The Whole Truth about Kids, Schools, and Covid-19 (Derek Thompson)

The following article comes from The Atlantic, January 2021. “Derek Thompson is a staff writer at The Atlantic, where he writes about economics, technology, and the media. He is the author of Hit Makers and the host of the podcast Crazy/Genius.”

Those school boards and superintendents who continue to keep schools closed in light of this evidence have the duty of explaining to their patrons why district schools have not re-opened. Perhaps the rates of infection among adults in the geographical area are very high and they are waiting for rates to come down. Or maybe there are insufficient funds to prepare buildings to meet Center for Disease Control guidelines. Or there are too many teachers refusing to enter schools because of underlying medical condition. Or there is a lack of phase-in plans for younger children and then older ones attending.

Whatever the reasons are, district policymakers need to explain clearly and coherently why their schools have not re-opened in light of the preponderance of evidence for opening classrooms to in-person instruction. That is task number one.

Federal health officials at the CDC this week called for children to return to American classrooms as soon as possible. In an essay in the Journal of the American Medical Association, they wrote that the “preponderance of available evidence” from the fall semester had reassured the agency that with adequate masking, distancing, and ventilation, the benefits of opening schools outweigh the risks of keeping kids at home for months.

The CDC’s judgment comes at a particularly fraught moment in the debate about kids, schools, and COVID-19. Parents are exhausted. Student suicides are surging. Teachers’ unions are facing national opprobrium for their reluctance to return to in-person instruction. And schools are already making noise about staying closed until 2022.

Into this maelstrom, the CDC seems to be shouting: Enough! To which, I would add: What took you so long?

Research from around the world has, since the beginning of the pandemic, indicated that people under 18, and especially younger kids, are less susceptible to infection, less likely to experience severe symptoms, and far less likely to be hospitalized or die. But the million-dollar question for school openings was always about transmission. The reasonable fear was that schools might open and let a bunch of bright-eyed, asymptomatic, virus-shedding kids roam the hallways and unleash a pathogenic terror that would infect teachers and their families.

“Back in August and September, we did not have a lot of data” to make a recommendation on schools, Margaret Honein, a member of the CDC’s COVID-19 team, told The New York Times. Okay, but September was 100 days, 15 weeks, and several dozen remote-learning school days ago! Meanwhile, anybody paying attention has long figured out that children are probably less likely to transmit the disease to teachers and peers. This is no longer a statistical secret lurking in the appendix of one esoteric paper. It has been the repeatedly replicated conclusion of a waterfall of research, from around the world, over the past six months.

In May 2020, a small Irish study of young students and education workers with COVID-19 interviewed more than 1,000 contacts and found “no case of onward transmission” to any children or adults. In June 2020, a Singapore study of three COVID-19 clusters found that “children are not the primary drivers” of outbreaks and that “the risk of SARS-CoV-2 transmission among children in schools, especially preschools, is likely to be low.”

By September, many U.S. scientists were going on record to say that transmission in schools seemed considerably rarer than in surrounding communities. “Everyone had a fear there would be explosive outbreaks of transmission in the schools,” Michael Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota, told The Washington Post. “We have to say that, to date, we have not seen those in the younger kids, and that is a really important observation.” Throughout the fall, the evidence accumulated. “Schools do not, in fact, appear to be major spreaders of COVID-19,” Emily Oster, an economist at Brown University, wrote last October in The Atlantic, summarizing the conclusions of her national dashboard of school cases.

In a January 2021 paper, a team of Norwegian researchers traced more than 200 primary-school children ages 5 to 13 with COVID-19. They found no cases of secondary spread. The findings “demonstrate the limited role of children in transmission of SARS-CoV-2 in school settings,” they wrote. Another study by researchers at Duke University of 35 North Carolina school districts with in-person teaching found no cases of child-to-adult spread in schools. They concluded that typical mitigation policies, such as masking and physical distancing, are sufficient to prevent school outbreaks. “Our data indicate that schools can reopen safely,” they concluded, as long as such policies remain in place.

If you have been intermittently following the news about COVID-19 transmission and children and remember only the scariest reports, you likely have two questions. What about that scary South Korean study? and What about that horrible summer-school outbreak in Israel?

Let’s start with South Korea. In July, a large Korean survey found that children ages 10 to 19 spread the coronavirus about as efficiently as, or even more aggressively than, older adults. (It found that kids under 10 did not transmit the virus as much.) This frightening conclusion was widely interpreted to rule out the possibility of in-person school for any children in fifth grade or above. But in August, the same Korean research team caveated those conclusions, saying it couldn’t prove whether the children in the study were infecting their parents, or whether those parents were infecting their kids, or whether entire households were being exposed by a third party.

More infamous was the reported outbreak at a Jerusalem high school over the summer, which made headlines around the world. The New York Times’ summary was representative: “When Covid Subsided, Israel Reopened Its Schools. It Didn’t Go Well.” Here’s how the Times described the outbreak:

The Israeli government invited the entire student body back in late May. Within days, infections were reported at a Jerusalem high school, which quickly mushroomed into the largest outbreak in a single school in Israel, possibly the world. The virus rippled out to the students’ homes and then to other schools and neighborhoods, ultimately infecting hundreds of students, teachers and relatives.

The Israeli lesson seemed simple: If you open your schools, cases will explode, the outbreak will reverberate throughout the country, and people will die.

Except it wasn’t that simple. Last week, a follow-up study of the Israel cluster found that what had been universally described as a school outbreak was really nothing of the sort. At the same time that Israel reopened schools, it eased restrictions on large group gatherings. “Easing restrictions on large scale gatherings was the major influence on this resurgence,” the authors concluded. “No increase was observed in COVID-19 … following school reopening.” The causal chain described by The New York Times was backwards. The real story went like this: Relax social-distancing measures in your community without vaccines, see cases explode, and then watch the outbreak ripple into schools.

As the evidence of children’s COVID-19 risk has diminished in the past six months, the evidence that families are struggling with school closures has mounted.

“If you ask me whether we are doing our duty as a society to look after children, my answer would be ‘No, I don’t think so,’” Matthew Snape, a pediatric researcher at the University of Oxford, told me. “There is clear evidence that shutting schools harms students directly, in terms of both their education and their mental and social health.”

Although the long-term scholastic and social effects of a year of remote learning on this generation of children are not yet clear, what we know already is damning enough: Remote learning has gutted public schools as high-income parents pull their kids into private schools and bespoke learning pods. Calls to mental-health hotlines have increased. In Las Vegas, home to the nation’s fifth-largest school district, a cluster of student suicides has pushed local officials to phase in elementary schools. More indirectly, school closures also result in the delay of immunization programs, interrupt free-lunch programs, and make impossible the edifying effects of play.

Nobody should claim that children cannot transmit this virus, or that schools are “safe” during the pandemic the same way that, say, talking on the telephone with a sibling who lives 2,000 miles away is safe.

But people under 18, and young children especially, are less susceptible to infection, less likely to experience severe symptoms, less likely to be hospitalized or die, and less likely to transmit the disease than older teenagers and young adults. Scientists aren’t entirely sure why, but one theory is that it has something to do with the way the virus docks with our cells. Coronaviruses are covered by a halo of spike-shaped proteins (that’s where the name comes from: corona, as in crown). These spikes are thought to attach to another protein on the surface of our cells called ACE2. Children have lower levels of ACE2 in their nasal tissue than adults do. That suggests that, under this theory, kids would provide fewer open ports for the virus to dock, invade, and ransack the rest of the body.

Overall, school cases are a reflection of their environment. If COVID-19 is running rampant through your town and you throw a bunch of kids and adults into a building without any safety protocols, the odds are pretty high that you’re going to exacerbate an outbreak. But as cases fall across the country we have to adjust the risk calculus. The choice before us is not between “Keep the schools closed until COVID-19 is eliminated, smallpox-style, from the face of the Earth” and “Open every school immediately.”

Instead, the United States needs a focused framework, guided by science and common sense, for how to open schools as safely and as soon as possible, considering the risk to students and parents from closed classrooms, while keeping teacher fears front of mind. That plan would look something like this.

  • Reopen the lower schools. Start with day cares and elementary schools, given their reduced transmission risk.
  • Enforce COVID-19 protocols both within schools and throughout the community. That means mandatory mask wearing in public and social distancing. It also means public officials should encourage “library rules” in public space—keeping quiet, or talking in whispers.
  • Accelerate vaccination procurement and distribution. The U.S. could be well below 100,000 daily COVID-19 cases by the middle of February, at the current rate of decline. The faster we vaccinate, the faster we can get back to normal.
  • Distribute high-quality scientific information. Most important, educate teachers about the lower transmission risk of young students—and the ongoing necessity of COVID-19 protocols—to get their enthusiastic buy-in, which will naturally be contingent on our success at reducing community spread and accelerating vaccination.
  • I don’t blame teachers for keeping schools closed—yet. I blame the government and the media. Public communication about this disease has been horrendous, and the Trump White House was a fount of nonsense. Meanwhile, some journalists and professionals, in an attempt to fight back against Trump’s disinformation, leaned too heavily into COVID pessimism and clung to outdated fears about secondary spread among young kids. That’s made a lot of people unnecessarily concerned that kids are silent vectors for this disease, and made teachers feel like they were being thrown to the wolves in a country that has failed in just about every pandemic test. If I were a teacher relying on information from the mainstream press—especially a teacher in a pandemic pod that included immunocompromised relatives—I might be pretty scared of going back to school.
  • Under the banner of safety, too many people have passed along alarmist information that has contributed to a lot of misery. Americans have to learn, and accept, that the preponderance of evidence simply doesn’t support the fears that govern school policy today.

13 Comments

Filed under compare education and medicine, leadership, school leaders

13 responses to “The Whole Truth about Kids, Schools, and Covid-19 (Derek Thompson)

  1. The CDC recommends opening of schools IF they meet the necessary criteria. 50% of schools in the U.S. have some deterioration issues due to lack of funding. How many school districts have the ability to follow social distancing? Many poverty level schools have classrooms that are overcrowded, with 30 or more in a closed-in room. Windows often don’t open and often water has been shut off. Hallways get crowded as do washrooms. How can buses have social distancing?

    I’m sure that none of this affects adults in schools. Teachers have died from COVID. Are you one who will say it could never have come from schools?
    …………………………………………………………………..
    Jan 13, 2021, 9:48am EST
    Updated on:Jan 13, 2021, 9:48am EST
    Nearly 2.3 million children in the U.S. have tested positive for COVID-19, according to a new report.
    The American Academy of Pediatrics says that is as of Jan. 7. About 171,000 new cases were identified in kids last week alone.
    The report includes children from newborn to 19 years old.
    It may be a large number, but looking at more than 22 million cases overall, data shows kids are still less likely to be hospitalized for COVID-19 and die from it.
    Health experts say they still want more data on how the virus might affect kids over time.

  2. David

    Hi Larry, thanks for posting this. I’ve read a lot about this issue and the gist is that there is a persistent drumbeat from some quarters to open schools at any cost, yet the science is till unclear. We often forget that the original COVID-19 virus is only at 1 year and now there are several variants. This Jan 21 piece from Nature highlights this: https://www.nature.com/articles/d41586-021-00139-3

    One thing that is clear: opening schools safely requires money. Schools have to be able to invest in enhancing ventilation, having the capacity to meet the distancing requirements, and having adequate sanitizing facilities. Many of us teachers have worked in classrooms with no windows–those rooms shouldn’t be used. If school districts don’t have the funds to make their facilities safe given the virus, then no, the schools shouldn’t be opened.

    • larrycuban

      Again, David, thanks for the link to the Nature article. Also, that schools need money to re-do ventilation, hire more people to clean and re-clean classrooms, halls, lunchrooms, etc. is self-evident yet still missing from what districts receive from the feds and state.

  3. I’ve long respected Dereck Thompson but this article lets ideology rule. Think of how disgusting the title is, “Just Open Schools, Already.” Even the authors of the North Carolina study say that they can’t make broad recommendations for all schools.

    When I followed his links, it looked like Thompson failed to read those studies carefully. Yes, they had good news, but only one finding that was as confident as his analysis is. Yes, a European study found:

    The investigators concluded that these data, together with the observation that rates of infection among teachers and nonteachers were generally similar, indicated that schools were not associated with accelerating community transmission.

    But European schools are now shut down and recent studied contradict Thompson’s claims.

    And, look at the careful wording and dates of the others he cited such as:

    * Though complete reopening of schools may have contributed to the spread of infection, it does not seem to have played a primary role per se, in the June-July 2020 resurgence

    *Decisions made today can help ensure safe operation of schools and provide critical services to children and adolescents in the US. Some of these decisions may be difficult. They include a commitment to implement community-based policies that reduce transmission when SARS-CoV-2 incidence is high (eg, by restricting indoor dining at restaurants), and school-based policies to postpone school-related activities that can increase risk of in-school transmission (eg, indoor sports practice or competition)

    *Children of all ages are infectious and capable of transmitting regardless of symptom status. Determining the relative infectiousness of children as compared to adults is difficult, given unknown numbers of asymptomatic cases which are underrepresented in studies of transmission. Household studies with children as index cases have so far been difficult to interpret due to bias from shared exposure (children and their contacts becoming infected simultaneously), increased exposure of caregiver to their symptomatic children post infection, and underrepresentation of asymptomatic cases.

    Contact tracing studies from schools have generally found very low rates of transmission, especially among younger children. There is evidence of larger outbreaks within secondary school age and adolescents, predominantly in schools during period of high community transmission.
    *with a recent systematic review suggesting that there are no evidence to support that children can become the main drivers of the COVID-19 pandemic, although it should be interpreted with caution as the investigation was carried out in the context of lockdown.

    And what about schools where there is so much resistance to masks and reckless openings of wrestling and basketball?

    So, as the mutated virus spreads, we should keep schools open because they are only spreaders, as opposed to super-spreaders. Would it be smarter to focus on reducing transmissions now, so we don’t see a worsening tragedy?

  4. Here’s the online title:
    https://www.theatlantic.com/ideas/archive/2021/01/just-open-schools-already/617849/
    The most inaccurate and irresponsible passage in the paper version was:

    Into this maelstrom, the CDC seems to be shouting: Enough! To which, I would add: What took you so long?

  5. Dr. David Patterson

    I am a County Board of Education Trustee (Placer County California) and we have been following the terribly confusing back and forth on re-open or not for months. The best point-counterpoint I have seen (heard) was a recent podcast from EdSource featuring Fresno Superintendent Bob Nelson as he explains urban districts opposition to Governor Newsom’s reopening plan while Dr. Jeanne Noble of UCSF says it is safe to return to schools. Can’t put the link here so search for – EdSource · Safe or unsafe to reopen schools now? Two contrasting views.

    But beyond all this about open or not, personally I have found way too little conversation about how we are going to accelerate the learning for the millions, and yes in California it is millions, of students who are being harmed every day they lose schooling. If there was more conversation about HELPING SUDENTS I would be less angry about conversations where people want a guarantee that they will not get COVID-19. How about a guarantee that we will address the needs of these students.

    • larrycuban

      Your are correct, Dr. Patterson,that the lack of solid information on the virus has put the re-opening of schools into turmoil. Conflicting answers to basic questions about transmissibility,where will additional funds for ventilation and frequent disinfecting come from, and how best to stem academic loss to students who are already disadvantaged have made re-opening schools a political football. The disturbing lack of a national plan and an early call from the former President to re-open schools nearly guaranteed that the issue would be politicized. And that is where the nation’s schools are now. Thank you for your comment.

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