The Great School Debate
“It is hard to imagine a more important issue than the safety of our country’s schoolchildren during a pandemic. As is often the case with an emerging infection, the data needed to make policy decisions about school reopening are incomplete.”
https://www.nejm.org/doi/full/10.1056/NEJMp2026045?query=featured_coronavirus
Over the last few weeks, I’ve spent significant time reviewing research to find clarity on whether and how children can safely return to school. The conclusion I’ve reached is confirmed by the article linked above. There isn’t enough data. And there is too much disease.
Please note, I understand there are a multitude of complexities with this issue. This post centers on safety in our current status.
Too little data…
The studies noted in CDC school guidance are a mix of surveillance reports from other countries, two journal articles (as of last week), and references to media stories.
Iowa incidence data tells us children 0-17 years comprise on 7% of cases detected. The primary issue with reliance on incidence data is children have been largely isolated and out of school since the start of the pandemic. This also leads to the inability to study transmission as children have largely been kept out of group settings.
A limited number of countries have some positive experience with school opening. Australia and Denmark implemented small class sizes, limited grades in person, distancing, extended time outdoors, and other measures which helped facilitate short-term in-person schooling.
A new study published today in the Lancet describes successful management of cases and contacts in New South Wales, Australia, with mitigation measures, frequent disinfecting, and other measures. The key in their scenario, was and still is, MANAGEABLE case counts. Iowa has more than 2 ½ times the number of cases than the entire COUNTRY of Australia (45,852 IA vs 17,923 AUS).
Israel allowed in-person instruction, had crowded classes, then allowed a temporary reprieve on mask wearing during a heat wave. Hundreds of students, staff, and family members became sick with the virus.
CDC published a study Friday where a camp in GA allowed 597 children and staffers, with state-based restrictions (though not consistent mask-wearing), to attend. After SIX DAYS, transmission resulted in 260 cases, 75% were symptomatic and the camp was closed. Children ages 6-10 were more likely to be infected than any other age group.
A South Korean study found transmission of the virus was highest among children ages 10-19, and while lowest among children nine and under, the study was so large (5,000 cases and 50,000+ contacts), the results are significant.
In sum, the data are all over the place.
Too much disease…
This week Polk County will reach 10,000 cases, more than 200 have died. By comparison, about 40 people died from H1N1 in 2009 in the entire state of Iowa. Another comparison – Iowa has more cases per population than all of its neighbors except Wisconsin and Missouri. Those states are less than 10,000 cases ahead while their populations are nearly DOUBLE ours. Iowa will exceed 50,000 cases in the next 10 days. Those are not the statistics our state should own. We should have 25,000 cases, and we should be capitalizing on our inherent advantage of having a low population density compared to many other states.
We need to focus on rural areas, gatherings, personal safety. Rural communities are not immune and will experience and perpetuate spikes in illness and death if actions are not taken.
Even with the number of sick, 10,000 cases in Polk, potentially 80,000-100,000 actual cases (according to CDC), that leaves the majority or 80% VULNERABLE to this disease. With an average of more than 400 new cases per day in Iowa, I cannot imagine a scenario where already strained public health resources will be able to manage the outcome of in-person school.
What do we do…
I struggle with this as a mom, public health advocate, and former educator. My belief is we need to be in a place where community disease is contained, where we can track, identify, and isolate cases, where the facets of state and local government (driven by public health and their data) have time to produce thorough, meaningful guidance to support schools. We are not in that place.
We have too little data and too much disease.
Please do your part. Protect yourself. Protect your children and families. We can do this together.
References
http://jogh.org/documents/issue202001/jogh-10-010376.pdf
https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30251-0/fulltext
https://www.cdc.gov/mmwr/volumes/69/wr/mm6931e1.htm