In Reopening U.S. Schools, Science Is Offering Few Clear Answers
As fall approaches in the U.S. and school districts debate whether to resume in-person classes, the issue is complicated by a dearth of knowledge about how Covid-19 is transmitted to and from children.
Other nations have sent children back to school — or never shuttered schools to begin with — but none has done so with the virus surging as it is in the U.S. On Monday, cases in the U.S. rose by 64,605 from a day earlier to 3.34 million.
It is now broadly recognized that the virus that causes Covid-19 can be airborne in crowded, indoor spaces like schools. And children are commonly known to be spreaders of other respiratory viruses, like the seasonal flu. But while there’s significant data showing children aren’t likely to become very ill from Covid-19, there’s less information on how likely they are to transmit it to others.
“All of the data from every country suggests kids have a low probability of getting sick and dying,” said Derek Cummings, who studies transmission of infectious diseases at University of Florida’s Emerging Pathogens Institute. “What we don’t know is how often they transmit the virus.”
The lack of specific data has made some states cautious about how best to move forward at a time when enormous pressure is building to reopen schools from parents who need to return to work, U.S. President Donald Trump, who sees it as a linchpin for the economy, and childhood development specialists concerned about the toll of the pandemic on children’s mental health.
On Monday, New York Governor Andrew Cuomo laid out criteria for the state’s schools reopening, saying they’ll be allowed to reopen this fall in regions that are in Phase 4 of reopening and have an infection rate of 5% or less on a rolling 14-day average. If the rate rises above 9%, he said, the schools will be re-closed. New York City is currently the only region not in Phase 4.
Trump “was wrong on the economic reopening and he’s wrong on the schools reopening,” Cuomo said in a briefing. “We’re not going to use our children as guinea pigs.”
In California, where cases of Covid-19 nearly doubled in the past two weeks, the state’s two largest school districts, Los Angeles Unified and San Diego Unified, issued a joint statement on Monday saying they wouldn’t resume in-person classes.
Low Infection Rate
Even as cases have risen in the U.S., confirmed infections among those under 18 remain low. Through May, those infections accounted for less than 2% of cases, according to the Centers for Disease Control and Prevention, numbers that have been similarly low around the globe.
While children are at a lower risk of getting very ill, a small number have died or required intensive care as a result of either the respiratory failure commonly associated with the virus or a frightening inflammatory condition sometimes described as similar to Kawasaki disease that causes heart or circulatory problems.
While that condition remains rare, surveillance researchers in a report in the New England Journal of Medicine identified around 186 cases of the disease in 26 U.S. states over a 2-month period. In a similar effort, researchers found 99 cases that met the definition of the emerging condition in New York State.
A bigger concern is that asymptomatic children may spread the disease more widely through communities.
Across the country, teachers have protested the reopening of schools, citing safety concerns. Major teacher’s unions have threatened strikes if states reopen schools without taking proper precautions. Randi Weingarten, the head of the American Federation of Teachers, has lambasted plans to barrel ahead with reopenings.
“Trump has consistently buried the science on #COVID19. Because of his carelessness, our country has now had to bury over 135,000 people who died from the pandemic,” she tweeted on Saturday.
Scant early data has suggested children may in fact be less likely to transmit the disease. One Chinese study, for example, found that of 65 of 68 children with confirmed COVID-19 admitted to a hospital lived in households with previously infected adults, indicating the child caught the virus from the adult rather than transmitting it.
In another study from Australia, nine students and nine staff members were infected across 15 schools, making close contact with 735 other students and 128 staffers. Only two secondary infections were found. There is also some evidence that younger children are less likely to spread the virus than older ones.
Still, “for every virus I can think of, kids get infected and transmit disease,” said the University of Florida’s Cummings. “I haven’t heard a convincing argument for why that isn’t the case here.”
In Denmark, the first European nation to send kids back to school, doing so did not appear to worsen the outbreak. In that country, however, infection levels never approached that of the U.S., and schools were opened gradually, with many safety measures in place, including dividing classes into several smaller groups and holding classes outside when possible.
“The best way forward would be to try different plans,” said Cummings. “Take everything we know about mask use, limiting time in the classroom and physical distancing and try a bunch of different models to see what works best.”
Eric Topol, the director of the Scripps Research Translational Institute, said that more studies of transmission among children will be imperative in reopening schools. But that’s a move that will take time, a luxury that states making decisions with September bearing down on them don’t have a lot of.
In its own guidelines, the American Association of Pediatrics suggested that “all policy considerations for the coming school year should start with a goal of having students physically present in school.”
But the group said schools should establish safety protocols including wearing masks, distancing desks, reducing interactions among kids and adults in different classes and using outdoor space when possible.
Kristin Moffitt, an expert in pediatric infectious disease at Boston Children’s Hospital, said that in regions where cases are declining, with proper risk-mitigation in place such as mask-wearing and social distancing, it is “feasible to make plans for children to return to classroom settings.”
While there is sparse data available, she said, there is also significant evidence that staying home from school has an extreme negative impact on children.
Still, schools that return to in-person classes should have contingency plans in place. “Nothing can be done to reduce transmission to zero,” Moffitt said.
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