There’s a good, if frustrating, article in Science magazine that surveys the world’s response to schooling during a pandemic. Sadly, the broad view of the global response reveals a patchwork of differing strategies, a shortage of data and research, and more confusion about how Dallas and Texas should best handle the reopening of schools this fall.
What makes drawing lessons from other countries and regions challenging is that the success of limiting the spread of COVID-19 in schools often tracks with the wider spread of the virus in the local society. In other words, in places where COVID-19 spread has stabilized, reopening the schools has not generally caused the number of infections to rebound. However, the article mentions how Texas has seen a spike in the number of COVID-19 cases at childcare facilities, which tracks with the state’s overall upward trajectory.
Perhaps the most disheartening aspect of the piece is that there simply isn’t enough data available anywhere to make informed decisions about limiting the virus’ spread through school populations. Kathryn Edwards, a pediatric infectious disease specialist at the Vanderbilt University School of Medicine who is advising the Nashville school system, had her research assistant spend 30 hours digging for data relating to how the virus spreads between younger students versus older students or whether school reopenings created outbreaks. She found very little research addressing the issue.
Without adequate data, there is no clear best strategy for reopening schools. So schools around the world are inventing their own solutions. A Canadian elementary school is limiting socializing among children at recess to groups of six, which requires 6 feet of distance from other clusters of children. Schools in Denmark have moved classes outside, including to nearby graveyards. In China, where children are used to wearing masks both in school and in public, the students can only remove their masks during lunch.
Austria tried this same approach but abandoned it a few weeks later when it found there was little spread in schools. But then, when schools in Jerusalem abandoned their mask policy during a heat wave, there was a major outbreak at a high school.
Which illustrates what is so frustrating about this virus. It is so difficult to get a handle on what works, what doesn’t, and why. We seem to know that the spread of COVID-19 is not as bad among children, but at what age does that threat increase? We know that young people don’t experience the same debilitating symptoms as adults, but we don’t know if there are other side effects that may affect them long term.
Shutting down schools likely helped contain the spread of the virus in some places, but shutting schools also damages children in many other ways, from education and developmental challenges to increased instances of child abuse. And we don’t know if schools can be blamed for an increase of the spread the virus to the wider population or if the presence of the virus among the wider population causes an increase of cases in schools:
Early data from European countries suggest the risk to the wider community is small. At least when local infection rates are low, opening schools with some precautions does not seem to cause a significant jump in infections elsewhere.
It’s hard to be sure, because in most places, schools reopened in concert with other aspects of public life. But in Denmark, nationwide case numbers continued to decline after day care centers and elementary schools opened on 15 April, and middle and high schools followed in May. In the Netherlands, new cases stayed flat and then dropped after elementary schools opened part-time on 11 May and high schools opened on 2 June. In Finland, Belgium, and Austria, too, officials say they found no evidence of increased spread of the novel coronavirus after schools reopened.
In a broader study of COVID-19 clusters worldwide, epidemiologist Gwen Knight at the London School of Hygiene & Tropical Medicine and her colleagues collected data before most school closings took effect. If schools were a major driver of viral spread, she says, “We would have expected to find more clusters linked to schools. That’s not what we found.” Still, she adds, without widespread testing of young people, who often don’t have symptoms, it’s hard to know for sure what role schools might play.
At the same time, open schools can change the overall balance of who becomes infected by adding cases among children. In Germany, the proportion of all new infections that were in children under age 19 ticked upward from about 10% in early May, when schools reopened, to nearly 20% in late June. But wider testing and a decline in cases among the elderly could also explain the increase. In Israel, infections among children increased steadily after schools opened. That paralleled a rise in cases nationwide, but it’s not clear whether the country’s rising caseload contributed to the increase within schools or vice versa.
“We try to focus the epidemiologic research and find the source but it’s hard,” Aflalo says. “We cannot say right now this is because of this or that.”