On Monday, I joined the Superintendents of Denver Public Schools (Susana Cordova) and Aurora Public Schools (Rico Munn) in a presentation to the Chamber of Commerce. I learned much about the challenges facing school systems as they develop protocols for reopening: for example, how many children can be on a school bus? (the answer: 24 on a bus that has capacity for 77); how can food be served to children? And, perhaps the most difficult overall question: In general, what level of control of the epidemic is needed for school reopening to pose an acceptable risk?
The rationale for reopening schools has been grounded in the inarguable direct benefits for children of being in school, and the indirect benefits of freeing parents for work and enhancing food security for children from impoverished families. The American Academy of Pediatrics (AAP) urges safe school reopening: “We recognize that children learn best when physically present in the classroom. But children get much more than academics at school.” And “Returning to school is important for the healthy development and well-being of children, but we must pursue reopening in a way that is safe for all students, teachers and staff.” The AAP also offers guidance for school reopening.
Last week, the Centers for Disease Control and Prevention (CDC) similarly called for school reopening. In a July 23 statement entitled The Importance of Reopening America’s Schools this Fall, the CDC concludes: “Reopening schools creates opportunity to invest in the education, well-being, and future of one of America’s greatest assets—our children—while taking every precaution to protect students, teachers, staff and all their families." Updated guidance for K-12 administrators has also been released, replacing earlier guidelines that were labeled by President Trump as “too tough and very expensive.” The new guidelines offer reasonable principles but will need to be complemented by detailed protocols in practice. Clear metrics for gauging the status of the epidemic for opening and for closing schools are not specified.
The discussion about school reopening lacks the needed holistic consideration of benefits and risks and the trade-offs between them. The benefits receive attention from the AAP and the CDC: education is more effective in schools; children are together; and parents are potentially freed to return to work without the need to be home with their children. Just-released national survey results document the adverse mental health consequences of the pandemic for parents and children and the increase in food insecurity, coming in part from lack of access to food in school programs. School reopening should help to reverse these consequences of the pandemic.
With regard to risks of reopening, a return to mixing of children and adults in schools raises concern for the in-school spread of SARS-CoV-2 infection among children and from children to adults working in schools, and at home and in the community for spread from children infected in schools to household contacts and the community at-large, respectively. School staff include many who are vulnerable to more severe COVID-19 illness because of age or underlying diseases. Appropriately, teachers have voiced concerns about their risks as schools reopen. Beyond the risks posed by schoolchildren to adults in schools, there is the broader question of the impact of school reopening on the pandemic generally.
We lack the evidence to characterize this trade-off between risks and benefits with the needed certainty. Information on transmission within schools is lacking because we have limited observation of the pandemic with schools open. The absence of evidence is not an assurance of safety, as proposed by some. A study in China that tracked mixing during the pandemic suggests that school closures can help to curb the epidemic but are not sufficient by themselves. I have seen little discussion as to how to track the impact of school reopening—an omission to be addressed.
And, politics and inequity surface again around school reopening. The Trump Administration and others have intertwined school reopening with politics, and the symbolism of a return to signaling “normalcy” in the fall at the time of the November election (enough said). School closings have highlighted the lack of access to resources needed for remote education for those with less resources (e.g., computers and broadband internet), particularly in communities of color. Now, better resourced families are joining together and assembling their own “pods” for their children, paying for instructors to come to their homes. During a recent zoom call with a former colleague from the University of Southern California, I said hello to her mother, a retired school teacher, who was being recruited to run a pod in an affluent neighborhood. Inequity coats every element of the pandemic.
Until next week,