By Dr. Ashish K. Jha, Dean, and Sameer Nair-Desai, Research Assistant, Brown University School of Public Health
As the worst wave yet of the COVID-19 pandemic sweeps across the nation, the data on schools is becoming clear: most schools can and should stay open, particularly for younger children (K through 8).
The benefits of in-person education
Despite the best efforts of education districts, there is no doubt that remote instruction generates large learning gaps and links to higher rates of mental illness, while depriving children of formative social and peer relationships. This is especially true in disadvantaged communities and vulnerable populations. The losses from extended school closings will likely be felt for generations to come. Schools are essential to the future of our nation, and integral to our economy.
Evidence supporting school openings
The case for schools being open, particularly in K-8 systems of education, rests on two key questions: whether schools drive transmission in the community and whether high community transmission rates lead to large spread of the virus within schools. The latest data has failed to find any compelling evidence that in-person schooling leads to meaningful increases in infections in the community. There is also a lack of evidence suggesting spread within schools, especially in schools with strong mitigation measures. And not for a lack of trying: studies focused on examining the spread of the virus within schools have consistently found little compelling evidence.
Two important resources collecting data from schools across the nation are a dashboard compiled by the National Education Association, and Brown University economist Emily Oster’s COVID-19 School Dashboard. According to the NEA’s dashboard, which captures 5,803 schools, only six states have recorded more than a thousand cumulative school cases (K-12) since July of this year. Idaho, the state with the most cases, recorded 4,462 new cases since July 16th. This represents only 7% of new cases in this window. In Michigan, 409 new cases were reported according to the NEA. This is only 0.2% of new cases in this window. Michigan’s own state data mirrors this trend. Since Michigan last updated its data on 10/12, staff cases have been roughly 0.17% of new cases, while student cases are near 0.43%. In Florida, the NEA reports 2,128 new cases since July 15th. This represents only 0.40% of new cases.
One database, eight million students
While the NEA tabulates state case counts, the COVID-19 School Dashboard queries schools around the nation on case counts and infection rates for both students and staff, records which mitigation strategies they employ, and tabulates school-wide demographics. The project currently captures over eight million students, out of which nearly four million attend school in-person. Since August, the percentage of schools which reported cluster outbreaks (more than five cases) has hovered around 2%. The percentage of students confirmed or assumed COVID-19 positive in the sample is less than 0.25%, and the percent of confirmed or assumed positive staff is only 0.37%.
Suggestive evidence from case studies around the United States also indicate weak associations between re-openings and higher transmission. Local studies of re-openings in smaller municipalities have found no correlations between re-openings and spikes in infection. In Florida, where school re-openings began back in August amidst a summer spike in cases, infection rates in smaller districts have largely mirrored community trends. Charlotte School District began reopening their schools to over 15,000 students on August 31st. Since then, school infection rates have remained lower than 0.50%. More notably, community cases did not spike immediately following these re-openings in late August. Manatee School District reopened even earlier, in mid-August. Their most recent school infection rates hover around 0.60%.
In New York state, schools began to reopen in mid-September. Community spread has remained stable during the phased re-openings in Bronx, Manhattan, and Richmond counties. After reopening all of its public schools, New York City school infection rates remain stable at around 0.20%.
School outbreaks? They usually start in the community
This evidence is not limited to the United States alone. In global settings, school re-openings accompanied by strong mitigation measures have resulted in a transition to in-person education without large spikes in infections. Two meta-analyses of scientific papers relating to global re-openings found no associations between re-openings and case spikes within schools, nor could they link subsequent community outbreaks back to school openings. The WHO recently confirmed that only a few large outbreaks have been linked to schools, most of which began in the community. Another meta-analysis found children younger than 20 were nearly 44% less likely than their older counterparts to risk secondary infection. Most of these effects came from those aged ten years or younger. Furthermore, according to a wide range of scientific papers, both susceptibility and infectivity increase with age. The WHO cites secondary and high schools as the prime nodes of outbreaks, noting children under 10 are particularly resilient to contagion.
Many of the key arguments against school being open during outbreaks rest on the fact that we don’t have robust data suggesting schools are safe. In other words, opponents of school openings suggest we simply do not know enough at this point to make informed policy decisions and it is safer to keep kids at home, despite its enormously high social, economic, and health costs. While this was a valid argument over the summer when we lacked any real data on whether schools could be open safely, that is no longer the case.
Schools are essential. We should treat them as such
The evidence from our raw data and from case studies around the nation suggest schools can be managed safely and effectively in a pandemic. Moreover, we think the time has come to treat schools as the societally essential functions that they are. They are essential for the well-being of children and essential to the economy. Educators need to be supported as essential workers. Schools should be exempted from closure requirements but be equipped with capacities for infection control so that they can function safely even when community spread levels increase.
Key infection control measures in schools, then, need to include mask requirements for students and staff, proper hygiene (handwashing), ventilation improvements and consistent testing of symptomatic individuals and tracing of contacts. In the case of cluster outbreaks, mandatory quarantines for infected individuals and their contacts need to be enforced.
It is clear from the data and experiences of individual school districts that opening schools in a pandemic with infection control measures in place does not lead to increased transmission of the virus. In many ways, schools can be the safest place to be for children during a pandemic.
New York City School Testing Results
New York State COVID Dashboard
Emily Oster COVID-19 School Dashboard
John Hopkins University CSSE Coronavirus Dashboard
Global Epidemics Testing Targets
Florida Schools Reopened En Masse, Feared COVID Surge Hasn’t Followed (USA Today)
Feared COVID Outbreaks in Schools Yet to Arrive, Early Data Shows (Washington Post)
School Openings Across Globe Suggest Ways to Keep Coronavirus at Bay (Science)
School Reopenings Pandemic In-Person Teaching (Vox)
Operating Schools During COVID-19 (CDC)
Too Many Schools Leave Learning to Chance During the Pandemic
Why Schools Probably Aren’t COVID Hotspots (Nature)
School Reopening Thresholds Vary Widely Across the Country (US News & World Report)
Children are Unlikely to be the Main Drivers of the COVID-19 Pandemic: A Systematic Review (Acta Paediatrica)
Interactive COVID-19 Schools Map Using COVID Tracker (New York Times)
Susceptibility to SARS-Cov-2 Infection Among Children and Adolescents Compared with Adults (JAMA Pediatrics)
Schoolchildren Seem Unlikely to Fuel Coronavirus Surges, Scientists Say (New York Times)
Were the Risks of Reopening Schools Exaggerated? (NPR)
What We Know About COVID-19 Transmission in Schools (WHO)
Schools Aren’t Super-Spreaders (The Atlantic)