Boston epidemiologists: We can reopen schools in the fall – if country closes bars and gyms now

Local experts argue that getting kids back to school will hinge on adjusting our priorities.

Demonstrators hold up signs during a "Bar Lives Matter" protest in Austin, Texas, on June 30. –Sergio Flores/Bloomberg

Schools are not a luxury item — they are part of the bedrock of society. They not only educate children, they also feed many of them. They provide a safer environment than home for some kids, and they are a beating heart in many communities. Long school closures during the novel coronavirus pandemic have exacerbated existing inequalities: Children whose parents can invest in a computer and an expensive online learning program will fall behind less than others whose parents cannot, or those who are working essential jobs that mean it’s impossible to support home schooling. Families are fighting, and women have ended up bearing the lion’s share of the child-care burden, which will have repercussions for gender inequality for years to come.

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Why did the pandemic force schools to close? The reasons are simple: If children can become infected, then they may be at risk of illness, and also could transmit the virus to others – their teachers, their families and their communities.

The benefits to society of schools being open, though, are greater than the benefits from opening most other institutions. Although we can mitigate transmission within schools to some degree, the best way to ensure that schools can open — and stay open — is to keep community spread of the virus low. Overall, reopening leads to more transmission, and right now, cases are ticking up across the South, as expected. That means activity in some other sectors of the economy will need to be reduced to preserve the education, feeding, socialization and safety of our children — and the ability of parents to do their work. Schools should be prioritized.

It’s true that children are probably less likely to become infected if exposed — estimates for kids hover around half as likely to pick up an infection per contact compared with an adult. And young kids are much, much less likely to become severely ill with the virus than older age groups — riding in a car is much more dangerous. However, car crashes are not infectious, and children infected with the virus are. There is some evidence that children are less infectious — that they might not transmit the virus as readily as adults — as well as less likely to get sick, although this is not altogether clear.

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So as the summer gets started, it might seem easy to argue that schools must open for normal business this fall. But we can’t overlook the potential for transmission in the school setting, which can only be reduced and not eliminated. Some tools to reduce that risk definitely work: distancing, hand-washing, mask use, testing and effective tracing and isolation of contacts if a case is found. Yet even as they plan for how to operate safely in person, school systems around the country are also preparing now for how to make online learning work well if they have to shut down again in the event of a large fall surge and extensive community transmission that once again threatens to overwhelm hospitals.

We can avoid that, and keep schools open, if we shift our priorities.

If we want schools to open in a few months and stay open, we need to keep community transmission low. The best way to do that is to suppress the spread of the virus. That means looking at what is reopening and when, and figuring out whether those sectors of the economy are really more important than schools. All reopening will likely increase community transmission to some degree.

So what are we all willing to give up to keep in-person education on the agenda? Can you forgo a night out at a bar or a trip to a casino? Can you give up dining inside a restaurant? What are you willing to give up to ensure that school openings don’t wind up pushing us over the edge? What are we willing to sacrifice? We need to decide where our priorities as a community lie, and in a way we can all support — whether we are ourselves parents, teachers or neither. We need to face this threat together.

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The two of us are acutely aware of the strains school closures place on families, having lived that life since March ourselves while we work from home. We asked ourselves what would make us feel confident to send our children to school both for their safety and the safety of their communities. The answer was not just the specific precautions that were being taken in schools, or the rates of testing in our community, but the amount of transmission outside school — which directly affects the risk that the virus will make its way into school buildings.

A single introduction is not a big deal, and a small outbreak can probably be halted with good infection control (with contact tracing, testing and isolating a subset of people). But once transmission outside the school becomes high enough, it will lead to more introductions into school, meaning that outbreaks become inevitable. And at that point, schools will be forced to close. If transmission approaches the levels of March, then entire school districts will likely close again, and we will be back where we started. And in fall and winter, social distancing will be harder than it is now, and everyone will be spending a lot more time indoors, where transmission increases.

The virus is still with us. That means all forms of reopening will increase transmission to some degree, though how much each opening (schools, bars, dining at restaurants, etc.) contributes is unclear. The overall risk from schools could be significant, though, given the numbers of children and teachers, and the number of contacts children make with each other and their parents, grandparents and other adults. We should work to keep that risk as low as possible and accommodate it. Reopening elsewhere has already been followed by outbreaks linked to schools.

We cannot return to our lives as they were at the start of the year without inviting the virus back, which would mean going through another devastating surge of infections and resulting shutdowns. Some things will have to change. Think of it like a budget: You have a certain amount of transmission you can tolerate without it becoming a threat. Because schools may contribute to the spread of the virus, we have to reduce transmission elsewhere to avoid going into the red overall — and to protect the schools themselves.

Deciding exactly how to do that means tough decisions about what is most important. If our society is going to ask businesses to take the hit for schools, the government should support them financially as much as possible, and it should also support those who lose their jobs as a result. But closing schools — and the high levels of community transmission that will have caused those closures — will result in more unemployment, as well as leaving children hungry and falling behind in their education. We are in the middle of a pandemic. We cannot have our cake and eat it, too. If we try, we might be left with no cake, and only ashes.

Helen Jenkins is an infectious disease epidemiologist at Boston University School of Public Health. William Hanage is an associate professor of epidemiology at the Center for Communicable Disease Dynamics at the Harvard T.H. Chan School of Public Health.


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