New evidence and recommendations for school openings: follow the science!

Teachers in the Chicago Public Schools have voted to refuse to teach in buildings, the functional equivalent of a strike, and their supporters claim their actions are entirely reasonable because those teachers fear for their lives.  At the same time, growing numbers of studies point to the overall safety of school reopening, giving communities reassurance that they don’t need to pit teachers against families, health against learning.

Here’s  a review of some of the new data.

First, on December 30, 2020, Dr. Marielle Fricchione, a pediatric infectious disease specialist with the Chicago Department of Public Health, and Dr. Allison Arwady, Chicago Department of Public Health Commissioner, published a study on the Archdiocese of Chicago schools’ reopening experiences in the fall.

As summarized at the Chicago Tribune,

The paper examined city schools in the Archdiocese of Chicago system, which began the school year with nearly 20,000 students and 2,750 staff members in-person, though the demographics of Catholic school students vary significantly from public schools.

Researchers found a “lower attack rate,” which is similar to an infection rate, for students and staff at schools than for the city itself. They also found that most clusters within a single school involved siblings and cases reported by schools were most often tied to other settings such as family and sports gatherings. The paper acknowledges limited applicability to high schools [due to lack of evidence due to the small number of Archdiocese high schools], but supports CPS in reopening “when the operational burden imposed by the second wave has subsided.”

Separately, AAP News reported on a study  out of North Carolina: among 100,000 students and staff over a nine week period, in schools open for a hybrid model, only 32 cases of in-school transmission were identified, compared to 773 community-acquired infections in the geographic area and time period.  What’s more, in none of these cases was a child identified as infecting an adult.  Among the three clusters, one was of pre-kindergarten students exempt from face coverings and the other two were in special needs classrooms.

Third, the CDC reported just yesterday on new studies lending more evidence to the case for successful in-school learning.  As reported at the Washington Post,

Schools operating in person have seen scant transmission of the coronavirus, particularly when masks and distancing are employed, but some indoor athletics have led to infections and should be curtailed if schools want to operate safely, researchers from the Centers for Disease Control and Prevention concluded in papers published Tuesday.

The CDC team reviewed data from studies in the United States and abroad and found the experience in schools different from nursing homes and high-density work sites where rapid spread has occurred.

“The preponderance of available evidence from the fall school semester has been reassuring,” wrote three CDC researchers in a viewpoint piece published online Tuesday in the Journal of the American Medical Association. “There has been little evidence that schools have contributed meaningfully to increased community transmission.”

The Post also cites a CDC study using data from Wisconsin, also just published yesterday, which found that

During the study period, widespread community transmission was observed, with 7%–40% of COVID-19 tests having positive results. Masking was required for all students and staff members at all schools, and rate of reported student mask-wearing was high (>92%). COVID-19 case rates among students and staff members were lower (191 cases among 5,530 persons, or 3,453 cases per 100,000) than were those in the county overall (5,466 per 100,000). Among the 191 cases identified in students and staff members, one in 20 cases among students was linked to in-school transmission; no infections among staff members were found to have been acquired at school. These findings suggest that, with proper mitigation strategies, K–12 schools might be capable of opening for in-person learning with minimal in-school transmission of SARS-CoV-2.

This is likewise extremely encouraging.

Finally, back in November, two experts from Harvard University’s T.H. Chan School of Public Health wrote at the Washington Post advocating for a reduction in the distancing mandate for children from six feet to three feet, writing,

six feet is not a magical cutoff. It has a weak scientific basis, coming from a fundamental misunderstanding going back decades that the tiny droplets we exhale when we breathe and talk will fall to the ground within six feet. The reality is that while some large droplets do fall out of the air, most are tiny and will stay aloft for an hour or more — traveling well beyond six feet. There is no bright-line cutoff.

Now, to be clear, these studies do not say that there is zero risk associated with in-person attendance.  But “zero risk” is an inappropriate expectation.  What matters is that teachers and students are not at greater risk, in-building, than is the case for the community at large — and this is especially significant with respect to Wisconsin, when positivity rates and infection rates were very high during the study period.

In addition, there’s another item that’s crucial as well:  the concept of risk compensation.

Even though there have been cases traced to in-school transmission, this is not proof that in-school learning increases the risk of transmission overall.  The greatest source of transmission is social gatherings in private homes, and supporters of restaurant re-opening have pointed out that dining in restaurants, in small groups and with the ventilation systems those restaurants have installed, is less riskier than the alternative, of individuals hosting large parties in their homes.  In the same way, to the extent that mandating remote learning causes more students to gather at parties, and increases the degree to which their parents, out of sympathy for their children unable to attend school, permit them to do so, remote learning mandates can be the indirect cause of more, rather than less, covid transmission.  None of these calculations attempt to calculate this; indeed, it would require a considerable degree of estimation to do so.  But we know the effect is greater than zero, and, depending on the particulars, may even wholly cancel out the apparent risk from in-person attendance.

As an actuary, I know that an individual’s personal experience says very little, and it’s important to look at studies such as this which evaluate covid infections for a large group.

As a mother, I have been sending my son to school at a parochial school since August, and that experience gives me a great deal of confidence in the measures the Archdiocesan schools have taken.  I know that the demand for in-person learning is not one that puts teachers’ lives at risk for families’ personal convenience, but that it is a very safe choice.

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