Spike in kids with COVID-19 means Israel unlikely to open schools

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While adults over the age of 40 are getting vaccinated at an almost miraculous rate, Israel is seeing a sharp rise in the number of children and teens getting infected with coronavirus, according to Health Ministry statistics.

Now, there is a possibility that even when the government starts to lift the lockdown, schools may not be able to open as originally assumed.

More than 50,000 children and teens have been diagnosed with coronavirus since the start of the month, many more than Israel saw in any month during the first or second waves.

“We got a letter from the Israeli Association of Pediatrics that says they are very worried about the rate of disease in younger students,” Health Minister Yuli Edelstein told The Jerusalem Post. “This is something we did not witness in previous waves of corona.”

Jerusalem’s Hadassah-University Medical Center last weekend opened Israel’s first coronavirus intensive-care unit for children with four patients. Today, according to the hospital, there are seven children being treated at the hospital, among them two who are intubated and in serious condition.

Instead of around 29% of new cases coming from children and teens, as in the second wave, now they are around 40% of cases, Public Health Services head Sharon Alroy-Preis said in the Knesset on Monday. The greatest spike was in children between the ages of six and nine, she said.

And according to Cyrille Cohen, head of Bar-Ilan University’s immunotherapy laboratory, the numbers seem to be rising.

The healthcare system is having difficulty explaining the outbreak, but one hypothesis is that it is tied to the British mutation, which has spread rapidly across Israel.

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“The British variant is more contagious, so it increases the chances of infection in children,” Cohen told the Post.

During the earlier waves, it seemed as if children were less likely to contract the virus and even more unlikely to experience symptoms, he said.

One idea for why children contracted the virus less was that they have fewer angiotensin-converting enzyme 2 (ACE2) proteins on the surface of their cells, Cohen said. ACE2 acts as the receptor for coronavirus, allowing it to infect cells. Fewer receptors would make them less susceptible to the virus.

“But now we are talking about a variant,” he stressed. The British variant is known to be between 30% and 74% more infectious, which means that even children would be more likely to catch this strain.

Another change might have to do with the population that is being vaccinated, around 80% of the 60-plus population, which means Israel is seeing the average age of infected people going down.

“We are protecting certain parts of the population, and other parts are less protected,” Cohen said. Children should not be vaccinated because they were not included in any full Phase III clinical trial, and there is not enough data on the impact of the vaccines on them, he said.

Right now, it is a question of numbers: There are almost 60,000 new cases of coronavirus diagnosed a week, a large number for a small country like Israel, Cohen said. Statistically, Israel is seeing more children affected and therefore more severe cases.

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“If the pie is bigger, then there will be more children with the disease and more of them coming to the hospital,” said Prof. Yechiel Schlesinger, medical director of Wilf Children’s Hospital at Shaare Zedek Medical Center in Jerusalem.

For the most part, children are still getting mild cases of the disease, he said. Most children do not even need to see a doctor, and of those who do, few are sent to the hospital and even fewer to the ICU, Schlesinger said.

But the rise in cases is raising questions about when and if schools can open again. Last week, Education Minister Yoav Gallant was pushing to open the entire school system at the end of lockdown. But on Tuesday morning, he told Army Radio he did not want to be responsible for children getting sick and that he would first consult with medical experts before pushing for such a move.

Students in grades 11 and 12 are getting vaccinated to allow them to go to school and resume classes. However, it takes four weeks from the first jab until a person reaches 95% protection, according to Pfizer’s protocol.

Moreover, Cohen said, there is still a question of whether people who are vaccinated can still contract the virus and infect others, which could put unvaccinated teachers, friends or family members at risk when these students return to school.

According to Edelstein, only 34% of the 200,000 eligible educational staff have been inoculated, despite pressure by the Teachers’ Union and Education Ministry to prioritize them. The low rate of vaccination would impact opening schools and the rate of isolation when classes do begin, he said.

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Moreover, while schools might not be the “initiating factor” when it comes to spreading the virus, they are a “contributing factor,” Alroy-Preis said Monday.

“Even with capsules, these are still larger gatherings,” she said. “At the moment, with the British variant it is worse.”

“I don’t think any normal person would ask for the opening of schools right now,” Edelstein told the Post.

Both Cohen and Schlesinger agreed with that position.

“I think it would be very difficult to open schools in this situation.” Cohen said.

“This is a complex question, and you have to weigh the risks of opening schools against not opening schools,” Schlesinger said. “It is my gut feeling to wait longer… I would lean toward keeping them closed.”

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