Kids in Classrooms Could Make the Pandemic Much Worse
Reopening schools would be a ‘crazy’ experiment in communities with rampant Covid-19 infections
Despite the intense eagerness to get kids back to school, reopening K-12 classrooms on the heels of this summer’s surge in Covid-19 cases in the United States looks more and more like a risky experiment — particularly amid emerging evidence that children are quite capable of carrying the coronavirus and are more contagious than previously realized.
Preliminary analyses in the early months of the pandemic suggested children were not significant carriers of the coronavirus. But time and further research have revealed that’s just not true.
- Children five and younger can pack high levels of SARS-CoV-2, the coronavirus that causes Covid-19, in their noses and throats — even more than adults, even if they’re only mildly ill, according to a recent study published in the journal JAMA Pediatrics. The potential contagiousness of younger children remains unclear, but they “can potentially be important drivers of SARS-CoV-2 spread in the general population,” the researchers conclude.
- In an outbreak at a June sleepover camp in Georgia, at least 260 children and adults contracted Covid-19 — about 44% of all kids and counselors. Among kids ages six to 10, 51% tested positive (the actual figure might be much higher because not all campers were tested). Precautions were taken, officials said, but campers weren’t required to wear masks and no efforts were made to increase ventilation in buildings.
- Research from South Korea, published in mid-July by the U.S. Centers for Disease Control and Prevention (CDC), found that infected individuals as young as 10 can be as contagious as adults.
Kids up through around age 10 “probably transmit less, maybe as much as 50% less,” compared with adults, says Ashish Jha, MD, a practicing internist and professor of medicine at Harvard Medical School who was not involved in the above studies. Less is, of course, not nothing, and nobody knows the actual transmission rate of Covid-19 by children.
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If done properly, and in locations where community spread is modest, Jha is optimistic schools can reopen relatively safely. “We need to do this as carefully as possible,” he told reporters in a press conference on August 3. “But there is no scientific certainty in the middle of a pandemic of a novel virus.”
Other experts offer a more blunt assessment. “I am convinced that you will see infections in schools,” says David Cennimo, MD, assistant professor of medicine and pediatrics at the Rutgers New Jersey Medical School. If it turns out children are significant drivers of new infections, then “I think it could make the pandemic much worse.”
“You’d be crazy”
Experts say the novel view of kids as carriers of the coronavirus was not obvious earlier in the pandemic for three reasons: Children aren’t tested as frequently as adults; they haven’t been studied as much in relation to Covid-19; and they’ve been largely sequestered since schools closed early on in the pandemic.
But many scientists and doctors are not surprised by the revelations. Young kids are notorious transmitters of the cold and flu, Cennimo points out. It could be, however, that their smaller body size and less-forceful coughs reduce the amount of the coronavirus that gets airborne, which scientists say is a primary means of the coronavirus transmission. Weak coughs make small children less likely than adults to spread tuberculosis, for example.
Meanwhile, the concern for school reopenings is not just about kids’ health, but also that of teachers, staff, parents, and other family members who may be at greater risk for severe complications. Early efforts are not encouraging, as numerous cities have reported cases in teachers and students.
“Schools may become a significant node, or hub, of their local Covid-19 transmission map by connecting sporadic clusters of community spread and spawning new ones.”
“I think you’d be crazy to try and open schools,” where ongoing outbreaks are occurring or increasing, Cennimo tells Elemental. When decision-makers counter that schools simply must reopen, for the sake of kids’ education and the broader economy, he responds: “Okay, well, I’m curious to see how this experiment plays out.”
Any such experiments could take weeks to play out. The virus can incubate for up to 14 days, and in that time one child could infect several kids, teachers, and staff, who all take the virus home and out into the community before anyone realizes there’s an outbreak in progress.
“Schools may become a significant node, or hub, of their local Covid-19 transmission map by connecting sporadic clusters of community spread and spawning new ones,” says Mark Cameron, PhD, an immunologist and medical researcher in the School of Medicine at Case Western Reserve University in Ohio. “This could place the entire community at the heart of a new outbreak, and inevitably risk the most vulnerable within it.”
But if done right…
Infectious-disease experts in the U.S. have outlined a laundry list of prevention measures for in-class instruction beyond physical distancing in classrooms and on buses, including increasing classroom ventilation and upgrading AC filters, as well as creating smaller class sizes to contain outbreaks in “bubbles.”
These and other measures should be part of a layered approach including periodic testing for the virus in students and staff, outdoor classes when possible, and masks even for young children, Jha argues. He is “flabbergasted” that the CDC does not recommend face coverings for young school kids.
Most health experts agree decisions need to be made based on local pandemic conditions. The timing to reopen in one community or state may be wildly different from another. They also say not all grades should not all be dealt with the same.
Jha advocates for a lower threshold to open K-5 schools, given the “overwhelming evidence” that in-person teaching is vital for this age group, and stricter thresholds for high schools, given the higher risk of spreadability.
Meanwhile, Jha also says that many parents, teachers, and administrators will have little tolerance for new infections occurring in schools. School officials he talks to often point out that testing is costly, and they ask him if they can skip that layer. “It depends on how lucky you feel,” he tells them. “We get one shot at opening schools for kids this fall. If we mess that up… you’re going to have completely destroyed the ability of that school to open up again anytime soon.”
“Not everywhere in the country is in the same boat. Some places there are very few cases, and it may be safe to open up. Some places, it’s really an extremely bad idea to open up schools.”
What level of risk is acceptable?
With new cases averaging more than 50,000 a day, the scope and intensity of the spread across the country make it much more difficult to do what health experts agree is vital as a precondition to reopening schools: Get the pandemic under control first.
Cennimo, the Rutgers doctor, says parents, teachers, and school administrators should be thinking not about whether infections will occur in schools, but about what rate of infections they’re willing to accept. If one or two infections would be the threshold for closure, “then you’re never going to be open.”
Experts recognize the need to open schools and the importance to children and parents, says Eleanor Murray, ScD, assistant professor of epidemiology at Boston University’s School of Public Health. But decisions should not involve binary open-or-closed choices, she says. Some students could be prioritized for in-class instruction based on their own educational or social needs, or if their parents are deemed essential workers who can’t work from home, for example. And Murray stresses that each school district should take into account the level of viral spread in their community.
“Not everywhere in the country is in the same boat,” she says. “Some places there are very few cases, and it may be safe to open up. Some places, it’s really an extremely bad idea to open up schools.”