In the summer of 2020, a commentary in Pediatrics by William Raszka, M.D., and Ben Lee, M.D., led to a flurry of interest around the globe. The duo of pediatric infectious disease experts found that “children are not significant drivers of the COVID-19 pandemic” based on an analysis of early studies from Switzerland, China, France and Australia. They wrote: “On the basis of these data, SARS-CoV-2 transmission in schools may be less important in community transmission than initially feared.” At a time when the world grappled with whether and how to reopen school safely, the response was immediate. Raszka and Lee were interviewed for major media outlets including CNN, Fox News, the Associated Press and San Jose Mercury News. They fielded calls from school leaders and government officials seeking guidance, helping to steer decision- making during a crucial time.

On March 25, 2021, Lee and Raszka received the Vermont State School Nurses Association’s (VSSNA) J. Ward Stackpole, M.D. Award. Named in memory of late pediatrician J. Ward Stackpole, M.D., this award was created to honor the achievements of champions of school health services in Vermont. In the award letter, VSSNA wrote, “We are grateful to you for sharing your time to meet with school nurses to educate and support our work in the midst of an incredibly busy time for you both.”

What have we learned over the past year about how children factor into transmission of the SARS-CoV-2 virus?

Dr. Raszka: We have learned that schools have been able to open and that children are not driving transmission in schools. And that, with appropriate mitigation strategies, even with pretty modest mitigation strategies in many states, schools have been able to open up. Around the nation, it’s been reassuring how few children are infected in schools and how little transmission there is between children in schools and between children and adults. School-based transmission has been very modest.

When the commentary in Pediatrics was published, the two of you fielded many inquiries from around the globe. What were some takeaways from that experience?

Dr. Lee: We were fortunate when it comes to timing. When the official publication went out, [reopening schools] was the most talked about topic in terms of how the pandem- ic was impacting kids, if not entire communities. One of the things that’s been fairly gratifying is that, from the beginning, our suspicion and our contention in looking at the data was that kids probably aren’t going to be the ones that are driving this. And we really do think that has been borne out through the global experience since we first wrote the commentary.

Dr. Raszka: It was a timely article. It was interesting using [the commentary] as a jumping- off point for what we did in Vermont, just the tremendous amount of work that went into opening schools in Vermont, the multidisciplinary approach and how much time and effort we spent on looking at the data. The governor actually had us come
to the press conference, and said “Present the data, please, because we’re going to act on this data.” That was really cool.

What are some thoughts on communicating nuanced public health data to the public? How did you approach that work?

Dr. Raszka: We would be very consistent in our messaging. We had three things to reinforce about kids: They’re less likely to transmit. We’re pretty confident they have less severe disease. Generally speaking, they seem to be underrepresented in terms of total number infections. Then we have to be humble about what we know and we don’t know. Things change. We would say this over and over and over again.

Dr. Lee: It’s a fine line between being authoritative in what you’re reporting, but also being cognizant of the limits of our knowledge and data. For a lay reader, who is not from a medical or scientific background, trying to delineate where that line is can be challenging. Also, it’s challenging to have a thoughtful public conversation in an era when every single aspect of the pandemic immediately becomes politicized.

What’s next for both of you?

Dr. Raszka: Ben and I wrote another commentary for Pediatrics. We reviewed the world’s literature on household transmission and children transmitting to adults and found that children can transmit the disease. They don’t seem to do it as efficiently as adults, generally speaking. But it’s time to move on. We need to figure out the pathophysiology [of the disease] and think about ways to minimize transmission.

Dr. Lee: I’m in the process of performing a pediatric COVID-19 antibody serosurvey in conjunction with Colchester School District with funding from Children’s Miracle Network Hospitals Fund. Since kids are often either mildly symptomatic or asymptomatically infected, one of the questions that’s always been out there is are we underestimating the true infection rates in kids? Serosurveys would be one way to help improve our data.