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Is it safe to go back to school yet? As the coronavirus has waned and then surged again in the U.S., this has been one of the biggest questions on the minds of parents, teachers and students. It’s also an incredibly tricky question to answer. I asked Derek Cummings, an expert in infectious disease transmission at University of Florida’s Emerging Pathogens Institute, and Emily Oster, economics professor at Brown University, about the risks and challenges that lie ahead.
Kristen V. Brown: Emily, I’d like to start with you. What is the best argument for reopening schools (if there is one)?
Emily Oster: There are several. The first is learning. Kids learn better face to face, especially younger kids. The second is that, for many kids, school is a safe space and important for both mental and physical health. Millions of kids rely on school for food. Finally, opening schools is key to opening the economy, since parents will struggle to work if kids are not at school.
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KVB: Derek, in its push to reopen schools, the Centers for Disease Control and Prevention (CDC) has repeatedly suggested that children are less likely to spread Covid-19. Where does that idea come from? Is it accurate?
Derek Cummings: This idea has come from a small number of studies from China and European settings that found that children had reduced transmission to household members, as well as on analyses of the broader pattern of cases in this outbreak where models suggested that one way to explain these patterns is that children transmit less. However, given multiple challenges in measuring infections and transmissions in kids, I do not think that there is sufficient evidence to conclude that children are less likely to spread SARS-CoV-2.
KVB: We have already seen one instance of a school opening and having to shut down again the very same day due to Covid-19. Derek, what consequences do you anticipate may come from opening schools too early?
DC: I fear that opening schools when communities have high prevalence of SARS-CoV-2 will not only contribute to community-wide transmission, but will be counter-productive to having open schools. If schools don’t implement necessary precautions and communities haven’t done the hard work to lower prevalence through other social distancing means (e.g. wearing masks, closing bars and other high-risk environments), schools will open only to have to close in a few weeks when outbreaks occur.
KVB: Derek, in your mind, is there a way to balance the competing needs of kids, the economy, and public health and safety?
DC: I believe there is, but it’s going to require going slow, assessing the impact of school reopening on transmission, and making adjustments. I think it also helps to recognize that these needs are aligned in many ways. Unchecked transmission of the virus is bad for the economy and schools. The best way to support ongoing schooling and a functioning economy is to respond to the pandemic rather than thinking we can go back to school or economic functions as they were before the pandemic.
KVB: Emily, in talking about reopening schools, there is the question of balancing health, the economy and also children’s mental health. How can we think about how to weigh all three of these?
EO: I think the main thing is to recognize the benefits to the economy and mental health, and then try to figure out how we can mitigate risks (and what risks are appropriate). I’ve seen many smart people argue that we need to open only when community spread is low. This makes sense to me. We open with masks, with distancing. We need to give schools resources to open safely. Once we do these things — if we can — then we can make an informed choice about whether opening safely is worth it.
KVB: Emily, how do we handle the issue that teachers, who would benefit economically from reopening schools, have protested those reopenings in many areas?
EO: I’m not sure that teachers always benefit economically from opening schools — in most cases, unionized teachers will continue to be paid even if schools do not open. Many teachers, even in low-prevalence areas, are really scared to return. As to how we handle that, I think the primary goal should be to use resources (which we need to provide!) to improve safety, and then try to do a better job communicating the measures that are in place.
KVB: Emily, Derek: There has been some talk of the idea of having an “exposure budget.” For example, if we reopen schools, we might have to shut down bars or restaurants. What do you think of this idea? Does it have any merit?
EO: I am strongly in favor of this idea. The bottom line is that we have to make choices. If we have open bars and restaurants and indoor water parks (seriously), they will contribute to community spread. This spread will make it more difficult to open schools. If we open schools, we are likely to see some increase in spread from those (I think much less than from bars). This all means there really is a choice between these things, at least at some times. So far, we seem to have prioritized things other than schools. This seems short-sighted to me.
DC: It’s a good way to think about our responses to this pandemic. From this spring, we saw that when we lock things down, and implement suites of social distancing and mask use, cases go down. Now, we have to figure out which ones we can relax and not have cases increase again. From a societal perspective, we also have to decide which functions are most important. I agree with the idea that we need to spend our exposure budget wisely. We should think about this not only in trade-offs between bars and schools, but within the classes of interventions there are trade-offs as well.
KVB: Emily and Derek: Already, we have seen many kids return to summer camps and also day care in places where schools do not intend to open in the fall. Is that different from going to school? Why or why not?
EO: Obviously they are not exactly the same. Summer camps are more likely to be outside and are (in some cases) logistically easier. Day care tends to serve younger children. So it’s not exactly the same. But I think it’s worth both trying to learn from these experiences and also to ask why they are different. In particular, many people have raised the question of how we can say it’s safe for Pre-K day care to be open and not Pre-K in schools. This seems like a reasonable question, and I’m not sure there is a good public-health answer. The answer probably lies, instead, in the difference in the workforces in these areas.
DC: I think both these settings are relevant but could differ in subtle ways. Kids spend more time around each other in overnight summer camps, increasing transmission risk. Some of this time is outdoors, as Emily notes, decreasing risk. The Pre-K age groups are really understudied in this outbreak. This is where I revert to work with other respiratory viruses. Prior work and certainly parents will tell you that their Pre-K children get respiratory infections all the time, they spread in day care and schools and very often lead to infections in households. Why do we think this virus would be any different from not only other respiratory viruses but other coronaviruses that infect and are transmitted by kids all the time?
KVB: Emily, Parents are obviously burdened by having kids at home instead of in school. Is there some alternative to bringing kids back to school that will help relieve that burden? One thing that comes to mind is a hybrid model, in which students are only in the physical classroom part of the time.
EO: A number of places have considered the hybrid model, and New York City is still planning on it, although I’ll say that for at least some parents the in and out of such a model seems as daunting (or more so) than being fully remote. People in places that are not in person have started talking through “pandemic pods” or homeschooling groups in which someone who’s not a parent is supervising, or parents share supervision. If parents need to work, there will need to be solutions like this. Obviously, these are going to be harder for lower-income families. In a number of locations, I think we’ll see school programs set up shop supervising remote learning for lower-income children, probably using school buildings. It should not escape us that this just looks like a worse, no-more-safe, version of school.