One Size May Not Fit All: COVID-19 Scenarios for School
How is Iowa doing?
Not well. We are among seven states with 14-day average increasing case counts. According to the White House definition of “hot spot” (a total of 100 cases or more per 100,000 people over the last 7 days), Polk County has held that designation for 52 consecutive days. With the recent derecho disaster, hospitalizations are up as well.
School models, thresholds, and rural/urban distinction
I’ve spent many hours immersed in anticipatory models the past few weeks. While there is more information to draw from, there is still too much disease.
Here is the basic scenario – if only 20 infectious students attend school in a large 90k+ person district, in-person, even with protections, it would take approximately eight weeks to reach the governor’s threshold (15-20% lab test positivity AND substantial school absence) for closure resulting in thousands of cases with UNLIMITED testing (using a transmission rate lower than the overall pandemic). The only way to mitigate an outbreak of that magnitude is to close school. The virus will inevitably be reintroduced with this cycle repeated until widespread vaccination. There are too many susceptible children in a district this size and too much community disease.
A tricky aspect of setting a threshold based on lab test positivity – if testing increases, the percent positivity is reduced for a longer period of time resulting in significantly more cases than if testing capacity were reached.
A second tricky point – rural schools are more likely to experience short-term, localized outbreaks with rapid increases in cases, not sustained, but occurring multiple times throughout the school year. With strong local public health partnership, these schools may be able to quickly identify and contain outbreaks. An in-person start to the year seems more appropriate in rural settings than urban.
There is little doubt now children can transmit COVID-19. Children are still likely to experience mild illness. However, MOST children are susceptible as they’ve been isolated from others for the majority of the pandemic. These scenarios do not touch upon the issue of illness among teachers and administrators, who will inevitably be affected.
In sum, I find it difficult to understand how an in-person school mandate and unilateral thresholds for closure will work to protect our students and teachers.
Personally, I do not look forward to online school. My kids benefit from interpersonal interaction. My kids already get WAY too much screen time. However, I have confidence in my kid’s teachers and administrators, and while extremely challenging, appreciate the effort put into meaningful planning. I am also hopeful that this is one unique year that will have an ending.
How do we change course?
We drive down community spread. It we reach a level of containment, the ability to reopen and interact changes. We cautiously approach sports and activities. We continue limiting our contacts with those who take precautions. Get your flu shot to protect against co-infection of influenza with COVID-19.
Some good news…
Contrary to earlier research (and updates), there is now a fair amount of confidence immunity to COVID-19 is retained after infection. Multiple, separate studies were able to demonstrate retention of reinfection-fighting response in our body’s warrior cells, even in asymptomatic infected people. This is excellent news. While more research is still needed to determine exactly how strong and for how long, this is encouraging news for vaccination as well as for those who have already had disease.
Take care, stay safe.
Articles on immunity:
https://www.medrxiv.org/content/10.1101/2020.08.14.20174490v1?referringSource=articleShare
https://www.cell.com/action/showPdf?pii=S0092-8674(20)31008-4&referringSource=articleShare
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7386524/?referringSource=articleShare
https://www.medrxiv.org/content/10.1101/2020.08.11.20171843v2?referringSource=articleShare
Article on school modeling:
https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30250-9/fulltext
Iowa Governor’s Guidance for Schools:
https://educateiowa.gov/sites/files/ed/documents/Return%20to%20Learn%2007302020.pdf
https://educateiowa.gov/sites/files/ed/documents/Evaluating%2007302020.pdf