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NPR Ed
Are The Risks Of Reopening Schools Exaggerated?
Anya Kamanetz
October 21, 2020
Students attend the first day of school in the small town of Labastida,
Spain, on Sept. 8. A recent study found no link between coronavirus
spikes and school reopenings in the country.
Alvaro Barrientos/AP
Despite widespread concerns, two new international studies show no
consistent relationship between in-person K-12 schooling and the spread
of the coronavirus. And a third study from the United States shows no
elevated risk to childcare workers who stayed on the job.
Combined with anecdotal reports from a number of U.S. states where
schools are open, as well as a crowdsourced dashboard of around 2,000
U.S. schools, some medical experts are saying it's time to shift the
discussion from the risks of opening K-12 schools to the risks of
keeping them closed.
"As a pediatrician, I am really seeing the negative impacts of these
school closures on children," Dr. Danielle Dooley, a medical director
at Children's National Hospital in Washington, D.C., told NPR. She
ticked off mental health problems, hunger, obesity due to inactivity,
missing routine medical care and the risk of child abuse — on top of
the loss of education. "Going to school is really vital for children.
They get their meals in school, their physical activity, their health
care, their education, of course."
While agreeing that emerging data is encouraging, other experts said
the United States as a whole has made little progress toward practices
that would allow schools to make reopening safer — from rapid and
regular testing, to contact tracing to identify the source of
outbreaks, to reporting school-associated cases publicly, regularly and
consistently.
"We are driving with the headlights off, and we've got kids in the
car," said Melinda Buntin, chair of the Department of Health Policy at
Vanderbilt School of Medicine, who has argued for reopening schools
with precautions.
Emerging evidence
Enric Álvarez at the Universitat Politècnica de Catalunya looked at
different regions within Spain for his recent co-authored working
paper. Spain's second wave of coronavirus cases started before the
school year began in September. Still, cases in one region dropped
three weeks after schools reopened, while others continued rising at
the same rate as before, and one stayed flat.
Nowhere, the research found, was there a spike that coincided with
reopening: "What we found is that the school [being opened] makes
absolutely no difference," Álvarez told NPR.
Spain does extensive contact tracing, so Álvarez was also able to
analyze how much schools are contributing to the spread of the
coronavirus. Álvarez said his research suggests the answer is: not
much. He found that, for all the students and staff who tested
positive, 87% of them did not infect anyone else at the school. They
were single cases.
"We are not sure that the environments of the schools may not have a
small and systematic effect," said Álvarez, "But it's pretty clear that
they don't have very major epidemic-changing effects, at least in
Spain, with the measures that are being taken in Spain."
These safety measures include mask-wearing for all children older than
6, ventilation, keeping students in small groups or "bubbles," and
social distancing of 1.5 meters — slightly less than the recommended 6
feet in the United States. When a case is detected, the entire "bubble"
is sent home for quarantine.
Insights for Education is a foundation that advises education
ministries around the globe. For their report, which was not peer
reviewed, they analyzed school reopening dates and coronavirus trends
from February through the end of September across 191 countries.
"There is no consistent pattern," said Dr. Randa Grob-Zakhary, who
heads the organization. "It's not that closing schools leads to a
decrease in cases, or that opening schools leads to a surge in cases."
Some countries, such as Thailand and South Africa, fully opened when
cases were low, with no apparent impact on transmission. Others, such
as Vietnam and Gambia, had cases rising during summer break, yet those
rates actually dropped after schools reopened. Japan, too, saw cases
rise, and then fall again, all while schools were fully reopened. But
the United Kingdom saw a strong upward trend that started around the
time of reopening schools.
"We're not saying at all that schools have nothing to do with cases,"
Grob-Zakhary said. What the data suggests instead is that opening
schools does not inevitably lead to increased case numbers.
What about the U.S.?
On Oct. 14, the Infectious Diseases Society of America gave a briefing
on safe school reopenings. Bottom line? "The data so far are not
indicating that schools are a superspreader site," said Dr. Preeti
Malani, an infectious disease specialist at the University of
Michigan's medical school.
One place in the U.S. where systematic data gathering is happening —
Utah — seems to echo the conclusions drawn by the new international
studies. Utah's state COVID-19 database clearly reports
school-associated cases by district. And while coronavirus spread is
relatively high in the state, State Superintendent of Public
Instruction Sydnee Dickson believes that schools are not, for the most
part, driving spread.
"Where you see cases on the rise in a neighborhood, in a county, we see
that tend to be reflected in a school," Dickson said. "[But] we're not
seeing spread by virtue of being in school together."
Tom Hudachko of the state's health department said that after both
colleges and schools reopened in early September, there was a rise in
cases among the 15-24 age group. But with targeted public health
messaging those cases have started to come down.
For the most part, Hudachko said, K-12 school clusters have been
concentrated at high schools. "We have had some outbreaks in middle
schools. They've been far less frequent. And elementary school numbers
seem to be one-offs here and there."
And these clusters — including one large reported outbreak with at
least 90 cases — have largely been traced to informal social gatherings
in homes, not to classrooms. (Álvarez, in Spain, also said that
clusters among young people there have been traced to social
gatherings, including rooftop and beach parties).
Few states are reporting school-related data as clearly as Utah. And
that's a shame, said Buntin at Vanderbilt. "One might argue that we're
running really a massive national experiment right now in schools,"
Buntin said, "and we're not collecting uniform data."
New Dashboard Tracks Coronavirus Cases In Schools Across 47 States
The largest centralized effort at such data collection in the United
States — the unofficial, crowdsourced COVID-19 School Response
Dashboard — has gotten a lot of publicity. But it is self-reported, not
a representative sample of schools.
Buntin and other experts said it's likely that the dashboard is biased
toward schools that are doing an exemplary job of following safety
precautions and are organized enough to share their results. Also, the
dashboard doesn't yet offer the ability to compare coronavirus cases
reported at schools with local case rates.
In the absence of data, there are scary and tragic anecdotes of
teachers around the country dying of COVID-19. But it's hard to
extrapolate from these incidents. It's not immediately clear whether
the educators contracted the virus at school, whether they are part of
school-based clusters, or what safety precautions were or were not
followed by the schools in question.
A recent study from Yale University could potentially shed some light
on these questions. It tracked 57,000 childcare workers, located in all
50 states, Washington, D.C., and Puerto Rico, for the first three
months of the pandemic in the United States. About half continued
caring for very young children, such as the children of essential
workers, while the other half stayed home. The study found no
difference in the rate of coronavirus infections between the two
groups, after accounting for demographic factors.
Walter Gilliam, lead author of the study and a professor of psychology
at the Yale Child Study Center, cautioned that it's difficult to
generalize this report to a K-12 schools setting, because the children
were mostly under the age of 6 and kept in very small groups — and, he
said, the childcare workers were trained in health and safety and
reported following strict protocols around disinfection. However, he
said, "I think it would be great to do this study with school teachers
and see what we can find out."
Risk and benefit
When you add up what we know and even what we still don't know, some
doctors and public health advocates said there are powerful arguments
for in-person schooling wherever possible, particularly for younger
students and those with special needs.
"Children under the age of 10 generally are at quite low risk of
acquiring symptomatic disease," from the coronavirus, said Dr. Rainu
Kaushal of Weill Cornell Medicine. And they rarely transmit it either.
It's a happy coincidence, Kaushal and others said, that the youngest
children face lower risk and are also the ones who have the hardest
time with virtual learning.
"I would like to see the students, especially the younger students, get
back," said Malani at the University of Michigan. "I feel more
encouraged that that can happen in a safe and thoughtful way."
Chicago Public Schools, one of the largest districts in the country,
seemed to take that guidance into consideration when it announced
recently a phased reopening starting with pre-K and special education.
Kaushal said it's important to keep in mind that Black, Latinx and
Native American communities are much more severely affected by
COVID-19. And that many of the "children that are at the severest risk
of disease, are also at the severest risk of not having a school open,
whether it be for food security, adult time, security, losing the time
to learn or losing the skills that they have acquired over the last
year or so."
Any decision made on school reopening, she said, has to focus on equity as well as safety. There are no easy trade-offs here.
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