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 usual caveats apply: This is early data, and hospitalizations lag cases. On the other hand, the trends are encouraging: The wave in Gauteng, South Africa, is already peaking. Additionally, 7 to 15 percent of children were hospitalized with Covid, not for Covid. This is a key distinction. Covid was an incidental discovery because of routine testing during a hospital visit for some other medical reason, or the patients were there for isolation, not treatment. (This has been seen in the United States and Britain, too, where consistently 15 to 20 percent of hospitalizations are incidental.)
The harms to kids from being out of school, on the other hand, are severe. They are accumulating. And they could last for decades.
Questions surrounding the Covid-19 vaccine and its rollout.
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.
As pressures to close schools again grow, we should recognize that the patterns of school closures and reopenings last year were defined by racial inequality. Black and Hispanic students were twice as likely as white students to be remote and were twice as likely to have no live access to a teacher. This disparity persisted into the spring of 2021 as schools reopened: Whereas 2 percent of majority white districts stayed closed, 18 percent of majority Black schools stayed remote, and nearly one in four majority Hispanic schools stayed closed.
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.
My colleagues and I wrote last fall about how school closings were preventing 14 million kids from getting the food they need. Low-income children get more than half of their calories from school meals. Kids with food insecurity are twice as likely to be in poor health as kids who are food-secure and are more likely to be hospitalized.
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.
So what should we do to keep risk low instead of closing schools again?
First and foremost, parents should get their eligible children vaccinated. The vaccines are safe and effective.
We also need to mandate vaccination for all adults in schools and day cares. Several school districts have already mandated staff vaccines, with great success. Los Angeles has 99 percent of public school teachers vaccinated after its mandate, and just as important, vaccination rates for nonteaching school staff members grew from 80 percent to 95 percent. The percentage of New York City’s full-time public school staff members who had received at least one vaccine dose went from about 70 percent in August, when the mandate was announced, to 95 percent by early October.
Schools should address ventilation and filtration shortfalls through basic measures that can be put in place quickly. Supplement any deficient mechanical system performance with portable air cleaners with HEPA filters to target four to six air changes per hour. And open up the windows if you have them; even a few inches helps.
But don’t stop with stopgap measures. There are still millions of dollars of stimulus dollars on the sidelines, waiting to be spent on schools. Investments in school infrastructure will help against Delta and Omicron and what will surely be Pi and Rho coming at us.
Vaccination mandates and improved ventilation are important proactive measures that school districts need to take. 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.
For those who test positive, the current protocol requires a 10-day isolation period, with no option to test out, even for the vaccinated. This is overly stringent and is causing more unnecessary missed schooling. Two negative rapid antigen tests on consecutive days and no symptoms should be enough to return safely.
We should make masking in schools voluntary rather than mandatory. Masking was a necessary inconvenience early on and in short stints was fine. But to think that two years of masking has no impact on socialization, learning and anxiety is shortsighted. Kids are resilient but not endlessly resilient.
Still, anyone who wants to wear a mask should be allowed to do so. One-way masking with an N95 or KF94 provides excellent protection, regardless of what others around you are doing or not doing. If children are vaccinated and wearing a high-performing mask, their risk is about as low as it gets in life.
We are coming up on two years of disrupted school. For those in the second grade, a life of closed schools, learning behind plexiglass and masks, learning to read without seeing their teachers’ mouths and no physical contact on the playground is all they’ve ever known. This is outrageous, dangerous and fear-based. The Omicron surge may make certain districts want to cling to these measures, but they shouldn’t.
As the costs of last year’s school closures became apparent, it became a mantra that “schools should be the last to close and first to open.” That sounded good and was catchy, and I think many people — including me — muttered this, suspecting deep in our minds that with the arrival of the vaccines, it wasn’t going to get bad enough again that anyone would contemplate closing schools anyway.
But now that there is an actual threat of schools closing, I’m realizing that this mantra was wrong. It should simply be, “Schools should never close.”
Joseph G. Allen is an associate professor and director of the Healthy Buildings program at Harvard T.H. Chan School of Public Health. He is also the chair of the Lancet Covid-19 Commission Task Force on Safe Work, Safe School and Safe Travel and a co-author of “Healthy Buildings.”
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