For schools to open safely we need to refocus our priorities, say medical experts.
Extraordinarily difficult decisions are being made right now across the country, as school administrators, public health officials and local governments attempt to answer the question of how—or whether—to send kids and teachers back to school this fall.
The biggest voices have picked up their megaphones to amplify the debate, with the American Academy of Pediatrics, the Centers for Disease Control and the White House all coming out in support of reopening schools. Other organizations, such as the National Federation of Teachers, have urged a gradual, cautious approach.
In almost every conversation about reopening schools, however, the focus has been on what schools need to do: Temperature screens, frequent testing, student cohorts, in-school health clinics, planning for outbreaks, spacing out desks, serving lunch in classrooms, staggering arrivals, alternating schedules, requiring masks, washing hands.
Recently the New England Journal of Medicine published its own paper on reopening schools, voicing its support for reopening elementary schools but shifting the focus away from a laundry list of to-dos and must-haves for beleaguered school administrators, underfunded school districts and overtaxed teachers.
Instead, the health and education experts who wrote the opinion focused on what should be painfully obvious to all of us by now:
Reopening schools safely isn't about what schools need to be doing. It's about what our country needs to be doing. And we're not doing it.
The sad truth is, no amount of safety preparations, hand-washing or social distancing is going to make schools safe to open when coronavirus transmission is unchecked in the community that school serves. In communities where the virus is not under control, the minute schools open their doors, the virus will walk in along with the kids, as has already been demonstrated.
As the NEJM article explains, "It would be best—and evidence from many countries demonstrates that it's possible—to lower community transmission rates by means of stringent control measures this summer so that schools can reopen this fall with an acceptable level of safety."
Epidemiologists have been urging all summer that communities work to get their transmission ratio down to 10 (or fewer) new daily cases per 100,000 people before reopening schools—although with the virus out of control in many states, some infectious disease experts have suggested that the case ratio could be as high as 25 in 100,000 before shut-down measures need to be put into place.
Under conditions of controlled community spread, however, schools could reopen with more confidence, as long as they were also supported and funded appropriately. "We believe that primary schools should be recognized as essential services—and school personnel as essential workers—and that school reopening plans should be developed and financed accordingly," the NEJM article notes.
Controlling community spread of the virus is an achievable goal, as has been observed in other countries where schools have managed to reopen without seeing an accompanying spike in transmission—but, as the authors note, that requires both national leadership and responsible local prioritization:
"The path to low transmission in other countries has included adherence to stringent community control measures—including closure of nonessential indoor work and recreational spaces. Such measures along with universal mask wearing must be implemented now in the United States if we are to bring case numbers down to safe levels for elementary schools to reopen this fall nationwide."
This perspective echoes that of many public health experts. "This should be a national priority," Anita Cicero, deputy director of the Johns Hopkins Center for Health Security, told Pro Publica. "It's measurably more important than reopening bars and restaurants."
And therein, apparently, lies the real problem. We have chosen, as a country, to prioritize non-essential services and activities like bowling alleys and restaurants over schools.
The authors of the NEJM paper, Dr. Meira Levinson of the Harvard School of Education and epidemiology experts Dr. Müge Çevik and Dr. Marc Lipsitch, addressed the risks and benefits of children and teachers returning to schools based on a review of all the available clinical and field evidence about children and coronavirus infection. The paper also reviews in depth the main reasons why in-person school is such a high priority—reasons that are familiar by now to most parents who have been following the issue, including "essential educational, social, and developmental benefits; neither the economy nor the health care system will be able to return to full strength given parents' caretaking responsibilities; and profound racial and socioeconomic injustices will be further exacerbated."
As their risk-benefit analysis makes clear, however, the risks of reopening schools can only be lowered to an acceptable level by controlling the virus transmission rate in the communities that schools serve—getting to that crucial 10 in 100,000 people ratio, or below it.
"The fundamental argument that children, families, educators, and society deserve to have safe and reliable primary schools should not be controversial," the authors write. "If we all agree on that principle, then it is inexcusable to open nonessential services for adults this summer if it forces students to remain at home even part-time this fall."
So how do we make schools safe to reopen? We choose to, by making decisions that prioritize controlling the spread of the virus.
We choose to open schools for kids by choosing to wear masks.
We choose to open schools for kids by choosing not to open non-essential services for adults.
We choose to open schools for kids by choosing to fund schools so that they can afford the services, tools and staff they desperately need in order to follow public health recommendations.
We choose to open schools for kids by making responsible decisions—the kinds of "adult" decisions our kids are relying on all of us to make.
"Our sense of responsibility toward children—at the very least, to protect them from the vicissitudes of life, including the poor decision making of adults who allow deadly infections to spiral out of control—is core to our humanity," the authors write. We can be the grownups our kids need us to be.
Close the bars. Close the bowling alleys. Close the gyms, the indoor restaurants, the indoor movie theaters.That way, we can really show that we prioritized reopening schools.
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