Keep schools open!

One of my favorite voices on this whole mess, Joseph Allen, “We Learned Our Lesson Last Year: Do Not Close Schools”

As the Omicron variant brings skyrocketing cases, colleges are suspending in-person classes, Broadway shows are canceling some performances, and companies are pushing back return-to-office dates. Most ominously, some politicians are calling to consider closing K-12 schools again, and a district in a Maryland suburb of Washington, D.C., decided recently to shift to remote learning until the middle of January. The dominoes are in danger of falling again. But a new round of widespread school closures would be a tragic mistake and should be off the table as an option.

The argument for keeping schools open rests on two constants ever since the Covid pandemic began: The risk of severe outcomes to kids from coronavirus infection is low, and the risks to kids from being out of school are high.

On risks from Covid: The weekly hospitalization rate for school-age children is approximately 1 in 100,000. This has stayed remarkably consistent throughout the pandemic — through the origin strain, the more transmissible Alpha and last winter’s surge and, yes, even through the summer Delta surge in the South and the fall Delta surge in the North.

As the American Academy of Pediatrics stated in a report released this month, “The available data indicate that Covid-19-associated hospitalization and death is uncommon in children.” There is also promising news regarding long Covid and children: A large meta-analysis published last month shows that kids who tested positive for the coronavirus have rates of persistent symptoms that are similar to those who tested negative, and when there were differences, they were small.

The early evidence from outside the United States suggests that kids will remain low risk during the Omicron surge as well. The latest data from South Africa for the week ending Dec. 12 shows that school-age children (5-to-19-year-olds) had the lowest hospitalization of any age group, and even with the Omicron uptick, the hospitalization rate is four to six per 100,000 — higher than one in 100,000 but still quite low. The latest data from Britain is similar. As of Dec. 12, the hospitalization rate for 5-to-14-year-olds is 1.4 per 100,000 — the lowest hospitalization rate of any age group…

The harms to kids from being out of school, on the other hand, are severe. They are accumulating. And they could last for decades…

Online learning isn’t the same as in-person learning. A report by McKinsey examining Covid-19 effects on the 2020-21 school year found that the pandemic left students five months behind on math and four months behind in reading. Schools with majority Black and brown populations saw deeper losses: six months behind in math and five to six months behind in reading. A separate study analyzing the impact of remote learning found that math and reading passing rates were lowest in poor areas and that going from fully virtual to fully in person counteracted the low math passing rates by 10 percentage points.

And that’s for students who were in school. One million students expected to be in school didn’t show up in person or online at all, with the largest declines in the youngest learners and in families living below the federal poverty line…

The effects of closed schools go far beyond learning loss. We have a full-on child mental health crisis on our hands. The proportion of pediatric hospital visits for mental health reasons increased significantly in 2020 as the pandemic hit and schools closed, and the trend only worsened as 2020 wore on.

Schools are the place where we first detect trouble at home, including neglect and abuse. Even short-term closings have steep consequences. In just the first three months of the pandemic, an analysis of data from New York City found a drop of nearly 8,000 in expected reports of allegations of child maltreatment. When researchers extrapolated that to the rest of the country, they estimated that more than 275,000 cases would have otherwise been reported…

And it’s not only children who suffer when there is no school. Kids doing school at home also meant many parents couldn’t be at work. This additional home work disproportionately fell on women, and differences in labor force participation between women and men, already stark, grew 5 percentage points from 2019 to 2020 in states offering primarily remote instruction.

All of these effects were predictable and, in fact, predicted. And they must not be repeated…

But when it comes to quarantining and masking, many schools should take a less intrusive approach than they currently are. This may seem counterintuitive in the midst of a surge, but because learning has been disrupted so much already, we need to prioritize keeping kids in school as much as possible and making the educational experience when they are there as rich as possible.

To that end, we need to stop quarantining entire classrooms when there is a positive case and instead establish so-called test-to-stay policies as the default. The Biden administration has finally woken up to this. If you test positive — or if you have any symptoms — you stay home. If you test negative, you’re in school.

This approach works. Los Angeles compared schools with test-to-stay policies and those without and found similar case rates across the schools, but the schools that didn’t have such policies lost over 90,000 in-person school days because of overquarantining. The schools that had test-to-stay policies lost zero days. Though we may feel tempted during the Omicron surge to use more restrictive measures, we should resist that urge. Test to stay will still be the best policy for schools, even as cases rise.

If rapid tests are not available, schools should not resort to quarantining entire classrooms. The default still should be keeping kids in classrooms, coupled with more aggressive monitoring of symptoms. This is less optimal than test to stay but preferable to sending entire classrooms home.

No, this is not risk.  What it is is a proper weighing of the many costs that come from closing schools.  And on a societal level, we need to prioritize keeping schools open. 

And Aaron Carroll from earlier this month, “We Opened the Schools and … It Was Fine”

Schools aren’t the problem. They never have been.

One of the frustrating things about the pandemic has been our inability, even at this late date, to understand why surges occur. [emphases mine] They hit communities with mask mandates, and communities without. Last year, we believed that the surge from October through February was caused by seasonal changes. The cold drove everyone indoors, where COVID was much more likely to spread, and therefore cases developed more quickly. This year, though, the surge began long before the weather turned cold. Vaccines are certainly protective and likely mitigate the severity of surges locally. Even so, things may worsen again—the data right now aren’t looking good for much of the country, and many people fear more hardship to come from the emergent Omicron variant—but no predictable pattern has emerged to explain what sets off periods of dramatic increases.

What is pretty certain, however, is that schools are not to blame. They didn’t cause the surges. They didn’t cause the massive numbers of hospitalizations and deaths that Florida experienced this summer and that Michigan appears to be experiencing now. They haven’t done nearly as much damage as bars, restaurants, and indoor events (including kids’ birthday parties), which never seem to receive the same amount of attention.

This doesn’t mean that kids aren’t getting COVID, of course. It doesn’t mean that kids aren’t in danger, haven’t gotten sick, haven’t been hospitalized by the thousands, and even died. Kids catch COVID, and transmission does occur in schools, but it is rare when precautions are taken. Because of this, the level of school transmission is sometimes lower than that of the surrounding community. Most schools are on guard, at least. Many require masks. More are being thoughtful about close contacts and group dynamics, and they enforce isolation and quarantine as much as they can. That may be inconvenient, but it’s hard to argue that it hasn’t made a difference.

It was not unreasonable to close schools before we really understood what we were dealing with and before we had vaccines that could dramatically reduce the risk of severe outcomes.  Given what we’ve learned and given the availability of vaccines for all school-aged children (alas, I sure wish uptake was much higher) schools really should be the last thing we close now.

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