By Foss Tighe
The United States is in the middle on an intense controversy over opening schools in the fall. There are many aspects of this debate. It has taken on strong partisan overtones, with Trump and his supporters forcefully pushing for a re-opening of schools. This is likely driven by the strong desire to return to a situation where “normal” economic activity can resume in time to aid the President’s re-election. For those opposed to Trump, there may be a knee jerk opposition to Trump’s position.
There is the complex and only partially understood science around children and COVID-19. There is strong evidence that the disease trajectory among children is vastly different from the virus’s behavior in adults, as evidenced by the very low death rate among children. But issues of transmission to and from children is less well understood. Added to the mix is the rare but strange COVID-19 related ‘Multisystem Inflammatory Syndrome in Children’.
Parent’s have an instinctive desire to protect their young. It is not surprising that many parents find the prospect of sending their children to school, while its not safe to get haircuts, an illogical situation.
For the first time in the COVID outbreak we have the involvement of a segment of the work force, who are well organized and often unionized. Teachers are flexing their political and social muscle across the country seeking to protect teachers from increased health risks posed by school re-opening. This is something that did not happen during the initial chaos of the outbreak with grocery store, delivery, public transport, first respondents and medical staff. See my blog post How US COVID-19 Strategy Maximizes Injustice.
For a huge number of families, remote learning poses massive childcare/work logistical problems. As the economy does start to open up, people are being called back to work. Parents of children who are remote learning face a daunting task of finding childcare. A traditional reliance on elderly relatives pose difficult to navigate moral issues regarding the potential risk of infection among older individuals. For many working from home is not always possible and even if it is, work performance could be easily impacted. Having to split your attention between work and supporting your child’s on-line education can be hard. And in poorer communities, the lack of adequate internet connections, computer equipment, and the necessary physical workspaces can make these burdens much greater.
Then there is of course, the issue of education itself. There are debates regarding the impact of continued remote learning vs in-person learning. Children of wealthier families often perform better across a wide range of education metrics, and its likely remote learning, which requires specialized equipment, study space and perhaps technical support, will exacerbate those issues. So failure to return to school will likely further disadvantage the disadvantaged.
Pandemic in US not Under Control
All of the above issues would not generate such intense conflict if the COVID-19 outbreak were under control. The failure of the United States to effectively control the COVID-19 outbreak can be seen through a comparison between the United States and other developed nations who have or are planning to open schools. The table below compares the positive test rate for a list of countries opening schools with that of the United States. The positive test rate is a considered a key metric by both the World Health Organization (WHO) and the US CDC.
|Country||Positive Test Rate|
The US positive rate (8.7%) is substantially higher than these other nations. As a side note, it is interesting to see that the US rate is higher than the rate is Sweden, where elementary schools never closed. Sweden has been widely criticized for not implementing adequate infection controls at the outbreak of the infection.
Asking Schools to Make Up the Difference
In the absense of a national policy to control the pandemic in the United States, it has fallen to local school systems to somehow design school opening plans that keep students, teachers and the community safe. In Massachusetts, where I live, the opening up guideance is quite complex. It places complex demands on staff who already have full-time jobs. Bus drivers, or optional monitors on buses are expected to be on the look out for symptematic students while they board the bus.
“Bus drivers or bus monitors (if applicable) should be appropriately trained to
observe students upon entry. If students appear symptomatic, and a parent/caregiver is
present to take them home, they should not be permitted to enter the school bus. If a
parent/caregiver is not present to take them home, bus monitors should refer students who
may be symptomatic to the school healthcare point of contact immediately upon arrival.“
– Massachusetts Fall Reopening Transportation Guidance
COVID-19 is notoriously difficult to identify even by trained medical staff. Patients who may appear more or less healthy can reveal serious pneumonia upon xray. And as we know children are much more likely to be asymptomatic than adults. The idea that a bus driver’s whose primary job is to safely drive a school bus through busy commuter traffic will also be able to effectivly function as a medical staff person on alert to hints of COVID-19 seems a little absurd. In addition if a driver thought a child has symptoms they are instructed to re-arrange the bus seating to place the symptomatic student app art from other students. Of course such seating re-arrangement would be difficult given the already rigid seating requirements put forward in the guidance document (See recommended seating chart in figure 1).
Within the Massachusetts guidance documents there is discussion of handling sick children. A isolated physical space needs to be designated to place children in until they can be picked up by a parent. This special area should ideally be equipped with special ventilation or air filters. The Urgent Care center I go to associated with my primary care physician has specially equipped exam rooms with either constantly running HEPA air filters or negative pressure air flow.
Sections of the guidance outline the importance of keeping children in small groups (pods) that spend the day together and don’t interact with children in other pods In part this is recommended to facilitate contact tracing should an infection be detected. Also if children do have symptoms, the schools are instructed to work with parents to get children tested quickly so that appropriate actions can be taken by the school.
All of these actions outline an entire “Parallel containment universe” within the school. A universe much like what constitutes what a proper infection containment strategy might look like for the entire nation.
- Careful Monitoring for Symptoms
- Isolation of individuals suspected on infection
- Facilities with special ventilation to hold students suspected of infection
- Rapid and efficient testing to determine if someone is in fact infected
- Contact tracing to isolate those who may have been in contact with an infected student.
While these plans can be commended for outlining control strategies consistent epidemiological science, they are plans our nation as a whole has failed to successfully implement. It seems unreasonable to expect school systems, historically under staffed and under funded, to somehow achieve the goals that entire U.S. Public Health System and Federal government could not achieve.
The issue of re-opening schools is causing great tension and divisions within our nation. I think we are placing an unrealistic expectation on our school systems to somehow compensate for the nation’s inability to get its act together regarding the COVID-19 pandemic. Our frustrations should be more appropriately focused on the failures of the Federal Government to lead a science based, consistent containment strategy from the first outbreak. If that had been done, school systems and teachers could be focusing on teaching rather than infection control.