Covid-19 and kids: America has botched school reopenings

As America enters another phase of rapid growth in cases and hospitalizations in its Covid-19 epidemic, among the mounting losses is public education. Schools around the nation are being forced to return to remote learning, or have never returned to an in-person model. Without a national policy, states and even individual school districts have been left to navigate the high-stakes and difficult decision of whether to proceed with in-person, hybrid, or remote education alone.

Unfortunately, many of these decisions seem to be driven by partisanship, rather than solid public health guidance and robust evidence. Much of the pattern of public school reopenings falls along political lines. The map of districts that are learning in-person and those that are in some form of hybrid or remote learning looks strikingly like an electoral map, with many politically “red” states largely allowing in-person classes, and many “blue” states doing hybrid or remote. And neither side — red or blue — has gotten it right.

Understanding how we are currently failing helps to shed light on how an effective, national strategy to open America’s schools, which the incoming Biden administration could spearhead, should look.

Blue states’ policies ultimately hurt children and families without controlling Covid-19

Blue states, which I define here as states that have voted Democratic in recent presidential elections, are certainly not a monolith, and there is variety among districts’ approaches. These, however, are more likely than red states to have remote or hybrid learning plans and are half as likely to have fully in-person learning, as a Brookings analysis found.

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In California and Washington, for example, approximately half of students remain in fully remote learning. In New York, 74 percent are in a fully remote or a hybrid model, with 26 percent in full-time in-person learning.

Over the summer, when plans for reopening were being developed and put into place, many blue states enjoyed low rates of Covid-19 transmission, making opening schools there fairly low risk, per Centers for Disease Control and Prevention guidance. Nevertheless, many districts in states such as California and New York proceeded with all-remote or hybrid models in which millions of children were not receiving much, if any, in-person instruction with professional educators.

In September and October, when daily case rates were rising slowly, but still under reasonable control, these states were slow to bring children back to school. Now that case rates are rising more quickly in much of the country, these districts remain in remote and hybrid models, and have perhaps missed their window to reopen.

At the same time, data have been emerging about the harms of ongoing school closures. Washington, DC’s public schools, which remain in a largely remote model despite having very low local new case rates until recently, report substantial reductions in kindergarten students meeting or exceeding benchmarks for reading. And Chicago Public Schools, which also remain in a largely remote model, report a stunning 15,000-student decrease in enrollment this year. Unforeseen extended school closures lead to lower test scores, lower educational attainment, and decreased earning potential.

These gaps are not impacting all groups equally. The Center on Reinventing Public Education (CRPE) reports that districts with the highest rates of poverty are nearly twice as likely to be operating with remote learning than districts with the lowest rates. The higher a district’s share of white students, the more likely it is to offer in-person instruction — a pattern that generally holds across cities, towns, suburbs and rural areas. A great racial and economic disparity is widening unnecessarily, one that will be sewn into the fabric of our society even beyond this generation if we do not rectify the problem now.

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Blue states are trying to control their Covid-19 epidemics, which is absolutely appropriate in the middle of a pandemic, but they misunderstand the utility of school closures. We now have experience with school openings, both in the US and globally, and there is little data to support the idea that schools are a major site of transmission or a driver of community spread.

For example, New York City has had schools open in a hybrid model since early October and monitors Covid-19 in the district by testing a random sample of students and staff. The most recent results, reported November 12, demonstrate that of more than 123,585 total tests conducted since October 9, only 228 were positive (0.19 percent); 95 students and 133 staff. These results are still early in the year, and students are not back yet full-time, but with more than a month of data, and during a time when cases are rising in New York generally, Covid-19 is not tearing through New York City Public Schools.

Students return to in-person learning in Orange, California, on August 24.
Paul Bersebach/MediaNews Group/Orange County Register/Getty Images

Nationally, the most recent data on the Covid-19 School Response Dashboard shows similarly low rates among students (0.24 percent) with low, but notably higher rates among staff (0.37 percent). To be clear, as rates rise in the community, rates are rising in schools. Children, of course, can be infected with Covid-19, and schools are not protected zones. But because schools have not been identified as a location where many cases of Covid-19 are transmitted, it is reasonable to think that with proper mitigation and a careful approach, we could have schools open and see little impact on Covid-19 transmission.

In comparison, there is a great deal of evidence that indoor dining, bars, and gyms are common sites of Covid-19 transmission. In a CDC study that tested 314 individuals for Covid-19, those who were infected were about twice as likely to report recently eating in a restaurant as those who tested negative. And the Wellcome Trust, which has been tracking the site of reported Covid-19 outbreaks since the epidemic began, found many examples of clusters linked to a wide range of other indoor settings, including restaurants, bars, parties, and workplaces, but few reports came from schools.

But despite the evidence that schools often have lower Covid-19 rates than their surrounding communities, and that gathering in settings like restaurants, bars, and gyms drives Covid-19 transmission, many of the states that vote blue are maintaining remote and hybrid educational models, while simultaneously trying to minimize restrictions on businesses.

In Boston, where case counts are rising, Mayor Marty Walsh announced in October that the city would move all public schools there to remote learning to, he says, protect the health of children and staff.

But restaurants have remained open in Boston, as have gyms and other public meeting places. The governor of Massachusetts recently enacted a statewide curfew on bars and restaurants, but he did not close them.

Philadelphia announced recently that its schools will remain in a fully remote model for the indefinite future. The Philadelphia situation is complex, because the city is now seeing out-of-control Covid-19 transmission, with case rates over 270 new cases per 100,000 people and a 12.5 percent test positivity rate as of November 13, which puts it in the CDC’s “highest risk” category for school opening. With this much coronavirus circulating in the community, it’s wise to close schools.

At the same time, the state of Pennsylvania remains in the “green” phase of reopening, meaning that there are minimal restrictions on businesses and meetings. In effect, the only response to the alarming case rates has been to close the schools.

Schools do not operate in a bubble, of course. If closing schools is the only intervention a jurisdiction takes to control its Covid-19 epidemic, incidence will continue to rise and schools will remain shuttered indefinitely.

So, quickly closing schools — where we have not seen a lot of transmission — while leaving higher-risk establishments open — where there is a lot of transmission — does not make sense. When faced with overwhelming case surge and crushing hospital demand, school closure could be necessary to prevent further Covid-19 surge, but only as one component of a larger plan to reduce mobility and control transmission.

Further, when school closures are necessary, if those closures are not coupled with restrictions designed to more generally reduce social mobility and prevent transmission, then Covid-19 cases will continue to rise and it will become still more difficult to open schools. Right now, in many blue states, schools are the first thing to close, while governors try desperately not to impact businesses. Such a policy is sacrificing our children in favor of working out, going out to dinner, and meeting friends for drinks. Blue states have it wrong.

A teacher starts to set up her classroom at Freedom Preparatory Academy on August 5, in Provo, Utah.
George Frey/Getty Images

Red states’ schools are open, often when they should not be

If the blue states are for holding back, many red states are recklessly opening their schools and increasing the odds of exposing children and staff to Covid-19 in the midst of raging outbreaks.

Many states that have voted Republican in recent presidential elections had more districts that returned to fully in-person learning this fall, even as their states were recording new highs in Covid-19 infections.

One district just outside of Salt Lake City, Utah, reopened for in-person learning at the same time that they saw case counts rising dramatically in their community. Approximately one month later, they reported one of the largest known school-based outbreaks to date. Many schools in Indiana opened for full in-person instruction in August, as the state was experiencing nearly 1,000 new Covid-19 diagnoses per day. Several schools quickly closed again when Covid-19 cases presented in school there.

By late October, Indiana had reported a cumulative prevalence of more than 5,000 cases of Covid-19 in its schools. In Idaho, where the largest districts have been either in-person or hybrid since September and community transmission is among the top 10 highest per capita in the country, schools saw their cases double in the first month and reported over 4,000 cases by mid-October.

Districts that have seen more Covid-19 in their schools have two things in common:

1) They opened when case rates in the community were very high, clearly higher than public health guidance recommends for safe reopening. For example, when Utah opened schools, the 14-day moving average of Covid-19 case rate in the community was 187 per 100,000 people, far above CDC’s threshold for “lower risk” reopening, which is 50 per 100,000 people.

2) They did not have statewide mask mandates, or masks were not routinely in use.

Conservatives argue that we cannot continue to hide from Covid-19 and that we must return to our normal activities, like school and work, if our country is to thrive. The paradox is excruciating to public health professionals, because we all agree: We do need to live and work in this pandemic and we do need to have our children in school.

But creating a false choice between reopening our economy and controlling the Covid-19 epidemic is counterproductive and will ultimately result in both more Covid-19 cases and worse economic performance.

Behind the drive to return to life as it was before the pandemic is a very real concern for the economy. One estimate of the economic damage caused by Covid-19 is $16 trillion, an unfathomably large number.

But the economy cannot truly return until we have Covid-19 under better control. If the disease is still surging in our communities, students are exposed and need to quarantine for 14 days — and in many cases, their parents cannot go to work. Some people might suggest that we simply stop the quarantining, continue to work, and abandon all efforts to control transmission in favor of economic stability. But we have seen what happens when Covid-19 spreads without mitigation; it overwhelms hospitals and threatens to collapse the health care system.

Further, the harms of out-of-control Covid-19 transmission are distributed unevenly in our society. The same way that closing schools tends to harm children of color and vulnerable populations, raging Covid-19 transmission tends to impact people of color and the under-served. Black and Latinx people are 2.5 to 3 times more likely to contract Covid-19 than white Americans, and 4 to 5 times more likely to be hospitalized. These disparities reflect the fact that Black and Latinx people are less likely to be working at home and more likely to live in close settings, outcomes of structural racism.

The way to safely and more equitably reopen our schools and our economy is first to control Covid-19 in our communities, so that it is safe to open schools, and then to consolidate those gains with strict mask mandates and reasonable restriction on social gathering. Blindly opening schools as one plank in a platform of Covid-19 denialism is exploiting our children for political gain and is unacceptable.

What a smart plan to open schools in America would look like

Our current political leaders are failing to provide a clear, national plan for reopening America’s schools. The incoming Biden-Harris administration has announced that it will provide new funds and guidance, but details have not yet emerged. Below are four essential elements for such a plan.

1) Clear guidance for when and how to open (and close) schools

Such guidance includes two components. One is reasonable, evidence-based thresholds for opening and closing our schools. The CDC has such guidance, but it is not clear how the thresholds were chosen. Further, the guidance has no bite.

At no time has the CDC said that districts may not open above a given threshold. They simply “advise caution” or “reconsideration” of current policy. We need strong federal action to prevent schools from opening when Covid-19 is not yet controlled in their communities. We also need clear and effective guidance for when schools should be open.

Second is making new strategy that envisions schools as one part of a larger public health policy. No district should employ school closures as the first intervention when Covid-19 cases rise. In a Covid-19 crisis, it may be necessary to close schools, but if so, then the school closures must be one component of a larger strategy that seeks to generally reduce mobility and social interaction, including restrictions on activities such as indoor dining, bars, gyms, and other places that we know Covid-19 is being transmitted.

2) Clear guidance for distancing in schools

While 6 feet has become the default stance on appropriate distancing from others in most of the US, 6-foot distance requirements greatly limit the ability of public schools to bring all students back full-time. The reality is, in many public school districts, if we insist on all students being 6 feet apart at all times, many districts simply will not have the space (and thus not really be able to bring all kids back to school full-time until there is an effective, widely distributed vaccine). That means that there is a very realistic scenario in which even in 2021 schools will need to use a hybrid instructional model.

Globally, the WHO identifies 1 meter (about 3.3 feet) as a minimum for distance from others. We need data-driven guidance for situations in which it is acceptable to distance less than 6 feet in educational settings.

Fortunately, data does exist to help us gauge the risk of Covid-19 transmission with contact of various distances. Perhaps, with quiet activity and good air flow and all students reliably in masks, a 4-foot distance might be acceptable. Covid-19 is always a question of risk and benefit. The benefit of being back in school full-time is clear. What are the real risks of occasionally being 4 to 5 feet apart during the school day if everyone is wearing masks?

3) Strong mask mandates at the federal, state, district, and school levels

Every message from every person of authority needs to reiterate the civic duty to wear a mask in public. Currently, many states leave masking mandates up to districts. This needs to change. People do not have a right to walk down the street naked, and almost every school district has a definition of clothing that is not appropriate to wear in school. Likewise, people do not have a right to have a naked face in school during this viral pandemic, and not wearing a mask is at least as inappropriate as wearing short shorts.

4) Robust testing and contact tracing

It’s critical that whenever any child develops symptoms consistent with Covid-19, it is fast, easy, and free to obtain testing. It is not possible for parents to keep their child out of school for many days every time that child develops a new runny nose, or winter cough. Symptomatic testing is important to make it possible to stay in school.

The role for asymptomatic screening is more complex. Routinely screening all members of the community holds promise as a strategy to identify and quarantine asymptomatic cases that may otherwise come to school. But we do not currently have the infrastructure or resources to make this happen. And in any case, the real pillars of safe school operation are community control, masks, and distancing. We cannot make asymptomatic screening a prerequisite to opening schools, because if we do, we will not be able to reopen.

This is what a plan to reopen looks like, but implementing it requires courageous leadership at the federal and state levels. With this plan in place, however, America can open its schools, keep students and teachers healthy, and contribute to a larger public health strategy to end the Covid-19 epidemic.

Benjamin P. Linas is an associate professor of epidemiology and an infectious disease physician at Boston University School of Medicine. Find him on Twitter @BenjaminLinas.