Question: Any thoughts of correlation of record high national cases and schools being open? I see a lot of schools are not spreading the virus stories but also that kids can be asymptomatic spreaders. It is confusing.
Answer: When reopened with appropriate risk mitigation measures, schools (K-12) seem to be low-risk transmission environments (see Q&A of 10/13 #Reopening and recent research from Spain here). But we still don’t have a good picture of schools and risk because we’ve done a terrible job collecting, analyzing, and sharing comprehensive data on schools. In fact, my friend and public health expert, Dr. Nirali Chakraborty, wrote a commentary on this very issue published yesterday in the Baltimore Sun, “Private schools could teach public systems about COVID — if they’re willing.” To further elaborate, let me start with three pieces of information that were unknown earlier in the pandemic:
- Children can contract and spread the virus (some relevant research is here and here, more background is in our Q&A for 9/2 #Kids);
- High-risk transmission settings are those that include closed spaces, crowded places, and/or close-contact settings (see Q&A for 10/30 #3 Cs); and
- Most of the SARS-CoV-2 transmission occurs in the home among family units, however, these individuals are less likely to infect others outside of their homes. The bigger spread comes from bursts where one person infects many (e.g. super-spreader events) (see Q&A for 10/9 #Overdispersion, and some relevant research published in Nature here and here).
Taking this information into account, we can surmise that schools as we knew them pre-pandemic — closed spaces, crowded places, close-contact settings — meet all the criteria of being potential high-risk transmission sites (e.g. super-spreader sites). So when we’re talking about school reopening, we have to put it into context. Are we talking about reopening schools as they were pre-pandemic? If so, the transmission risk is high, particularly in areas with moderate to high levels of community transmission. But to my knowledge, that’s not what we’re talking about. We’re talking about school reopening in the context of risk mitigation measures. Then the question becomes — in the context of limited resources, which risk mitigation measures are the most effective?
And this is where we need better data across the country from public and private schools — on mitigation measures implemented, protocols adopted, case counts, school-based transmission, and more. Individuals are trying to fill the gap, but their data are limited and include only those schools that opt-in (Q&A of 10/13 #Reopening). We need our local, state, and federal governments to help us make informed decisions! As Dr. Chakraborty wrote in her commentary about Maryland (but it’s applicable to any state, in my opinion),
“… the state of Maryland should be leading the way for governmental data reporting standards, building the trust that is so needed among parents, teachers and school systems so that our children can be back in school, where they belong. Many parents are being asked to make the decision of whether to send their children back to a hybrid model, or remain virtual… parents, striving in an information void, to make the best decisions they can. Fill the void, and more children may return to school.”
Finally, a recent working paper (not yet peer reviewed) written by scientists at Spain’s Universitat Politècnica de Catalunya explored whether community infection rates were correlated with school reopening in Spain, concluding that school reopenings were not associated with increased incidence of community transmission. As described in a related NPR report, schools in Spain reopened with numerous safety measures, including “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.” These findings add to the growing evidence-base that when reopened with appropriate risk mitigation measures, schools (K-12) seem to be low-risk transmission environments.
To conclude, I think that we’re generally talking about schools and risk incorrectly. I see so many questions like, “Are schools safe?,” when we need to be asking, “Which mitigation measures should we mandate for schools to safely reopen, especially in the context of limited resources?; Of the schools that have reopened successfully, what have they done?” Comprehensive, publicly available data are required to answer these key questions and ultimately get our children and teachers safely back into school buildings!