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John Thompson writes below about the ongoing confusion about whether it is safe to reopen schools. Trump and DeVos demanded that schools reopen without the resources to reopen safely. Now, the debate continues, with a mixture of science, hope, and fear. I am not a public health expert, and I offer no advice. But common sense suggests that teachers should be vaccinated first, along with other essential workers. Teaching in a room with a large group of students all day long, it seems to me, is materially different than shopping in a store where one enters and leaves within 15-20 minutes. If we expect teachers to be frontline workers, they should get the vaccinations and PPE equipment they need.
Today we’re in a situation in regard to reopening schools that is similar and different to that of the first six months of the Covid pandemic. Then, it seemed likely that schools could reopen by the fall semester as long as we respected public health evidence, and set smart priorities, such as reopening schools not bars. But Trump and his acolytes politicized the pandemic, even leading the way to super-spreadings by holding crowded political and motorcycle rallies, as well as pushing the premature reopenings of indoor dining and partying.
I’m afraid, however, that we’re also in a situation similar to last November when it should have been obvious that the holidays were coming, bringing super-spreads. Rarely do we face school reopening issues that lead to obvious conclusions. However, it would have been crazy to reopen schools as Thanksgiving approached, prompting the surge which would feed the super-surges of Christmas and New Years. Even so, true believers in the claim that educators were being too cautious often continued to ramp up the blame game. In “When Trump Was Right and Many Democrats Wrong” (Nov 18), Nick Kristof criticized Democrats for failing to learn from Europeans who had safely kept their schools open.
Ironically, Kristof’s editorial was published 6 days after Spiegel International’s “Reevaluating Children’s Role in the Pandemic.” It explained in great detail that “a large study from Austria shows that SARS-CoV-2 infects just as many schoolchildren as it does teachers. Other surveys indicate that while young children may show no symptoms, they are quite efficient at spreading the virus.”
Spiegel explained, “‘Schools are not islands of serenity,’ says study leader Michael Wagner, a professor of microbiology at the University of Vienna. Leaving them open is ‘a significant risk.’” Moreover, “‘Children reflect the infection levels they are surrounded by,’ says microbiologist Wagner. But because they are so often asymptomatic, they are ‘severely undertested,’ leading him to believe that there are a rather significant number of unreported cases.”
In fairness, even if Kristof had read about and contemplated the new situation in Europe, he could not have known that it would foreshadow the most important pandemic challenge we face today. But he no longer has an excuse for sticking with his simplistic attacks on teachers.
As the super-spread that took off in November subsides, and given the fact that President Biden has replaced Trump, it could be argued that we should be able to safely reopen schools over the next 100 days. As was true in the summer and the fall, new scientific research keeps producing evidence that schools can operate safely in person, especially in places where masking, social distancing, and public health guidelines are respected when dealing with community transmissions. Recent studies documented successes in North Carolina, Wisconsin, and European schools. Research keeps confirming that schools for the youngest children are the least likely to spread the virus. And a recent JAMA study concludes “there has been little evidence that schools have contributed meaningfully to increased community transmission.”
On the other hand, the path JAMA describes toward “return primarily or fully to in-person instructional delivery” also requires “steps to reduce community transmission and limiting school-related activities such as indoor sports practice or competition that could increase transmission risk.” For instance, it cites a recent wrestling tournament where, “Among the 130 tournament participants, 38 (30%) had laboratory-confirmed SARS-CoV-2 infection diagnosed, but less than half the participants were tested. At least 446 contacts of these cases have been identified.” These and secondary transmissions are still being studied.
Sadly, we’re also seeing a repeat of the politicization of public health which contributed so much to the super-spreads that made it impossible for so many urban districts to reopen in the fall. One of the worst examples is Derek Thompson’s article published online with the title, “Open Schools, Already.” Thompson began with an oversimplified characterization of the Center for Disease Control’s call to reopen schools “as soon as possible,” and asserted, “the CDC seems to be shouting: Enough! To which, I would add: What took you so long”?
I always follow the links in these reports, and almost always I find a story more complicated than anticipated. But, these reports tend to start with the conclusion about whether schools can reopen safely, followed by a number of disclaimers and warnings. Thompson turned out to be one of the most extreme examples of a respected reporter misrepresenting the complexities documented in the sources he cited.
Rather than get into the weeds of methodology, before addressing Thompson’s misleading arguments, I’ll just mention a few more differences between today’s questions and those of the summer and fall. New research estimates that 59 percent of transmissions, not 35 percent as previously estimated, are by asymptomatic persons. Moreover, we now have evidence that teens are more likely to spread the virus than originally thought. And a new study of infections in Florida and China shows that children may be more likely to be asymptomatic, and they may be 60% more likely than adults over 60 to spread the infection.
These findings, combined with the lack of testing and contact tracing in many places, call into question the previously understandable conclusions by some that schools aren’t major contributors to community transmission.
Also, there are new reasons to worry about the unknown, but potentially serious, harm done by Covid to asymptomatic persons.
Getting back to Thompson’s article as a case study in misrepresenting complex science, North Carolina and Wisconsin offer just two of many examples of studies of small samples of committed school systems that are not representative of many other districts. In “Incidence and Secondary Transmission of SARS-CoV-2 Infections in Schools,” Duke University researchers found that infections were rare in “35 North Carolina schools that offered in-person teaching for at least some of the 9 weeks, with only 17 staying open to students for the entire quarter.”
The researchers acknowledged that the sample of schools “may select for school districts that enforce adherence to preventative measures, emphasize transparency, and cooperate with peers.” These characteristics “are likely associated with greater adherence to masking, reduced secondary transmission, and lower risks.” And, when two districts faced reduced compliance with masking and distancing, a nonprofit stepped in to reinforce those policies.
In response to my questions on methodology, co-author Daniel Benjamin volunteered that the key to success:
Is that there is 99% mask compliance for every person in the mainstream curriculum that steps on school property. It’s the mitigation strategies—distancing, masking, hand hygiene that are crucially important. If a school district does not do these things, they will likely make the pandemic worse by being open. This is why we don’t advise “you should open” or “you should go remote”…. It’s all about the public health measures.
And while we’re reading more optimistic reports by reliable researchers like JAMA and the CDC, let’s not forget their qualifying statements, such as the CDC’s summary of Wisconsin infections from Sept 3 to Nov16. Schools were the 4th largest source of infections, following long term care and corrections facilities, and colleges; an estimated 14% of infections were linked to schools.
These are just a few of the new pieces of evidence that schools may not be super-spreaders, but they are spreaders. But, how fast do we want to reopen those spreaders as the virus variant comes to the United States? The New York Times cites the CDC and other institutions that predict the more contagious U.K. variant will be predominant by March. If so, will it make sense to not reclose the schools that contribute to spread, even if they don’t drive the increase in infections?
The reopening of schools in 100 days is a reasonable goal, but decisions on the pace of reopenings and when it is necessary to reclose schools, should not be politicized. My sense, however, is that more of the press, and public health and education advocates are now discussing politics more, and complicated science relatively less. For instance, there has been a steady increase in charter school advocates implicitly or explicitly blaming shutdowns on unions. Robert Pondiscio’s “How Anger Over Covid Closures Can Fuel the School Choice Movement” is just one recent example.
At the same time, more journalists are focusing on the differences between statements by some of Biden’s public health experts, and his apparently more balanced approach, as well that of teachers and unions, than the nuances of medical science conclusions. Moreover,, the Washington Post explains, “CDC researchers looked to Europe’s experience in the fall to inform their conclusion that ‘there has been (emphasis mine) little evidence that schools have contributed meaningfully to increased community transmission.’”
But new research from Europe leads towards a new conclusion, articulated by Celso Cunha, director of the medical microbiology unit at Nova University of Lisbon’s Institute of Hygiene and Tropical Medicine, “By themselves, schools are not the main problem, but it makes sense to close them when the numbers are so high that anything can have an impact on the health system as a whole,”
The Wall Street Journal also reports:
A consensus is emerging in Europe that children are a considerable factor in the spread of Covid-19—and more countries are shutting schools for the first time since the spring.
Closures have been announced recently in the U.K., Germany, Ireland, Austria, Denmark and the Netherlands on concerns about a more infectious variant of the virus first detected in the U.K. and rising case counts despite lockdowns. …
The Journal quoted the director of the University of Geneva’s Institute of Global Health, “In the second wave we acquired much more evidence that schoolchildren are almost equally, if not more infected by SARS-CoV-2 than others.”
And as Spiegel reported in November, Europeans have had to ask, “Might children, in fact, be mini-superspreaders running around without so much as a sore throat as they pass the virus on to classmates, parents and siblings?”
I sure can’t anticipate the answer to that question, but unless we can discuss it in a non-ideological manner, we might fail at both the reopening of schools within 100 days, and contribute to a resurgence of Covid.