air Health Our Health podcast. She is a grandmother of very young children and the mother of adult children who are teachers. This school year is certainly bringing her professional and personal lives colliding together, which is happening to many of us in healthcare.
Fortunately, these scientists and others show that there are simple steps we can take to mitigate risk. Indoor air quality in schools has long been poor, and increasing ventilation is good for kids both now in this pandemic and for their futures. If a school has an HVAC system, parents can ask whether there are at least 6 air changes per hour in their classrooms and whether there are MERV 13 filters or higher. If not, there are simple steps that can be taken to ensure natural ventilation. With the placement of portable HEPA filters that are certified to be safe by resources such as CARB, and with a CADR (Clean Air Delivery Rate) to ensure that there are at least six air changes per hour in each classroom, we can likely dramatically reduce the risk to our kids. The EPA provides more information, including ensuring filters are not positioned to blow air from one person to another. Most importantly, both this report, the EPA, and others note that newer technologies such as ionizers have less of a track record and the potential to generate harmful compounds. Parents should be aware of this, and ensure that well-studied, protective measures such as ventilation and mechanical filtration with MERV and HEPA are included as well while we wait for more information about newer technologies to emerge.
Every layer of protection matters; often these interventions are pitted against each other. Some say we shouldn’t mask, just ventilate. Others say that vaccines or masks alone are enough. The explosive delta variant has shown us that it is time to err on the side of caution for once in this pandemic; let’s use masking indoors, outdoor lunches when able, vaccinate the eligible, and do our best to provide healthy indoor air.
Six air changes per hour and HEPA grade filtration of indoor air for our children is an investment in their futures for long beyond when the COVID-19 pandemic fades from view. We know there is poor indoor air quality in multiple schools, from inadequate ventilation to air pollution to wildfire smoke. Kids learn better and have less absenteeism in healthy air. COVID-19 has just added fuel to that fire. Let this be a torch to light our way forward to healthy indoor air- starting right now.
Most importantly, we need to make sure this opportunity is available to all children, particularly those who have often been left behind in this pandemic. Heartbreakingly, there are kids who never logged on last year or showed up to school, and may have families afraid to send them this year. There are federal funds available from the COVID-19 relief bills to ensure that we can provide this assistance even to already financially-distressed schools. Nothing will ever make our children completely safe, which is the persistent ache of being a parent. However, they deserve a school year in person if possible, and we as the adults in their lives, should do our best to make sure they get it.
Don’t buy your kids’ teachers apples this year. Get them some HEPA filters.
Erika Maria Moseson is a practicing, board-certified pulmonary and critical care physician. She is founder, Air Health Our Health, an educational website and podcast on the importance of healthy air and a stable climate, and can be reached on Facebook and Instagram.
Image credit: Shutterstock.com
