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Why children’s ‘choice’ about COVID-19 masking at school needs far more discussion

Children deserve agency in decisions that affect them, but adults are ultimately responsible for making decisions in children’s best interests.



Who is determining children's capacity to decide whether or not to wear a mask and what's at stake in their decision? THE CANADIAN PRESS/Nathan Denette

Public health pandemic responses across Canada continue to be fluid. Like other provinces, Nova Scotia has moved away from mandatory masking protocols in public spaces toward individual choice and recommendations, including in schools.

Communication to families of school-aged children directs students, teachers, and staff to make their own choice about masking.

Can a five-year-old make such a health-related decision on their own behalf? What about an 11-year-old?

From our vantage point as academics who work at intersections of education and health care, public health recommendations and provinces’ removal of clear masking requirements don’t appear to consider a child’s capacity to make decisions that affect their health.

How this “individual choice” approach plays out for students in schools needs to be carefully considered.

A teacher wears a mask next to a list of pandemic rules in the classroom about keeping one's mask on and washing hands.
When provinces mandated wearing masks at school in earlier stages of the pandemic, teachers were responsible for leading and enforcing mask wearing. THE CANADIAN PRESS/Nathan Denette

Who is responsible for children’s health?

As children’s rights advocates have noted throughout the pandemic, it is unethical to exclude children from conversations about issues that affect them.

However, the child’s right to be heard does not necessarily translate into being capable of making complex health-related decisions for themselves.

The World Health Organization leads global initiatives to protect the health of children and supports countries who want assistance developing their own national policies.

The federal government, in large part through Health Canada, is responsible for maintaining and improving the health of Canadians in line with the Canada Health Act.

Each provincial government is responsible for the management and delivery of health-care services.

Adult guardians hold decision-making responsibility on behalf of their children’s health.

Why, then, are students deciding for themselves whether or not to wear a mask in enclosed public spaces during a pandemic?

Ethical decision-making capacity?

For ethical reasons, fields like clinical psychology, health care and law are concerned with a person’s capacity to make decisions.

Medical researchers and doctors Craig Barstow and colleagues argue that patients have medical decision-making capacity if they can “demonstrate understanding of the situation, appreciate the consequences of their decision and reasoning in their thought process, and if they can communicate their wishes.”

The work on specifically understanding a child’s competency to make choices that affect one’s health and development is widely known in health-care and legal settings serving children and adolescents. Unfortunately, there is a paucity of research on a child’s capacity to make decisions in school settings.

Fundamentally, the criteria for being capable to make a decision are the same for children as adults.

Children standing outside a school wearing masks.
Can children appreciate the consequences of a decision to mask or not to mask? THE CANADIAN PRESS/Nathan Denette

What adults need to ask

Key questions adults need to ask themselves when determining a child’s capacity to decide include:

  1. What supports does the child have, and what unique risk factors might need to be considered in each context?
  2. Does the child understand and can they communicate the question being asked in their own words?
  3. Does the child have the autonomy needed to make a decision for themselves?
  4. Is there an established relationship with an adult whereby a child can feel comfortable asking questions to clarify understanding of the decision and potential short- and long-term consequences? Which adult is responsible for this in classrooms?
  5. Do guardians expect teachers to be responsible for enforcing choices parents want children to make? If so, how will teachers manage this?
  6. Will peer-comparison or other social pressures unduly influence the child?
  7. Do the responsible adults in that child’s life (guardians, teachers, school leadership, politicians establishing recommendations) understand that they are ultimately responsible for any risks that children take regarding their own health?

In Nova Scotia, unlike the legislated age to drive (16), or to vote (18), there is no specified age a child must reach before they are able to make decisions that relate to their health.

Where psychologists, social workers or physicians are involved with children’s health and wellness, the treating psychologist, social worker or physician must determine, on a case by case basis, whether a child is capable of making decisions in their best interest.

Teachers are not trained to determine capacity to decide. Have we given children a choice that they cannot make?

Read more: Teachers are on the front lines with students in the coronavirus pandemic

Difficult to assess

A box of masks seen on a school table.
How are children thinking about possible futures and evidence when they consider whether or not to mask? THE CANADIAN PRESS/Andrew Vaughan

Decision-making capacity is difficult to assess in children, and develops from early to late childhood and into adolescence.

As explained in the psychologist Piaget’s theory of cognitive development, a child who has not yet reached adolescence is unlikely to have the capacity to think about possible futures.

This would include a child’s capacity to consider evidence in a way that helps them decide whether or not to wear a mask.

The issue for public education can be framed within one question: Who is determining students’ capacity to decide?

Adults ultimately responsible

It is critical that adults responsible for the health of children understand the complexity of decision-making capacity, so as to decide whether it is developmentally appropriate to allow students in elementary and high schools to engage in health-related decision-making.

To be clear, we are not advocating for or against any particular health recommendation or mandate. Experts in infectious diseases and public health should lead that conversation.

However, our hope is this article raises awareness that, whereas children deserve agency in decisions that affect them, it is adults who are are ultimately responsible for fully considering the implications of federal and provincial mandates and policies on children’s rights and well-being — and subsequently for making decisions in children’s best interests.

The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

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I’m headed to London soon for #EUBIO22. Care to join me?

Adrian Rawcliffe
It was great getting back to a live ESMO conference/webinar in Paris followed by a live pop-up event for the Endpoints 11 in Boston. We’re…



Adrian Rawcliffe

It was great getting back to a live ESMO conference/webinar in Paris followed by a live pop-up event for the Endpoints 11 in Boston. We’re staying on the road in October with our return for a live/streaming EUBIO22 in London.

Kate Bingham

Silicon Valley Bank’s Nooman Haque and I are once again jumping back into the thick of it with a slate of virtual and live events on October 12. I’ll get the ball rolling with a virtual fireside chat with Novo Nordisk R&D chief Marcus Schindler, covering their pipeline plans and BD work.

After that I’ve teed up two webinars on mRNA research — with some of the top experts in Europe — and the oncology scene, building better CARs in Europe.

That afternoon, we’ll switch to a live/streaming hybrid event, with a chance to gather once again now that the pandemic has faded. I’ve recruited a panel of top biotech execs to look at surviving the crazy public market, with Adrian Rawcliffe, the CEO of Adaptimmune, SV’s Kate Bingham, Mereo CEO Denise Scots-Knight and Andrew Hopkins, chief of Exscientia.

Andrew Hopkins
Denise Scots-Knight

That will be followed by my special, live fireside chat with Susan Galbraith, the oncology R&D chief at AstraZeneca. And then we’ll turn to Nooman’s panel, where he’ll be talking with Katya Smirnyagina with Oxford Science Enterprises, Maina Bhaman with Sofinnova Partners and Rosetta Capital’s Jonathan Hepple about navigating the severe capital headwinds.

You can review the full schedule and buy tickets here and review everything we have planned. It will be a packed day. I hope to see you there. It’s been several years now since I’ve had a chance to meet people in the Golden Triangle. I’m very much looking forward to it.

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We can turn to popular culture for lessons about how to live with COVID-19 as endemic

As COVID-19 transitions from a pandemic to an endemic, apocalyptic science-fiction and zombie movies contain examples of how to adjust to the new norm…




An endemic means that COVID-19 is still around, but it no longer disrupts everyday life. (Shutterstock)

In 2021, conversations began on whether the COVID-19 pandemic will, or even can, end. As a literary and cultural theorist, I started looking for shifts in stories about pandemics and contagion. It turns out that several stories also question how and when a pandemic becomes endemic.

Read more: COVID will likely shift from pandemic to endemic — but what does that mean?

The 2020 film Peninsula, a sequel to the Korean zombie film, Train to Busan, ends with a group of survivors rescued and transported to a zombie-free Hong Kong. In it, Jooni (played by Re Lee) spent her formative years living through the zombie epidemic. When she is rescued, she responds to being informed that she’s “going to a better place” by admitting that “this place wasn’t bad either.”

Jooni’s response points toward the shift in contagion narratives that has emerged since the spread of COVID-19. This shift marks a rejection of the push-for-survival narratives in favour of something more indicative of an endemic.

Found within

Contagion follows a general cycle: outbreak, epidemic, pandemic and endemic. The determinants of each stage rely upon the rate of spread within a specified geographic region.

Etymologically, the word “endemic” has its origins with the Greek words én and dēmos, meaning “in the people.” Thus, it refers to something that is regularly found within a population.

Infectious disease physician Stephen Parodi asserts that an endemic just means that a disease, while still prevalent within a population, no longer disrupts our daily lives.

Similarly, genomics and viral evolution researcher Aris Katzourakis argues that endemics occur when infection rates are static — neither rising nor falling. Because this stasis occurs differently with each situation, there is no set threshold at which a pandemic becomes endemic.

Not all diseases reach endemic status. And, if endemic status is reached, it does not mean the virus is gone, but rather that things have become “normal.”

Survival narratives

We’re most likely familiar with contagion narratives. After all, Steven Soderbergh’s 2011 film Contagion, was the most watched film on Canadian Netflix in March 2020. Conveniently, this was when most Canadian provinces went into lockdown during the early stages of the COVID-19 pandemic.

A clip from the film Contagion showing the disease spreading throughout the world.

In survival-based contagion narratives, characters often discuss methods for survival and generally refer to themselves as survivors. Contagion chronicles the transmission of a deadly virus that is brought from Hong Kong to the United States. In response, the U.S. Centers for Disease Control is tasked with tracing its origins and finding a cure. The film follows Mitch Emhoff (Matt Damon), who is immune, as he tries to keep his daughter safe in a crumbling Minneapolis.

Ultimately, a vaccine is successfully synthesized, but only after millions have succumbed to the virus.

Like many science fiction and horror films that envision some sort of apocalyptic end, Contagion focuses on the basic requirements for survival: shelter, food, water and medicine.

However, it also deals with the breakdown of government systems and the violence that accompanies it.

A “new” normal

In contrast, contagion narratives that have turned endemic take place many years after the initial outbreak. In these stories, the infected population is regularly present, but the remaining uninfected population isn’t regularly infected.

A spin-off to the zombie series The Walking Dead takes place a decade after the initial outbreak. In the two seasons of The Walking Dead: World Beyond (2020-2021) four young protagonists — Hope (Alexa Mansour), Iris (Aliyah Royale), Silas (Hal Cumpston) and Elton (Nicolas Cantu) — represent the first generation to come of age within the zombie-infested world.

The four youth spent their formative years in an infected world — similar to Jooni in Peninsula. For these characters, zombies are part of their daily lives, and their constant presence is normalized.

The trailer for the second season of AMC’s The Walking Dead: World Beyond.

The setting in World Beyond has electricity, helicopters and modern medicine. Characters in endemic narratives have regular access to shelter, food, water and medicine, so they don’t need to resort to violence over limited resources. And notably, they also don’t often refer to themselves as survivors.

Endemic narratives acknowledge that existing within an infected space alongside a virus is not necessarily a bad thing, and that not all inhabitants within infected spaces desire to leave. It is rare in endemic narratives for a character to become infected.

Instead of going out on zombie-killing expeditions in the manner that occurs frequently in the other Walking Dead stories, the characters in World Beyond generally leave the zombies alone. They mark the zombies with different colours of spray-paint to chronicle what they call “migration patterns.”

The zombies have therefore just become another species for the characters to live alongside — something more endemic.

The Walking Dead, Fear the Walking Dead (2015-), Z Nation (2014-18), and many other survival-based stories seem to return to the past. In contrast, endemic narratives maintain a present and sometimes even future-looking approach.

Learning from stories

According to film producer and media professor Mick Broderick, survival stories maintain a status quo. They seek a “nostalgically yearned-for less-complex existence.” It provides solace to imagine an earlier, simpler time when living through a pandemic.

However, the shift from survival to endemic in contagion narratives provides us with many important possibilities. The one I think is quite relevant right now is that it presents us with a way of living with contagion. After all, watching these characters survive a pandemic helps us imagine that we can too.

Krista Collier-Jarvis does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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Xi Reemerges In 1st Public Appearance After ‘Coup’ Rumors

Xi Reemerges In 1st Public Appearance After ‘Coup’ Rumors

So much for the "coup in China" and "Xi is missing" rumor mill of the past week,…



Xi Reemerges In 1st Public Appearance After 'Coup' Rumors

So much for the "coup in China" and "Xi is missing" rumor mill of the past week, which at one point saw Chinese President Xi Jinping's name trending high on Twitter...

"Chinese President Xi Jinping visited an exhibition in Beijing on Tuesday, according to state television, in his first public appearance since returning to China from an official trip to Central Asia in mid-September – dispelling unverified rumours that he was under house arrest."

He had arrived in Samarkand, Uzbekistan on September 15 - and attended the days-long Shanghai Cooperation Organization (SCO) summit - where he met with Russian President Vladimir Putin, among others.

Xi is "back"...image via state media screenshot

Importantly, it had been his first foreign trip in two years. Xi had not traveled outside of the country since before the Covid-19 pandemic began.

But upon returning the Beijing, he hadn't been seen in the public eye since that mid-September trip, fueling speculation and rumors in the West and on social media. Some pundits floated the idea that he had been under "house arrest" amid political instability and a possible coup attempt.

According to a Tuesday Bloomberg description of the Chinese leader's "re-emergence" in the public eye, which has effectively ended the bizarre rumors

Xi, wearing a mask, visited an exhibition in Beijing on Tuesday about China's achievements over the past decade, state-run news outlet Xinhua reported. The Chinese leader was accompanied by the other six members of the Politburo Standing Committee, a sign of unity after rumors circulated on Twitter about a challenge to his power.

He'll likely cinch his third five-year term as leader at the major Chinese Communist party’s (CCP) meeting on October 16. The CCP meeting comes only once every half-decade.

What had added to prior rumors was the fact that the 69-year old Xi recently undertook a purge of key senior security officials. This included arrests on corruption charges of the former police chiefs of Shanghai, Chongqing and Shanxi.

More importantly, former vice minister of public security Sun Lijun and former justice minister Fu Zhenghua were also sacked and faced severe charges.

Concerning Sun Lijun, state media made this shocking announcement a week ago: "Sun Lijun, former Chinese vice minister of public security, was sentenced to death with a two-year reprieve for taking more than 646 million yuan of bribes, manipulating the stock market, and illegally possessing firearms, according to the Intermediate People's Court of Changchun in Northeast China's Jilin Province on Friday." The suspended death sentence means he'll spend life in prison.

Tyler Durden Wed, 09/28/2022 - 14:05

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