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OLYMPIA, Wash. – Washington state reported over 500 new COVID-19 cases Sunday, with total cases passing 98,000. The Washington State Department of Health reported 530 new COVID-19 cases and 24 additional hospitalizations. The state health department is no longer reporting coronavirus deaths on the weekend, instead reported deaths will be included in Monday’s total.

Offensive lineman James Ferentz is reportedly the latest Patriots player to test positive.

This week our readers have lots of … interesting … queries involving opening windows during winter in North Dakota, trying not to breathe during a micro-encounter and spraying a mask with … oil?

How physician Deborah Birx’s unreasonable demands for hospital data created a “debacle” at CDC

An open letter expresses dismay at the nation’s public-health response to the Covid-19 pandemic and calls for the federal agency to play a more central role.

There were 51 people with the virus hospitalized as of Friday, a new record.

Critics said the study, sponsored by the W.H.O., was too poorly conducted to be definitive.

Governments around the globe are responding to the coronavirus disease 2019 (COVID-19)–related economic crisis with unprecedented economic recovery packages ([ 1 ][1]), which at the time of writing surpassed USD 12 trillion. Several influential voices, including the United Nations (UN) secretary-general, heads of state, companies, investors, and central banks, have called for post–COVID-19 economic recovery efforts to be used to catalyze the necessary longer-term transformation toward a more sustainable and resilient society. Here we shine a light on the opportunity for these investments to support a green recovery by inventorying and classifying the latest information on governments’ fiscal stimulus plans ([ 1 ][1]) and comparing the size of these measures to estimates of low-carbon energy investment needs compatible with the 2015 UN Paris Agreement. We show that low-carbon investments to put the world on an ambitious track toward net zero carbon dioxide emissions by mid-century are dwarfed by currently announced COVID-19 stimulus funds. But marked differences across countries and regions at differing stages of development emphasize the role that international support and global partnership must play to create conditions that enable a global climate-positive recovery. Current climate commitments by countries for the next decade remain woefully inadequate to meet the climate goals spelled out in the Paris Agreement ([ 2 ][2]). Decisive action in the coming decade would be needed to set the emissions of the most important greenhouse gas—carbon dioxide—on a path to net zero by mid-century ([ 3 ][3]) while ensuring that livelihoods of billions of people in developing countries continue to improve. The record decline in global greenhouse gas emissions in the first half of 2020 due to the COVID-19–related economic disruption will almost certainly rebound when economic activity picks up again and could ultimately have a negligible impact on global warming over the longer term—unless COVID-19 recovery also induces a longer-term structural change in the economy ([ 4 ][4]). Governments have announced a variety of policy responses aimed at alleviating the consequences of the COVID-19 crisis ([ 1 ][1]). We focus on economic stimulus tools deployed explicitly through countries’ fiscal systems, taking stock of the packages for 149 countries [see table S1 in the supplementary materials (SM)]. As of end of August 2020, our tracking framework showed aggregate fiscal stimuli amounting to USD 12.2 trillion, 80% of which comes from countries in the Organization for Economic Cooperation and Development (see the figure and fig. S1). The U.S. stimulus is the largest single package to date, constituting a quarter of all global commitments, although the European Union (EU) as a bloc accounts for even more (combining measures by national governments and the European Commission). Our disaggregation of the packages for this analysis follows the approach of the International Monetary Fund (IMF), whose COVID-19 Policy Tracker is the source for our stimulus data ([ 1 ][1]). Stimulus packages are divided into two categories: “above-the-line” measures and liquidity support. The former includes additional spending and forgone or deferred revenue, whereas the latter includes instruments such as loans, guarantees, and equity injections. About 70% of stimulus can be classified as “above-the-line” measures, with 7% targeted for the health sector and 63% for other sectors. The remaining 30% is for liquidity support. The level of specification of countries’ stimulus packages varies widely, limiting understanding of the explicit targets governments will aim to achieve with their plans. Although several governments have announced their intentions to earmark portions of their packages for a “green recovery,” the exact details remain largely unclear, and most governments have not yet signaled how they intend to spend their money. This uncertainty notwithstanding, the massive influx of support will be consequential in shaping the postpandemic global economy. We demonstrate the potential impact that current stimulus could have for a low-carbon energy system transformation. Although such a transformation requires a wide array of policy measures to come to fruition, the spending and liquidity support being put forward can be a powerful catalyst for a climate-positive recovery. Quantitative modeling studies of pathways compatible with the Paris Agreement agree that a low-carbon transformation is predicated on decarbonizing the production and use of energy ([ 3 ][3], [ 5 ][5], [ 6 ][6]), responsible for about two-thirds of economy-wide greenhouse gas emissions. To meet the Paris goals, energy supply would need to fully decarbonize by mid-century, if not before ([ 3 ][3], [ 5 ][5], [ 6 ][6]). Aggregate stimulus estimates ([ 1 ][1]), green recovery scenarios ([ 7 ][7]), or suggestions for green recovery policy packages ([ 8 ][8]) have been published, among a plethora of analyses related to the pandemic. We compare the magnitude of COVID-19 recovery stimulus to the levels of energy system investment required for putting the world on a path toward achieving the goals of the Paris Agreement ([ 5 ][5]), based on the average estimate across six energy-economy models that were included in the recent Special Report on Global Warming of 1.5°C by the Intergovernmental Panel on Climate Change (IPCC) ([ 3 ][3]). Although individual model estimates can differ by up to ±50%, the conclusions deriving from our analysis are nevertheless robust. Investments here refer to capital expenses for resource extraction, their conversion, power generation, transmission, and storage, together with efficiency improvements that reduce energy use in buildings, transport, and industry (see SM for details). The crucial insight emerging from this comparison (see the figure) is the following: Low -carbon investments over the next several years to put the world on track toward net zero carbon dioxide emissions by mid-century are dwarfed by COVID-19 stimulus. Though impressive, a closer look at the numbers points to opportunities as well as challenges. Average annual low-carbon energy and end-use energy efficiency investment needs under a Paris-compatible pathway have been estimated at about USD 1.4 trillion per year globally over the near term between 2020 and 2024 ([ 3 ][3], [ 5 ][5]). This yearly estimate of low-carbon energy investments amounts to some 10% of the total pledged COVID-19 stimulus to date (see the figure and figs. S3 and S4), or about half of stimulus when investments are cumulated over the 5-year 2020–2024 period. Given that stimulus is expected to be spent over the course of a few fiscal years only and governments have traditionally played a minority role in energy investment globally, the potential for the current tranche of public funding to support a green recovery over the next years is thus enormous. ![Figure][9] Economic stimulus and energy investments Liquidity support includes loans, guarantees, and quasi-fiscal operations. General spending reflects measures aimed at non–health sectors of the economy and which include supporting individuals, households, and businesses, as well as forgone and deferred revenue. Energy investments are representative of average annual energy system investments over the near term (2020–2024) in a low-carbon pathway consistent with achieving the UN Paris Agreement. Annual investment shifts represent the difference in fossil fuel and low-carbon investments between current policies and a low-carbon pathway consistent with the Paris Agreement. In the absence of specific sectoral allocations, announced stimulus is classified as General spending, e.g., for China. Data and additional figures are available in the supplementary materials. GRAPHIC: N. CARY/ SCIENCE The comparison between stimulus funding and low-carbon energy investment needs becomes sharper when concentrating specifically on those investments above and beyond a non–Paris-compatible trajectory, like the one society has been on up to now. About USD 1.1 trillion per year of low-carbon energy investment has been estimated for such a non-Paris path, together with an accompanying USD 1.1 trillion in fossil fuels. These amounts would ensure sufficient infrastructure and technology deployment for global energy demand to be met, yet still tilting toward a rather weak, pre-COVID climate policy environment worldwide ([ 3 ][3], [ 5 ][5]). The additional investment needed to shift low-carbon energy investment onto a Paris-compatible pathway thus amounts to about USD 300 billion per year globally over the coming 5 years (see the figure and figs. S5 to S7), less than 3% of total pledged stimulus to date or 12% when considered over the entire 2020–2024 period. Simply put, if even a fraction of current government stimulus would be directed in a responsible manner toward a green recovery, the marginal benefits for a low-carbon future could be considerable. Despite the order-of-magnitude difference in these numbers, there is an important additional part to this story: Increases in low-carbon investments have to be accompanied by divestments from high-carbon fossil fuels in the range of USD 280 billion per year over the same near-term period. These divestments are distinct from the possible removal of fossil-fuel subsidies, which also range in the hundreds of billions of USD but mainly target consumption instead of production of fossil fuels ([ 9 ][10]). Subtracting divestments from investments indicates that the overall increase in net annual investments to achieve an ambitious low-carbon transformation in the energy sector are notably small (see fig. S3): about 20 additional billion USD per year globally. This represents a mere 0.2% of the total announced stimulus to date (compare figs. S5 and S1), or 1% over the 2020–2024 period. These numbers highlight that a climate-positive COVID-19 recovery relies as much on supporting green investments as it does on avoiding lock-in in polluting ones. Of course, not all stimulus should be expected to go into the energy transition. Our analysis indicates that, understandably, a substantial number of shares of “above-the-line” measures are earmarked for other sectors, such as health and financial relief for individuals and households. Moreover, governments are typically responsible for only a limited share of investment in low-carbon energy across the world ([ 10 ][11]). What governments can do, though, is mobilize private investment by channeling stimulus into dedicated public financing mechanisms. For example, liquidity measures for development banks can help them to proactively support low-carbon investments, particularly in developing countries, and through that reduce perceived risks faced by private investors ([ 11 ][12]). Today’s exceptional circumstances could also give rise to low-carbon energy and efficiency investment needs or opportunities that exceed those estimated by earlier studies. For example, today’s historically low interest rates support the competitiveness of green technologies. Moreover, the investment estimates relied upon here derive from welfare-optimizing scenarios using neoclassical economic theory that assess substantial, yet sustained and gradual changes in investment patterns over the long term in an otherwise stable socioeconomic context ([ 5 ][5]). These assumptions are in stark contrast with today’s reality. Nonequilibrium economic theory might be more adequate in a crisis context and may suggest that substantially increasing green investments beyond the estimates provided here could offer further benefits for growth ([ 12 ][13]). Beyond the global situation, we find that when looking more regionally, total stimulus in all cases exceeds annual low-carbon energy investment needs for an ambitious Paris-compatible pathway (see figs. S8 and S9; here we look at macro regions as defined in table S2 and which are often used in energy-economy modeling). However, clear differences exist between regions and countries. The EU and United States have issued the largest stimulus packages globally, both in absolute terms and relative to the size of their economies. Total stimulus exceeds average annual low-carbon energy investment needs by a factor of 20 in the United States and by over 30 in the EU (see the figure and fig. S2). Even when considering the entire 2020–2024 period, total stimulus remains several times larger than low-carbon energy investment needs. Developing economies are in a different situation. So far, the combined stimulus available to low- and lower-middle income countries amounts to only a tiny fraction (less than 4%) of total global stimulus and even including upper-middle income economies raises this share to 14% only. These numbers exclude potential international support, which to date remains negligibly small compared to the pledged domestic COVID-19 stimulus. This discrepancy will not only affect developing countries’ ability to recover from the COVID-19 crisis but also the world’s collective ability to achieve the Paris Agreement climate goals. Despite recovery packages in developing countries being smaller than in developed countries [both in absolute terms and as a share of gross domestic product (GDP)], annual low-carbon energy investment needs are generally larger in these rapidly growing economies in a relative sense (see the figure and fig. S8). For example, India’s total annual low-carbon energy investment needs relative to its GDP are about four times higher than those of the EU, and the country’s stimulus package relative to its GDP is about a quarter the size of the EU’s. Institutionalizing international support within intergovernmental systems such as the Green Climate Fund of the United Nations Framework Convention on Climate Change or multilateral development banks could help to solidify the partnerships needed to enable a global climate-positive recovery. Furthermore, targeted financial instruments, like blended finance, have also been suggested as a means to increase low-carbon investment flows to developing countries ([ 11 ][12], [ 13 ][14]). Blended finance uses government, multilateral, or philanthropic money to lower the risk for private investors and therewith mobilize additional private investments in developing countries. International support of only a small fraction of current COVID-19 stimulus could thus already provide a lever to catalyze a low-carbon transformation in this first half of the decade. As developing countries are struggling with the economic fallout of the COVID-19 crisis, mobilizing additional domestic resources might seem challenging, both financially and politically. To this end, a range of measures with both near-term economic benefits and long-term climate-positive potential can prove effective ([ 8 ][8]). In the context of a postcrisis recovery, governments will be looking for stimulus measures that can boost employment, scale rapidly, and increase societies’ resilience to future shocks. Targeting a green transformation of the energy system as the proverbial engine of the economy can provide such ancillary benefits. Investment in clean energy has been identified as a driver of employment ([ 7 ][7], [ 14 ][15]); it can also spur innovation and diffusion of technologies across borders—an essential catalyst for low-carbon transformations of economies worldwide ([ 15 ][16]). Renewable energy investments have demonstrated a large potential for job creation and often offer a more desirable risk profile for investors ([ 14 ][15]). Technologies like solar photovoltaics and wind turbines are of a small, modular size that allows for a more rapid upscaling of production and much shorter project lead times. At the same time, achieving a low-carbon transformation involves more than just investments in low-carbon energy. It requires a broad range of reinforcing policy measures, including taxation and subsidy reform, research and innovation, professional training, and education. It will also require a variety of financial instruments, from direct infrastructural investments and capital spending to liquidity support and loan guarantees for private sector investments. In the post–COVID-19 context, this means that beyond the fiscal injections that governments can supply, recovery packages should encompass incentives, policies, taxes or rebates, mandates, and other supportive regulations that facilitate the achievement of long-term climate goals. By serving as a clear signal to investors, green recovery packages also reduce the likelihood of stranded assets. By contrast, polluting recovery packages that include unconditional oil and gas company bailouts may serve to increase the number of assets that will someday be stranded. Unless governments embed their stimulus support in a coherent long-term vision—for example, by combining support to polluting sectors with a reorientation program for their workforce—the risk for additional disruption and accompanying economic hardship in the medium term will remain high. All of these attributes make holistic green policies attractive in the context of a postcrisis recovery, and given the many ancillary society-wide benefits, governments may even choose to adopt green recovery targets beyond those presented here. In sum, a small fraction of announced COVID-19 economic recovery packages could provide the necessary financial basis for a decided shift toward a Paris Agreement–compatible future. The dual crises of COVID-19 and climate change are global problems requiring bold government action, international cooperation, and sustainable and inclusive solutions. Though challenging politically, our findings show that these solutions are well within budget. [science.sciencemag.org/content/370/6514/298/suppl/DC1][17] 1. [↵][18]IMF, Policy Responses to COVID-19 – Policy Tracker. International Monetary Fund (2020); [www.imf.org/en/Topics/imf-and-covid19/Policy-Responses-to-COVID-19][19]. 2. [↵][20]1. N. Höhne et al ., Nature 579, 25 (2020). [OpenUrl][21] 3. 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[↵][29]IEA, “Sustainable Recovery” (International Energy Agency, Paris, France, 2020); [www.iea.org/reports/sustainable-recovery][30]. 8. [↵][31]1. C. Hepburn, 2. B. O’Callaghan, 3. N. Stern, 4. J. Stiglitz, 5. D. Zenghelis , Oxf. Rev. Econ. Policy 36 (suppl. 1), S359 (2020). [OpenUrl][32] 9. [↵][33]1. J. Jewell et al ., Nature 554, 229 (2018). [OpenUrl][34] 10. [↵][35]IRENA, CPI, “Global Landscape of Renewable Energy Finance” (International Renewable Energy Agency, Abu Dhabi, 2018), p. 44. 11. [↵][36]1. B. Steffen, 2. T. S. Schmidt , Nat. Energy 4, 75 (2019). [OpenUrl][37] 12. [↵][38]1. H. Pollitt, 2. J.-F. Mercure , Clim. Policy 18, 184 (2018). [OpenUrl][39] 13. [↵][40]1. B. Tonkonogy, 2. J. Brown, 3. V. Micale, 4. X. Wang, 5. A. Clark , “Blended Finance in Clean Energy: Experiences and Opportunities” (Climate Policy Initiative, 2018), p. 38. 14. [↵][41]1. C. Wilson et al ., Science 368, 36 (2020). [OpenUrl][42][Abstract/FREE Full Text][43] 15. [↵][44]1. D. Acemoglu et al ., Am. Econ. Rev. 108, 3450 (2018). [OpenUrl][45] 16. [↵][46]1. M. Andrijevic et al ., Climate-analytics/covid_recovery: Data and analysis scripts, Zenodo (2020); . Acknowledgments: We thank E. Campiglio and J. Tanaka for their feedback on international financial support mechanisms, and acknowledge the contributions of J. Kim, B. Yesil, and K. Lee, who provided excellent research assistance for the curation of the data. M.A. and C.F.S. acknowledge support by the German Federal Ministry of Education and Research (01LS1905A). The views expressed in this paper are those of the authors and do not necessarily reflect those of their institutions. All data and codes are available at Zenodo ([ 16 ][47]). 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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has brought distinct challenges to the care of children and adolescents globally. Unusually for a respiratory viral infection, children and adolescents are at much lower risk from symptomatic coronavirus disease 2019 (COVID-19) than any other age group. The near-global closure of schools in response to the pandemic reflected the reasonable expectation from previous respiratory virus outbreaks that children would be a key component of the transmission chain. However, emerging evidence suggests that this is most likely not the case. A minority of children experience a postinfectious inflammatory syndrome, the pathology and long-term outcomes of which are poorly understood. However, relative to their risk of contracting disease, children and adolescents have been disproportionately affected by lockdown measures, and advocates of child health need to ensure that children’s rights to health and social care, mental health support, and education are protected throughout subsequent pandemic waves. Evidence from contact-tracing studies suggest that children and teenagers are less susceptible to SARS-CoV-2 infection than adults; however, community swabbing and seroprevalence studies conducted outside of outbreak settings suggest that infection rates are similar to those in older age groups ([ 1 ][1]–[ 3 ][2]). Only half of children and teenagers with antibodies against SARS-CoV-2 have experienced symptoms, and there is growing evidence that there is a broad range of presentations, emphasizing the limitations of community-based prevalence studies based on testing only children with respiratory symptoms. Hospitalization for severe acute COVID-19 in children is rare, but among these pediatric inpatients, respiratory symptoms are more apparent than in infected children in the community ([ 4 ][3]). Case fatality in hospitalized children is, fortunately, relatively low at 1% (compared with 27% across all ages) ([ 4 ][3]). The reason for the lower burden of symptomatic disease in children is not yet clear. Upper airway expression of angiotensin-converting enzyme 2 (ACE2), a receptor for the SARS-CoV-2 spike protein, increases with age, and higher ACE2 expression correlates with being positive for SARS-CoV-2 genomic RNA in swabs of upper respiratory tracts from symptomatic children, but not with viral load ([ 5 ][4]). An alternative proposal is the absence in children of maladaptive immune responses that lead to acute respiratory distress syndrome (ARDS) in older age groups ([ 6 ][5]), but there are likely other unidentified mechanisms. Understanding the nature of immune responses in children is important given the rare, but potentially severe, multisystem inflammatory syndrome observed in more than 1000 children and adolescents in multiple countries during the first wave of COVID-19 ([ 7 ][6]). Known variously as pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS), multisystem inflammatory syndrome in children (MIS-C), or Kawasaki-like disease, the illness presents with persistent fever accompanied, to a variable extent, by gastrointestinal symptoms, rash, and conjunctival inflammation. Laboratory markers of inflammation are very high, and myocarditis is a distinct, and potentially fatal, feature. Children and young people with PIMS-TS are more likely to have antibodies to SARS-CoV-2 than evidence of virus from nasal swabs, with presentations usually 4 to 6 weeks after infection. The cardiac involvement initially led to this condition being described as a variant of Kawasaki disease (in which an unknown trigger leads to an inflammatory disease, resulting in coronary artery inflammation). However, a comprehensive case series clearly delineated PIMS-TS from Kawasaki disease, with children who experience PIMS-TS being substantially older and with increased circulating concentrations of ferritin (a marker of inflammation) and D-dimer and troponin (markers of cardiovascular damage), which are rarely seen in Kawasaki disease ([ 8 ][7]). A dominant feature of PIMS-TS is myocarditis, transient myocardial dysfunction, and shock, which are present in approximately half of UK and U.S. case series ([ 8 ][7], [ 9 ][8]). In the UK, a Delphi national consensus statement has recently been proposed ([ 10 ][9]) to guide investigation and management of this condition, which focuses on supportive care and enrolling patients into a specific arm of the RECOVERY randomized controlled trial to evaluate the use of corticosteroids and intravenous immunoglobulin in patients with acute PIMS-TS. Fortunately, fatalities are rare [occurring in 10 of the 570 cases reported to the U.S. Centers for Disease Control and Prevention between March and July 2020, and none of 52 cases in a UK series ([ 4 ][3], [ 9 ][8])]. However, the long-term consequences are unknown, and all children and teenagers who experience PIMS-TS require ongoing cardiac review. Proposed mechanisms for this illness have focused on a maladaptive acquired immune response to SARS-CoV-2 infection, and a dysregulated humoral immune response is suggested by increased antibodies against multiple, non–SARS-CoV-2, respiratory viruses in severe MIS-C but not mild MIS-C or acute COVID-19 ([ 5 ][4]). Understanding this response is crucial when considering the risks and benefits of immunizing children against COVID-19, should a vaccine become available. Of the vaccines being tested in clinical trials, none have yet been administered to children, with priority instead being given, appropriately, to older age groups. The most advanced candidate, ChAdOX1-nCOV-19, is currently in phase 2 and 3 studies that include a pediatric arm for 5 to 12 year olds (NCT04400838), receiving half the full adult dose in this study. However, this study arm is not currently active and will commence enrolment only once the safety profile in adults is more complete. Given the low rates of disease in children, they are likely to be a low priority to receive a vaccine unless it is definitively shown that (i) children have an important role in the transmission of the virus and (ii) the vaccine reduces viral shedding (and hence reduces transmission). To what extent do children transmit SARS-CoV-2? Recent reports that young children acutely unwell with COVID-19 have concentrations of viral RNA in nasal aspirates that are similar to, or higher, than adults ([ 5 ][4]) raised concerns that their role in transmission may have been underestimated. However, one of these studies compared children within the first week of illness with adults with more than 7 days of symptoms, when viral load is expected to be reduced ([ 5 ][4]). Such studies need to be interpreted with consideration of the very low numbers of children with symptomatic COVID-19. Of greater concern is the possibility that viral shedding could be occurring from asymptomatic children and that, given schools “bridge” households, this could create a pool of ongoing viral circulation responsible for introductions of virus to the pupils’ homes and beyond. Understanding this issue is fundamental to resolving what has been an unprecedented global disruption to primary (children of ∼5 to 11 years) and secondary (children aged 11 to 18 years) education. Given the near universal closing of schools in conjunction with other lockdown measures, it has been difficult to determine what benefit, if any, closing schools has over other interventions. However, there is some reassurance: Multiple studies of contacts of primary and secondary school children with known SARS-CoV-2 infection showed minimal onward transmission in schools ([ 3 ][2]). Furthermore, after the reopening of primary schools in the UK, only 1 of 23,358 nasal swabs taken from children in June 2020 had detectable SARS-CoV-2, giving an estimate of 3.9 cases per 100,000 students ([ 2 ][10]). Looked at from another perspective, when household outbreaks of infection have occurred, it appears that children were responsible for only a small minority of household introductions of the virus. Also, recent surveys found that reopening of schools in a number of European countries in April and May had no clear impact on community transmission, with cases continuing to fall in most countries after reopening ([ 11 ][11]). Nevertheless, recent experiences of substantial outbreaks of COVID-19 related to children and teenagers show that there is no room for complacency. In May, an Israeli secondary school was shut shortly after a postlockdown reopening after the identification of two symptomatic students independently infected with SARS-CoV-2. A subsequent schoolwide testing campaign revealed that 153 (13.2%) students and 25 (16.6%) staff had detectable SARS-CoV-2 infection, and contact tracing revealed a further 87 cases in non–school attendees ([ 12 ][12]). Although formal studies were not conducted to definitively show school-based transmission, potential contributory factors included a heat wave that led to extensive use of air-conditioning and exemptions from face mask wearing, relatively crowded classrooms (with 35 to 38 per class with 1.1 to 1.3 m2 between students), and shared schoolyard and outdoor spaces. As schools in the Northern Hemisphere reopen after summer holidays, risk mitigation strategies adopted to variable degrees include creating separate cohorts (or “bubbles”) within schools that interact minimally with each other, use of face masks in crowded areas (if not the classroom itself ), and regular screening of students and staff. The coming months will provide an invaluable opportunity to identify which of these measures are most effective at minimizing transmission, to generate a standard “best practice” that balances young peoples’ rights to an education with the need to protect the broader community from further transmission. However, it is inevitable that there will be students attending school while infected with SARS-CoV-2, and likely there will be some school outbreaks, with the frequency of these events reflecting levels of community transmission. Regardless, it is hard to support the opening of retail and hospitality sectors while schools remain shut, as occurred in many countries earlier this year. School closures and attendant loss of other protective systems for children (such as limited social care and health visiting) highlight the indirect, but very real, harms being disproportionately borne by children and teenagers as a result of measures to mitigate the COVID-19 pandemic. In the UK, it is estimated that the impact on education thus far may lead to a quarter of the national workforce having lower skills and attainment for a generation after the mid-2020s, leading to the loss of billions of dollars in national wealth ([ 11 ][11]). Additionally, there are a variety of other harms to children’s health, including the risk of reemergence of vaccine-preventable diseases such as measles because of disruptions to immunization programs. There are many other areas of potential indirect harm to children, including an increase in home injuries (accidental and nonaccidental) when children have been less visible to social protection systems because of lockdowns. In Italy, hospitalizations for accidents at home increased markedly during the COVID-19 lockdown and potentially posed a higher threat to children’s health than COVID-19 ([ 13 ][13]). UK pediatricians report that delay in presentations to hospital or disrupted services contributed to the deaths of equal numbers of children that were reported to have died with SARS-CoV-2 infection ([ 14 ][14]). Many countries are seeing evidence that mental health in young people has been adversely affected by school closures and lockdowns. For example, preliminary evidence suggests that deaths by suicide of young people under 18 years old increased during lockdown in England ([ 15 ][15]). The role of children in transmission of SARS-CoV-2 remains unclear; however, existing evidence points to educational settings playing only a limited role in transmission when mitigation measures are in place, in marked contrast to other respiratory viruses. In the event of seemingly inevitable future waves of COVID-19, there is likely to be further pressures to close schools. There is now an evidence base on which to make decisions, and school closures should be undertaken with trepidation given the indirect harms that they incur. Pandemic mitigation measures that affect children’s wellbeing should only happen if evidence exists that they help because there is plenty of evidence that they do harm. 1. [↵][16]What’s the STORY, “Serum testing of representative youngsters” (2020); . 2. [↵][17]1. S. Ladhani , PHE publications gateway number: GW-1599 (Public Health England, 2020); . 3. [↵][18]1. R. M. Viner et al ., medRxiv 20108126 [Preprint] 21 August 2020; 10.1101/2020.05.20.20108126. 4. [↵][19]1. O. V. Swann et al ; ISARIC4C Investigators, BMJ 370, m3249 (2020). [OpenUrl][20][Abstract/FREE Full Text][21] 5. [↵][22]1. L. M. Yonker et al ., J. Pediatr. S0022-3476(20)31023-4 (2020). 10.1016/j.jpeds.2020.08.037 6. [↵][23]1. A. Fialkowski et al ., Pediatr. Pulmonol. (2020). 10.1002/ppul.24981 7. [↵][24]1. A. H. Rowley , Nat. Rev. Immunol. 20, 453 (2020). [OpenUrl][25][CrossRef][26][PubMed][27] 8. [↵][28]1. E. Whittaker et al ; PIMS-TS Study Group and EUCLIDS and PERFORM Consortia, JAMA 324, 259 (2020). 10.1001/jama.2020.10369 [OpenUrl][29][PubMed][30] 9. [↵][31]1. S. Godfred-Cato et al ; California MIS-C Response Team, MMWR Morb. Mortal. Wkly. Rep. 69, 1074 (2020). [OpenUrl][32][CrossRef][33][PubMed][34] 10. [↵][35]1. R. Horwood et al ., medRxiv 20156075 [Preprint] 23 July 2020; 10.1101/2020.07.17.20156075. 11. [↵][36]The DELVE Initiative, “Balancing the risks of pupils returning to schools” (Royal Society DELVE Initiative, 2020); . 12. [↵][37]1. C. Stein-Zamir et al ., Euro Surveill. 25, (2020). 10.2807/1560-7917.ES.2020.25.29.2001352 13. [↵][38]1. S. Bressan, 2. E. Gallo, 3. F. Tirelli, 4. D. Gregori, 5. L. Da Dalt , Arch. Dis. Child. archdischild-2020-319547 (2020). 10.1136/archdischild-2020-319547 14. [↵][39]1. R. M. Lynn, 2. J. L. Avis, 3. S. Lenton, 4. Z. Amin-Chowdhury, 5. S. N. Ladhani , Arch. Dis. Child. archdischild-2020-319848 (2020). 10.1136/archdischild-2020-319848 15. [↵][40]1. D. Odd et al ., “Child suicide rates during the COVID-19 pandemic in England: Real-time surveillance” (Healthcare Quality Improvement Partnership 2020); https://bit.ly/3moxo2V. 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Additionally, a Fairbanks Pioneer Home resident recently hospitalized with the virus died on Wednesday.