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COVID: Should schools reopen?


The common question that has been posed is, 'can schools be safely opened'. This is an important question. An equally important one is whether it is safe for schools not to open. There is an important risk/benefit analysis (RBA) that must be weighed:

1. What is the health risk to children?

2. What is the risk of children infecting teachers and/or family?

3. Can precautions be taken to decrease the risk of infectivity and to track/isolate COVID cases?

4. What is the knowledge gap between in-school learning and e-learning?

5. What is the social/emotional cost to children due to prolonged isolation?

I will address each one in order:


1. What is the health risk to children?


It is well established that the risk of mortality for COVID-19 for otherwise healthy children is relatively minimal (far less than influenza or RSV). Children appear to have decreased levels of the ACE-2 protein that allows the SARS-COV2 virus to enter the cells. While there are other morbidity risks including MIS-C. These are still overwhelmingly rare events.

2. What is the risk of children infecting teachers and/or family?

This is probably the most challenging question because there does not appear to be a clear consensus on this. COVID-19 is also well-known to be extremely dangerous to older and immunocompromised adults (of which up to 25% of teachers may fall into this category). Children have been thought to be less likely to infect others possibly due to decreased lung ACE2 levels, but a recent study found that children with the virus actually appear to have a higher concentration of viral particles in their nasopharynx than adults. This alone does not prove that they are more likely to spread it but it is possible (and there is some evidence to this point). A counterpoint to this is an article by the American Academy of Pediatrics which argues that the data shows that children are relatively minor spreaders of COVID-19. This challenge will likely boil down to each individual family’s circumstances. A family with immunocompromised children at home or Grandma living upstairs may decide the risk is not worth the benefits of in-person school. An otherwise healthy family without risk-factors may feel more comfortable with the uncertainty.

3. Can precautions be taken to decrease the risk of infectivity and to track/isolate COVID cases?

There certainly are precautions that can be put in place to minimize the risk. Staggered

school drop-offs and smaller or no bussing to avoid crowding. Lunch in the classroom. Increased hand-sanitizing stations. Plastic barriers at the desks and the teachers’ desk. Masks while walking around the campus. Infrared temperature checks of everyone upon entry. Isolation rooms. Decreased class sizes and social distancing within classrooms. There are plenty of other creative ways to decrease the risk of transmission.


Counties or districts with particularly high prevalence rates should consider closing schools until the numbers are more manageable and the risk of overburdening the healthcare system is diminished. Classrooms and schools should be closed temporarily as needed if/when children contract COVID (we will address how schools can effectively contain an infection in a future article).

4. What is the knowledge gap between in-school learning and e-learning?

Empirically, online or e-learning has been at best tolerable and oftentimes an absolute disaster academically. There are so many factors involved including the teacher's (in)ability to utilize the online tool, internet connectively issues, children’s own difficulty with staring at a screen all day, and distractions at home to name a few. Much has been written about the lost academic year of 2019-2020. American education already suffers from prolonged summer vacation, and this just adds further insult to injury. The biggest impact is on those of poorer socioeconomic backgrounds as they have less access to private tutors, less likely to have the environment most conducive to e-learning and parents are less able to take time off of work to help. Children with learning disabilities are also impacted greatly as are those who rely on specialized in-school therapies.

5. What is the social/emotional cost to children due to prolonged isolation?

The emotional cost of continued isolation is tremendous. In one study, nearly a quarter of children had new-onset anxiety and/or depression after just 1 month of e-learning. This is likely to worsen significantly as prolonged isolation continues. Many children rely on school for food, healthcare, and even safety. The social disconnectedness and emotional toll that this generation of children will likely suffer are impossible to fully envision or measure.

Final thoughts:

The risk-benefit analysis to me is clear, schools must have an in-school option this fall. However, there is no right or wrong answer individually. Everyone needs to weigh their own circumstances based on high-risk family members, each individual child’s needs, and many other personal factors.

Finally, teachers are essential workers just like physicians are. Healthcare workers did what

needed to be done for the good of society. Having said that, teachers should have the option of teaching in the e-learning setting. There will still be a significant proportion of parents who will not send their kids to school and will opt for e-learning. This may be due to having high-risk individuals at home or if the children are themselves immunocompromised or a multitude of other factors that cannot be covered in this brief article. Those teachers who teach in-school should receive hazard pay commensurate with their increased risk and role as essential workers (medical professionals have shamefully not received this by and large but that is another discussion).

Summary:

The need for in-person school is tremendous from an educational, social, and emotional standpoint. There are risks and it is unknown to what extent children may or may not spread COVID, however proper precautions can be placed to mitigate this risk to the extent possible. Some families will certainly continue to enroll their children in e-learning and this should remain available. Once schools reopen, we may find out that there is a significant resultant spread, and we may even need to rethink if schools can remain open. If MLB was able to try it with baseball though, aren’t our children worth the effort? I for one will send my children back to school when it restarts. What are your thoughts, will you send your children to school? Leave a comment below!

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