Hi, Everyone,
As fall approaches, one of the most important questions on many people's minds is whether it's safe for kids (and teachers and other employees) to go back to school.
Unfortunately, this is not an easy question to answer-and the answer varies based on several factors, some of which will be different from one district to another.
These factors include:
- How likely it is for kids to become infected
- How efficiently kids spread the virus
- The rate of transmission in the surrounding community
- The measures the school is taking to limit the spread
- Each family's individual circumstances
How likely is it for kids to become infected?
Three new studies or reports have been published in the past few weeks that shed light on how the coronavirus impacts kids. Vox summarized these studies in a recent article, which I recommend reading. The short version is that, in the United States, children under the age of 18 account for less than 7 percent of COVID-19 cases, and 0.1 percent of the deaths.
While COVID-19 is generally a mild disease in children, it's important to note that it can be serious-and even fatal-in some cases. Some studies suggest that between 0.6 and 9 percent of COVID-19 cases in children result in hospitalization. And, more rarely, children can develop a severe, multi-system inflammatory condition that resembles Kawasaki disease.
Serious complications appear to be more common in children with pre-existing conditions and in Hispanic and Black children. (This is yet another case of how BIPOC are disproportionately affected by COVID-19.)
It does seem that younger children (under the age of 10) are more likely to have mild illness, whereas older children's risk of severe illness is closer to that of adults. We don't yet know why this is.
Finally, kids are less likely than adults to acquire the virus in the first place given the same amount of exposure. A study published in Nature in June found that children and young adults under 20 years of age were about half as likely to get sick after exposure than adults, and studies in other countries have found similar results.
How efficiently do kids spread the virus?
Early on, the common belief was that children don't efficiently spread the virus. Recent studies suggest that this may be true in children under 10 years of age. However, kids over 10
appear to spread the virus at similar rates as adults.
However, there are some caveats here. A preprint (a study that hasn't been peer-reviewed) from Italy found that kids under the age of 14 are slightly less likely to be infected than adults, but are almost 10 percent more likely to spread the virus.
Also, a new study from July 21 found that kids have even higher viral loads than adults. It's not yet clear what to make of these findings, and the fact that these kids have higher loads of the virus doesn't necessarily mean that they're more infectious. More research is needed here.
Why the rate of transmission in the community is a key factor
When the rate of overall transmission in the community is low, kids are far less likely to acquire and spread the virus. And vice versa. It's a simple numbers game.
This explains why some countries and locations have been able to keep schools open without major outbreaks, whereas others (like Israel) have experienced significant outbreaks in schools.
Dr. Megan Ranney broke this down in a recent Twitter thread. Her conclusion:
"Once #COVID19 infection rates start to rise, it would be foolhardy to keep schools open IRL. And we should be planning NOW for how to keep kids healthy, safe, & fed, because that moment will likely come for every state."
Put differently, the best way to ensure that schools can open is to limit the rate of overall spread in the local community. The United States has done an atrocious job with this.
What measures are schools taking to limit the spread?
The most important factors in limiting the spread of the virus are distance, ventilation, masks, and time. Each of these is challenging in a school environment-especially with younger children.
In order to maintain six feet of distance between children, schools will have to limit class size, perhaps allowing half of each class to attend on alternate days. It's somewhat unrealistic to expect young children to remember to stay six feet apart, and if teachers are expected to "police" this, there will be a lot less time for instruction.
Ventilation is a crucial factor-yet one that is often overlooked, and that many schools are unprepared for. Some studies suggest that the risk of catching the virus is 19 times higher indoors than outdoors, and this is especially true in poorly ventilated indoor spaces.
Masks can help to reduce spread, but again, it's difficult for young children to wear them consistently and for teachers and administrators to enforce this.
Time is the final factor. As I've mentioned before, the risk of getting the virus can be expressed in a simple mathematical formula: volume of exposure + time. The longer someone is exposed to the virus, the higher the risk of getting it. At school, kids are together for many hours, so time is not on our side in this case.
Why each family's circumstances matter
In addition to all of the factors above, we also have to consider each family's individual circumstances. Say you have children and you also have an elderly parent living with you who has several pre-existing conditions that put them at higher risk of severe COVID-19 infection. You might be less likely to send your kids to school in that case. On the other hand, if you're an essential worker and/or you simply can't afford to stay home with your kids, you may have to send them to school-regardless of the risks.
As you can see, this is not a cut and dried issue with an easy answer that applies to everyone. Each local school district (and possibly individual school), and each family, will have to make their own decision based on all of the factors I've mentioned in this email.
In health,
Chris
P.S. In a future email, I'll share some ideas for alternative models of education and learning for those of you that have decided not to send your kids to school in person and that are questioning whether online learning is the right choice.
