Tuesday, Jun 18, 2024

New Findings Favor Reopening the School

Several recent reports and recommendations by pediatricians and public health experts are urging officials to return American children to their schools and classrooms full time, as quickly as possible. Findings based upon scientific data from recent outbreaks show that, unlike the flu, otherwise healthy children under the age of 10 are largely immune to the effects of the coronavirus, and if they do get infected, they rarely pass it on to others.

This has led a panel of experts commissioned by the National Academies of Science, Engineering and Medicine (NASEM) to urge the immediate reopening, whenever possible, of elementary schools and schools for children with disabilities, because a large proportion of those children are unable to learn effectively at home via the internet.

NASEM committee member Caitlin Rivers, an epidemiologist at Johns Hopkins Bloomberg School of Public Health, told the New York Times that, to the extent possible, “it should be a priority for [all school] districts to reopen for in-person learning, especially for younger ages.”

Another committee member, Keisha Scarlett, a senior administrator of the Seattle public school system, noted that remote learning initiatives were ineffective in teaching students from lower income and minority families for a variety of reasons. They range from lack of access and inexperience with technology to inadequate cooperation, support and supervision of the remote learning sessions by parents.

The NASEM recommendations were more explicit than the guidelines for school reopenings issued to date by the Centers for Disease Control and Prevention (CDC) and other advisory groups. The NASEM report called for limiting the spread of the virus by requiring frequent hand-washing and physical distancing, and the elimination of group activities such as serving meals in lunchroom and recess periods. It also called for surgical-quality masks to be worn by all teachers and staff members during school hours, and for cloth face coverings to be worn by all students, including those in elementary school, and that they be checked regularly for any sign of Covid symptoms, rather than relying on temperature checks.


The NASEM report calls for the federal and state governments to fund crash programs to upgrade the ability of the ventilation and air-filtration systems in all school buildings. According to the federal Government Accountability Office, 41 percent of public-school districts across the country need to update or replace the heating, ventilation and air-conditioning systems in at least half of their schools to make them capable of eliminating airborne transmission of the coronavirus. The estimated cost for such upgrades for each typical school district, with eight school buildings serving about 3,200 students, is about $1.8 million.

The NASEM panel declined to recommend a specific rate of positive infections that would force the lockdown of local school systems. According to Dr. Rivers, decisions about when to open, close or reopen schools were deliberately left to the discretion of local school officials, because, “There is no single prevalence or threshold that would be appropriate for all communities.” Local school board task forces, including public health experts, representatives of teachers and families, should be able to consider different factors, including the rates of coronavirus infections, hospitalizations and deaths, as well as the percentage of diagnostic tests that are positive, in making those decisions and contingency plans for when students, teachers or school staff become infected.


The NASEM report did not make any specific recommendations about whether to reopen their middle schools and high schools, whose students are somewhat more vulnerable than younger children to coronavirus infections.

Dr. Ashish Jha, the director of the Harvard Global Health Institute, approves of the distinction the NASEM report made between younger and older children. “The risk is different for a third grader than for a 10th grader, and I say that as the dad of a third grader and a 10th grader,” Dr. Jha said.

A study of the victims of the original Covid outbreak in China shows that teenagers become infected by the virus at about one-quarter of the average rate of infection for adults. This suggests that the risk of spreading the infection could be lowered to acceptable levels in reopened middle schools and high schools with strict enforcement of mask wearing and social distancing rules, and other measure to monitor students for symptoms and reduce incidents of close interaction during the school day.


The generally successful experience in 22 European countries which have already reopened their schools without creating an infection spike suggests that such an approach could be successful, especially with younger children, in areas where the underlying infection rate is not too high. For example, Norway, Denmark and Finland and Japan did not experience a spike of new cases after they reopened their schools for younger children this spring.

The Netherlands began reopening its schools on May 11, and by June 8, all students had fully returned to live classes. Students up to the age of 12 were allowed to get close to other children and adults. Students between 13 to 17 were also allowed to come into close contact with each other, but were required to maintain a six-foot social distancing space.

The strategy seemed to have worked. The National Institute for Public Health and the Environment in the Netherlands said it received “a few reports” of infections among school employees, but none appeared to have caught the virus from school children. The infections appeared to be due to infected faculty members and other adult staff interacting with one another.

Similarly, in the US, there have been no reported Covid clusters at child care centers that were allowed stay open during the lockdown to care for the children of essential workers.

Data collected by the CDC about the spread of the virus in the US through May 30 supports the theory that young children and teenagers are much less susceptible to the virus than adults.

The incidence of infection for children under 10 was 51.1 cases per 100,000 people in the population, and 117.3 per 100,000 for those between the ages of 10 and 19. For adults ages 20-29, the incidence roughly quadruples to 401.6 per 100,000, and peaks for those over age 80 at 902 per 100,000.


On the other hand, in several countries, including Israel, China and South Korea, schools were reopened but were closed again after the rate of new Covid infections started to spike.

A new study in South Korea of 5,706 people who reported symptoms between January 20 and March 27 indicates that infected young people between the ages of 10 and 20 can spread the virus about as readily as older adults do. However, the study took place during a period when South Korean schools were shut down, leaving those youth from densely populated South Korean urban communities at home all day and on their own. Whether their infection rate would have been just as high if they had still been spending their days learning in school classrooms is a matter of speculation.

A New York Times report on the South Korean study noted another flaw in its methodology—only those who first developed symptoms of Covid-19 in their household were tracked. It provided no information about whether asymptomatic but infected teenagers spread the virus to others. “I think it was always going to be the case that symptomatic children are infectious,” a disappointed Dr. Rivers said. “The questions about the role of children are more around whether children who don’t have symptoms are infectious.”

There is also a relevant evidence about the effect of school closings on the spread of a deadly virus from the 1918 Spanish flu epidemic which killed 50 million people around the world. According to a Johns Hopkins study of the pandemic, published in 2006, “When schools closed for [the 1918] winter holiday in Chicago, more influenza cases developed among pupils . . . than when schools were in session.”


Scientists are still trying to understand why the immune systems of healthy young children do a better job of resisting the coronavirus than in adults. Researchers writing in the Journal of the American Medical Association suggest that it may be due to the fact that children’s cells have fewer of the ACE2 receptors that the “spike” in the coronavirus can latch onto to start an infection.

Infected young children who are asymptomatic or who suffer very mild cases are not considered a major threat to spread the virus because they are not actively coughing up droplets or emitting aerosols with a high concentration of the virus that can infect others who come into contact with them nearby.

Children almost always get the virus from adults, and the primary location for that transmission is at home. Researchers at the University of Geneva’s medical school studied the households of 39 Swiss children infected with Covid-19. Contact tracing revealed that in only three cases (8%) was a child the suspected source of the infection

Most of the few children and teens who do become seriously ill due to the virus have underlying medical conditions or compromised immune systems, but almost all do eventually recover, because their immune systems do not overreact by creating a cytokine storm, which causes most of the fatalities in younger adults. Again, scientists do not yet know why.

A very small percentage of children who get infected and recover later develop a serious complication called multi-system inflammatory syndrome, or MIS-C. The CDC identified 186 cases of MIS-C in 26 states from March 15 through May 20. Most of the children did get better with proper medical care.


In fact, the overall mortality risk of Covid in children is far smaller than from the common seasonal flu virus. As of mid-June, only 26 American children under the age of 15 had died from Covid. By comparison, during the first six months of this year, an estimated 122 children under the age of 15 died from the common flu. Also, unlike the coronavirus, which is primarily a threat to children who are already ill or immuno-compromised, children killed by the common flu are often perfectly healthy before they are struck down.

The intensity of the annual flu outbreak varies widely from year to year, even though an updated flu vaccine is developed and widely distributed for each flu season. During the 2017-2018 flu season, which was declared by the CDC to be a pandemic, the virus took the lives of close to 600 children across the country. Most died within seven days of developing their first symptoms, and over one-third died at home or in an emergency room before they could be admitted to a hospital. Yet, no government official or public health official has ever recommended closing schools in areas across the country with flu outbreaks to protect their students from the common flu, which poses a much greater risk to their lives than the virus does.


Another belief associated with Covid is that schools cannot be safely reopened, and normal public gatherings cannot resume, until an effective vaccine is developed. Because there is an intense worldwide race to develop such a vaccine, with several leading candidates already starting human trials to test their safety and effectiveness, there is also a widespread belief that at least one of them will be successful at providing long-term immunity to the virus.

However, that flies in the face of the experience with the flu vaccine, which has been widely available and constantly improved over decades, yet offers a limited amount of immunity to those who have been vaccinated.

For example, during the 2017-2018 flu epidemic, the California Department of Public Health reported that out of 120 tracked children who either died from a flu infection or who had to be admitted to an ICU to be successfully treated, 61 of them (50.8%) had previously been inoculated with the vaccine developed for that flu season. In 2018, CDC published a study of six flu seasons which found that half of flu-related deaths occurred in otherwise healthy children, 22% of whom fell ill after being fully vaccinated.


Meanwhile, on June 30, the American Academy of Pediatrics (AAP) issued a strong recommendation that all schools in the country be reopened so that children could be “physically present in school” and avoid the major health, social and educational risks associated with keeping children at home.

In an interview with the New York Times, Dr. Sean O’Leary, a pediatric infectious disease specialist at the University of Colorado who helped write the AAP’s guidelines, said, “As pediatricians, many of us have recognized already the impact that having schools closed even for a couple months had on children. At the same time, a lot of us are parents. We experienced our own kids doing online learning. There really wasn’t a lot of learning happening. Now we’re seeing studies documenting this. Kids being home led to increases in behavioral health problems. There were reports of increased rates of abuse.

“Of course, the reason they were at home was to help control the pandemic. But we know a lot more now than we did then, when schools first closed. . . This virus is different from most of the respiratory viruses we deal with every year. School-age kids clearly play a role in driving influenza rates within communities. That doesn’t seem to be the case with Covid-19. . .

“From our perspective as pediatricians, the downsides of having kids at home versus in school are outweighed by the small incremental gain you would get from having kids six feet apart as opposed to five, four or three. When you add into that other mitigation measures like mask wearing, particularly for older kids, and frequent hand washing, you can bring the risk down. . .

“There are a couple of things we know now that we didn’t know when we closed schools down in March. One is that masks really do seem to work. They are very effective. Two, physical distancing works as well. . . Schools can do a lot of things to really make the environment as safe as possible.

“Reopening schools is so important for the kids, but really for the entire community. So much of our world relies on kids being in school and parents being able to work,” Dr. O’Leary concluded.

Dr. Nathaniel Beers, who co-wrote the AAP’s recommendations, says that they are largely consistent with those in the NASEM report. “The only nuanced difference is that the NASEM acknowledged the disproportionate impact on younger kids of not being in school,” he said, but while teenagers are generally better able to learn online than younger children, they can suffer serious social and emotional consequences from being separated from their peers.

“Adolescence is a period of time in life when you are to be exploring your own sense of self and developing your identity,” he said. “It’s difficult to do that if you are at home with your parents all the time.”


On July 10, Pediatrics, the journal of the AAP, published an op-ed piece on the Covid-19 virus spread entitled “The Child Is Not to Blame.” One of its co-authors, Dr. William Raszka, a pediatric infectious disease specialist at the University of Vermont’s Larner College of Medicine, said, “The data are striking. The key takeaway is that children are not driving the pandemic. . . It is congregating adults who aren’t following safety protocols who are responsible for driving the upward curve.”

To substantiate their conclusions, the authors of the op-ed cited the published findings of studies in several countries around the world.

For example, Australia’s National Center for Immunization Research and Surveillance reported that nine Covid-positive students and nine infected adult staff members at 15 schools in the province of New South Wales who were tracked in March and April spread the virus to only two out of 735 other students to whom they were exposed, and to none of another 128 “close contacts” among school teachers and staff.

Ireland’s first Covid patient was a child who was infected during a visit to Northern Italy in early March, and then returned to his school in Ireland, where he infected three students along with a teacher and two other adult instructors. But none of the 924 other students in the school who were exposed to the three infected kids before the school was caught the virus.

An English tourist who caught the coronavirus in Singapore visited a ski chalet in France, where he infected 11 others, including a child who later visited three schools and a ski class. None of that child’s more than 80 classmates became infected.

The authors of the Pediatrics op-ed also say that statistical models which predict the future course of the epidemic say that closing schools would have a relatively minor effect on the spread of the virus compared to the impact of social distancing and the wearing of masks.

Another concern is that to reopen fully with in-person classes this fall, schools across the country will need to hire additional staff to replace older or medically compromised educators and other staff members unwilling to risk returning to their classrooms and offices, even if strict measures are imposed to mitigate the spread of the virus. An estimated 28 percent of the more than 3.8 million full-time teachers in this country are older than 50, and about a third of school principals are over 55, putting them at higher risk if they are infected by the virus.


The teachers’ unions, concerned about the possible health risk to their members, are lobbying to keep the schools closed. But closing down the schools and switching to remote learning proved to be hugely disruptive this spring, and many parents are insisting that their elected officials find a safe and practical way for their schools to fully reopen for their children in the fall.

Pediatricians joined with parents in demanding that the educational, social and emotional needs of school children be put first, and that teachers be re-classified as “essential” workers whose continued services are at least as vital to the future of our country as grocery and liquor store clerks, bus and delivery drivers and garbage collectors. In addition to educating our children, classroom teachers who see them every day also serve, on behalf of society, as their first line of defense against the threats of physical abuse, neglect, bullying, and psychological problems.

Children urgently need to return to school for their own good, for the sake of working families, and to make possible a return to some semblance of normalcy for American society. But public-school teachers’ unions are making extreme demands, which are making their swift return to the classroom all but impossible, and some of which have nothing to do with protecting the health of students or teachers.


Nobody challenges the right of teachers to demand every reasonable protection, or the moral obligation to allow older teachers and those with health problems to be excused from their jobs for the duration of the Covid threat, with pay and benefits.

But the United Teachers of Los Angeles, for example, has no right to hold the return of students to their classrooms hostage to demands for the fulfillment of unrelated partisan political goals, such as defunding the police, and then opportunistically shifting that money to public education.

Ironically, the union’s newspaper admits that “vulnerable students… were disproportionately negatively impacted by the. . . shift to crisis distance learning,” while continuing to oppose the reopening of Los Angeles schools.

The mainstream media and the Democrats each sense a chance to damage President Trump’s re-election chances by extending the school closures and thereby delaying the economy’s recovery from the artificially induced coronavirus recession. They have urged the teacher’s unions to press their impossible demands for an ironclad guarantee that no child or adult will get sick from Covid-19 before allowing schools to fully reopen, while making false claims that they are based upon the latest scientific findings.


House Speaker Nancy Pelosi was being dishonest when she recently said in a CNN interview, “Going back to school presents the biggest risk for the spread of coronavirus. They (Republicans) ignore science and they ignore governance in order to make this happen.”

Just the opposite is true. Dr. Scott Atlas, the former chief of neuroradiology at the Stanford University Medical Center, and now a senior fellow and health care expert at the Hoover Institution, was outraged by Pelosi’s statement which “is totally antithetical to the [scientific] data,” and said it made him feel as if he is “living in [the imaginary reality of] a Kafka novel.”

Responsible scientific researchers in the field, such as Dr. Rivers of Johns Hopkins, point out that “even with extensive mitigation measures, it’s not possible to reduce the risk to zero, and that has to be part of the discussions.” Even the safest medicines have some negative side effects to go with their benefits, and in prescribing them, doctors are always weighing the potential risks against the likely rewards.

Even for young children, most of whom seem to enjoy a substantial natural immunity to the virus, the risk of infection in returning to their classrooms is still slightly greater than zero. But at the same time, we have to recognize the long-term damage being done to our children’s future by continuing to deny them an effective classroom learning experience.


Preparing the children for the future as best as possible be one of the country’s top priorities. It is time to stop destroying their hopes for the future for the convenience of their teachers. The best teachers put the interests of their students first. Of course, teachers truly afraid for their own health should stay home.

The worst choice society can make is to rob children of the opportunity that is only available through a good education that teaches them and inspires them to seek knowledge and find wisdom through reason and the learned ability to think for themselves. Denying them these gifts for any reason is not only selfish, but also short-sighted and counterproductive to the county’s future.

Any viable school reopening plan must include effective measures to protect the health of teachers and other school staff members as well as the children. It needs to be both flexible in terms of its timing, and realistic with respect to the actual dimensions of the Covid-19 threat.

Above all, in seeking the proper public policy response, the goal must be to maximize our greatest resource, the future our children, rather than any short-term partisan political advantage.



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