As America moves into another phase of rapid growth in cases and hospitalizations in its Covid-19 epidemic, public education is among the increasing losses. Schools across the country are forced to return to distance learning or have never returned to a personal model. Without a national policy, states and even individual school districts have had to make the high stakes and the difficult decision of whether to continue with personal, hybrid, or distance learning alone.
Unfortunately, many of these decisions appear to be based on partiality rather than solid public health guidelines and evidence. Much of the pattern of public schools reopening is political. The map of the districts learning in person and those doing some form of hybrid or distant learning looks strikingly like a voting card, with many politically “red” states largely allowing personal tuition and many “blue” states doing hybrid or Remote. And neither side – red or blue – got it right.
Understanding how we are failing now helps shed light on what an effective national strategy for opening America's schools that the future Biden administration could lead should be.
The blue states' policies ultimately harm children and families without controlling Covid-19
Blue states, which I define here as states that voted democratically in the recent presidential election, are certainly not a monolith, and the approaches of the districts are different. However, they're more likely than red states to have distance or hybrid learning plans, and half as likely to learn completely in person, a Brookings analysis found.
In California and Washington, for example, approximately half of students stay on distance learning. In New York, 74 percent are in a fully remote or hybrid model, and 26 percent are full-time in face-to-face learning.
During the summer when reopening plans were being developed and implemented, many blue states had low transmission rates of Covid-19, which made opening schools there a relatively low risk, according to the guidelines of the Centers for Disease Control and Prevention. Still, many districts in states such as California and New York adopted all-remote or hybrid models, with millions of children receiving little, if any, personal tuition from professional educators.
In September and October, when daily case rates rose slowly but were still under adequate control, these states were slow getting children back to school. Now that case rates are rising faster in much of the country, these districts remain in remote and hybrid models and may have missed their reopening window.
At the same time, data were published on the damage caused by ongoing school closings. Washington, DC public schools, which until recently remained in a largely remote model despite very low local case rates, report significant declines in kindergarten students meeting or exceeding benchmarks for reading. And the Chicago Public Schools, also in a largely remote model, have seen a staggering 15,000 drop in enrollments this year. Unforeseen prolonged school closings lead to lower test scores, lower levels of education and reduced earning potential.
These gaps do not affect all groups equally. The Center for Reinventing Public Education (CRPE) reports that districts with the highest poverty rate are almost twice as likely to have distance learning as districts with the lowest rate. The higher the proportion of white students in a district, the more likely it will be taught face-to-face – a pattern that generally applies in cities, suburbs, and rural areas. Great racial and economic inequality is growing unnecessarily, one that will be sewn into the fabric of our society beyond this generation if we do not resolve the problem now.
Blue states are trying to control their Covid-19 epidemics, which is perfectly appropriate in the middle of a pandemic, but they misunderstand the usefulness of school closings. We now have experience of school openings, both in the US and around the world, and there is little data to support the idea that schools are a major transmission point or driver of diffusion in the community.
For example, New York City has opened schools in a hybrid model since early October and is monitoring Covid-19 in the district by testing a random sample of students and staff. The latest results, released on November 12, show that of more than 123,585 tests performed since October 9, only 228 were positive (0.19 percent); 95 students and 133 employees. These results are still at the beginning of the year and the students are not yet back full-time but with more than a month of data. At a time when cases in New York are generally on the rise, Covid-19 is not ripping through New York city public schools.
Students will return to face-to-face study in Orange, California on August 24th. Paul Bersebach / MediaNews Group / Orange County Register / Getty Images
Nationally, the latest data in the Covid-19 School Response Dashboard shows similarly low rates for students (0.24 percent) with low, but significantly higher rates for employees (0.37 percent). To be clear, when rates go up in the community, rates go up in schools. Children can of course be infected with Covid-19, and schools are not protected areas. However, since schools have not been identified as a place where many cases of Covid-19 are transmitted, it is reasonable to believe that with reasonable mitigation and a careful approach, we could open schools with little impact on the transmission of Covid-19 could see.
In comparison, there is ample evidence that restaurants, bars, and gyms indoors are often infected with Covid-19. In a CDC study that tested 314 people for Covid-19, those who were infected said they had recently eaten in a restaurant about twice as often as those who tested negative. And the Wellcome Trust, which has been tracking the location of the reported Covid-19 outbreaks since the epidemic began, has found many examples of clusters associated with a variety of other indoor facilities, 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 collecting in settings such as restaurants, bars, and gyms encourages transmission of Covid-19, many of the states that are blue are keeping remote, as well as hybrid educational models while trying to minimize the restrictions for companies.
In Boston, where cases are rising, Mayor Marty Walsh announced in October that the city would switch all public schools there to distance learning to protect the health of children and employees.
But Boston restaurants are still open, as are gyms and other public hangouts. The Massachusetts governor recently put a nationwide curfew on bars and restaurants, but has not closed it.
Philadelphia recently announced that its schools will remain in a completely secluded model indefinitely. The situation in Philadelphia is complex as the city is currently seeing runaway Covid-19 transmission with case rates of over 270 new cases per 100,000 people and a test positivity rate of 12.5 percent as of November 13, which puts it in the CDC “Highest risk” category for school opening. With so much coronavirus rife in the community, it is advisable to close schools.
At the same time, the state of Pennsylvania is still in the "green" phase of reopening, which means that companies and meetings are subject to minimal restrictions. In fact, the only response to the alarming case rates has been to close schools.
Schools don't work in a bubble, of course. If school closings are the only action any jurisdiction takes to fight their Covid-19 epidemic, the incidence will continue to rise and schools will remain closed indefinitely.
So there is no point in closing schools quickly – where we haven't seen a lot of transmission – and leaving higher risk institutions open – where there is a lot of transmission – makes no sense. With an overwhelming surge in cases and a stifling demand for hospitals, a school closure may be needed to prevent Covid-19 from rising again, but only as a component of a larger plan to reduce mobility and control transmission.
If school closings are required and those closings are not accompanied by restrictions designed to reduce social mobility in general and prevent transmission, the cases of Covid-19 will continue to increase and schools will become even more difficult to open. Currently, schools are the first to close in many blue states as governors desperately try not to disrupt businesses. Such a policy sacrifices our children in favor of exercise, dinner and meeting friends for a drink. Blue states got it wrong.
A teacher begins setting up her classroom at Freedom Preparatory Academy August 5 in Provo, Utah. George Frey / Getty Images
Schools in the Red States are often open when they are not
If the blue states want to hold back, many red states are ruthlessly opening their schools, increasing the likelihood of children and employees being exposed to Covid-19 amid angry outbreaks.
Many states that voted Republicans in the recent presidential election had more districts learning fully face-to-face again this fall, despite their states seeing new highs in Covid-19 infections.
A district outside of Salt Lake City, Utah, reopened to face-to-face learning as the number of cases in their community rose dramatically. About a month later, they reported one of the largest known school-related outbreaks to date. Many Indiana schools opened for full face-to-face tuition in August as the state was diagnosed with nearly 1,000 new Covid-19 diagnoses every day. Some schools quickly closed when Covid-19 cases were presented at school.
By the end of 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 personal or hybrid since September and community transmission is among the ten highest per capita in the country, schools doubled their cases 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 the fall rates in the community were very high and well above public health recommendations for a safe reopening. For example, when Utah opened schools, the community's 14-day moving average Covid-19 case rate was 187 per 100,000 people, well above the CDC “lower risk” reopening threshold of 50 per 100,000 people amounts.
2) They did not have nationwide mask mandates or masks were not used routinely.
Conservatives argue that we can no longer 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 intolerable to health professionals because we all agree: we must live and work in this pandemic, and we must have our children in school.
However, making the wrong choice between reopening our economy and fighting the Covid-19 epidemic is counterproductive and will ultimately result in both more Covid-19 cases and poorer economic performance.
Behind the urge to come back to life as it was before the pandemic is a very real concern for the economy. An estimate of the economic damage caused by Covid-19 is $ 16 trillion, an unfathomably large number.
But the economy cannot really return until we have better control of Covid-19. If the disease is still on the rise in our communities, then students will be exposed and will have to be quarantined for 14 days – and in many cases their parents will not be able to go to work. Some people might suggest that we just end the quarantine, keep working, and abandon all efforts to control the transmission in favor of economic stability. But we saw what happens when Covid-19 spreads without slowing down. it overwhelms hospitals and threatens to collapse the health system.
In addition, the damage caused by out-of-control Covid-19 transmission is unevenly distributed in our society. Just as school closings tends to harm colored children and vulnerable populations, the frenzied transmission of Covid-19 tends to affect people of color and underserved. Black and Latinx patients are 2.5 to 3 times more likely to contract Covid-19 than white Americans, and 4 to 5 times more likely to be in the hospital. These differences reflect the fact that blacks and Latin Americans are less likely to work from home and are more likely to live in close quarters due to structural racism.
The path to a safer and fairer reopening of our schools and our economy is first to control Covid-19 in our communities so it is safe to open schools, and then to allocate those profits with strict mask mandates and a reasonable restriction on social cohesion consolidate. The blind opening of schools as a plank on a platform of Covid-19 denialism uses our children for political purposes and is unacceptable.
What a smart plan to open schools in America would look like
Our current political leaders do not provide a clear national plan for the reopening of American schools. Biden-Harris's new administration has announced that it will provide new funding and guidance, but details are not yet known. Below are four essential elements for such a plan.
1) Clear instructions on when and how schools should be opened (and closed)
This guide has two components. One of them is sensible, evidence-based thresholds for opening and closing our schools. The CDC has such guidelines, but it is not clear how the thresholds were chosen. Furthermore, the guide has no bite.
At no point has the CDC stated that districts may not open above a certain threshold. They simply advise caution or reconsideration of the current policy. We need strong federal measures to prevent schools from opening if Covid-19 is not yet controlled in their communities. We also need clear and effective guidance on when schools should be open.
Second, a new strategy is being developed to include schools as part of a broader public health policy. No district should use school closings as an initial intervention when Covid-19 cases arise. Schools may need to be closed in a Covid 19 crisis. However, if it does, school closings need to be part of a broader strategy aimed at reducing mobility and social interaction in general, including restrictions on activities such as indoor dining. Bars, gyms, and other places we know Covid-19 can be transmitted from.
2) Clear guidance on distancing in schools
While 6 feet has become the default setting for adequate distancing from others in most of the United States, 6 feet severely limits public schools' ability to bring all students back all day. The reality is that in many public school districts, if we insist that all students be 6 feet apart at all times, many districts simply don't have enough space (and therefore not really able to get all the kids back to school all day there is an effective, widely used vaccine). This means that there is a very realistic scenario in which schools will have to use a hybrid teaching model even in 2021.
Globally, the WHO identifies at least 1 meter for the distance to others. We need data-driven guidance for situations where it is acceptable to be less than 6 feet away in an educational setting.
Fortunately, there is data that can help us estimate the risk of Covid-19 transmission from contact at different distances. Perhaps with quiet activity, good airflow, and all students who wear masks reliably, a distance of 4 feet is acceptable. Covid-19 is always a question of risk and benefit. The advantage of going back to school full-time is obvious. What are the real risks of having an occasional 4 to 5 foot gap during the school day with everyone wearing masks?
3) Strong mask mandates at the federal, state, district and school levels
Any message from any person in authority must affirm the civic duty to wear a mask in public. Currently, many states are leaving masking mandates to the districts. That needs to change. People have no right to walk down the street naked, and almost every school district has a definition of clothing that is not suitable for wearing in school. Likewise, during this viral pandemic, people have no right to a bare face in school, and wearing a mask is at least as inappropriate as wearing short shorts.
4) Robust testing and contact tracing
It is important that any child get tests quickly, easily, and free of charge if they develop symptoms that are compatible with Covid-19. Parents cannot keep their child away from school for many days every time the child develops a new runny nose or winter cough. Symptomatic tests are important for staying in school.
The role for asymptomatic screening is more complex. Routine screening of all members of the community is a promising strategy to identify and quarantine asymptomatic cases that might otherwise be coming to school. However, we currently don't have the infrastructure or the resources to achieve this. In either case, the real pillars of safe school operations are community control, masks, and distancing. We cannot make asymptomatic screening a requirement for schools to open because if we do, we cannot reopen.
This is what a reopening plan looks like, but implementation requires courageous federal and state leadership. With this plan, however, America can open its schools, keep students and teachers healthy, and contribute to a broader 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.
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