The case for re-opening schools, partway

I don’t envy school officials right now. They have to weigh two horrible possibilities …

  1. Keeping kids at home, where they’re falling behind their peers (particularly in underserved communities) and suffering mental health issues, including a greater risk of suicide. For a longer list of lifelong problems incurred by school closures, see this NPR story, especially the last six paragraphs.)
  2. Bringing kids into school amid concerns of spreading COVID-19.

Fortunately, evidence to help them make better decisions is mounting …

Studies on school transmission

The news is pretty good.

South Korea: “Jeong and other researchers said schools are not a high-risk setting for Covid-19 transmission, while hinting that school closures might have caused more harm than good.” (Jan. 21, Korea JoongAng Daily)

Duke/UNC: 32 cases of in-school transmission among nearly 100,000 people. ““Our data indicate that schools can reopen safely if they develop and adhere to specific SARS-CoV-2 prevention policies.” (Jan. 8, AAP)

Sweden: “Despite Sweden’s having kept schools and preschools open, we found a low incidence of severe Covid-19 among schoolchildren and children of preschool age during the SARS-CoV-2 pandemic.” (Jan. 6, New England Journal of Medicine)

Norway: “Studies from several European countries have shown minimal transmission of SARS-CoV-2 from paediatric index cases in schools [37]. However, the majority of these studies did not consider asymptomatic infections and did not screen all contacts. Our study confirms and strengthens these data, as we found minimal transmission even with a prospective design and systematic testing of all contacts twice during quarantine.” (Jan. 7, Eurosurveillance)

Germany: “Johannes Huebner, the head of the pediatric infectious disease department at the Ludwig-Maximilians University Hospital in Munich, recently told NPR correspondent Rob Schmitz that scientific studies have not detected high rates of transmission in schools. ‘Most of the infections are brought into the schools by adults, by teachers, and then spread among kids. But most of the time, it’s only single cases. It’s two, three kids, five maybe that get positive.'” (Nov. 13, NPR story on Europe leaving schools open)

Various (dated but thorough): “Data collected globally have previously shown that schools can reopen safely when community transmission is low. But even in places where community infections were on the rise, outbreaks in schools were uncommon, particularly when precautions were taken to reduce transmission.” (Oct. 29, Nature)

Global (but dated): “In most infections or COVID-19 cases reported in children, infection was acquired at home.” (Oct. 21, WHO)

Studies on asymptomatic transmission

The news is less good, and it’s a reminder that safety precautions must be taken and testing should be frequent.

Austria: More data that asymptomatic kids may spread the disease, but note some shaky claims in this story, notion that the UK made no progress with a lockdown. The UK in general hasn’t had the best response. (Jan. 15, Der Spiegel)

UK: “There is evidence to suggest that people who don’t display symptoms of Covid-19 may have lower viral loads, which means they are less likely to infect others.” The story goes into detail about rapid testing. (Jan. 2, The Guardian/The Observer)

Current COVID-19 rates

Bad, but dropping after the holiday surge.

Global: Mitigation works. (Jan. 23, Our World in Data)

USA:The backlogs appear to be largely behind us, and the underlying trends are moving in the right direction for most of the country. Even for the states experiencing the worst outbreaks, we are seeing early indications that the rates of cases, hospitalizations, and deaths are easing, though some areas are still reporting dangerously high case and hospitalization levels and wrenching death rates.” (Jan. 21, COVID Tracking Project)

Safety measures

Masks: Duh.

Vaccines: “Pfizer and Moderna together have pledged to deliver 200 million doses by the end of March.” Of course, the devil’s in the details in making sure teachers get priority. (Jan. 23, The Philadelphia Inquirer)

Quick, frequent testing: “With $20 billion, Mina argues, the government could build four factories that produce enough antigen tests to stop most outbreaks in the country. That may sound like a lot of money, but it’s just 1 percent of the COVID-19 stimulus package, the CARES Act.” That’s an indictment of the Trump regime, but it’s also an example of what schools can do with testing. (Nov. 20, The Atlantic)

Treatment: The global medical community doesn’t get enough credit for what it’s done to improve treatment over a short period of time (Nov. 14, Spectrum News and Sept. 20, NPR). Several new medications moved forward in October and November, and a study this month shows convalescent plasma (which I’ve donated twice) is helpful (Jan. 13, Harvard). We still need to know more about long-term effects for those of us who’ve survived — personally, I’m not sure my lung capacity has recovered, though I’m also getting older.

Quarantine: Spring Break could be a problem if people are traveling. This is merely a suggestion, and it may not be feasible, but would a quarantine help?

Bottom line

On the personal level, forcing people back to school is a bad idea, though I’d hope all the information above convinces more people that it’s safe.

The only question left is the issue of collective responsibility. We ask people to wear masks so that they won’t spread the disease, even to those who are taking precautions, and overwhelm our hospitals.

Based on the information above, the chances of schools adding to overwhelmed hospitals seems slim, particularly if all the right precautions are taken. Running schools at half capacity by alternating students helps with social distancing. Requiring masks is a no-brainer, and we should all keep an eye on the evolving guidance on what kind of masks we should be using. We should also test often — two quick tests that are 85% accurate are better than one test that’s 90% and takes longer to process.

Face-to-face meetings with teachers and peer interaction are so important. I can’t see any reason we shouldn’t be planning to open partway in March, when rates will have dropped farther and more people will be vaccinated, and all the way this fall.

We can do this. And we need to.

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