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Here are some things I think that San Antonio (and other officials) should consider when evaluating whether /when to close K-12 schools, given what has been reported about the population most vulnerable to #COVID19.

(IANAEpidemiologist)

Spoiler Alert: More than 60 million Americans live in multigenerational households, meaning that those most vulnerable to the virus *cannot* isolate themselves from kids who bring the virus home with them from school.

First, I should say that I am persuaded by the guidance I have seen from experts that extreme social distancing measures are needed *now* and it is better to do them too soon than too late. So, cancel events, work from home, close universities and schools.

We have seen lots of universities transition to online classes over the last few days, even when there are not many local cases. Many have said that concerns about students returning from travels far & wide from spring break is a factor in their decision.

chronicle.com/article/the-co…

I am truly mystified as to why we are not seeing proactive K-12 school closures across the US now, particularly before students return from spring break travels. Once they come back, it seems likely that the horse will have left the barn in slowing community spread.

Although children do not appear to get very ill when they have coronavirus, they are apparently able to spread it through their secretions for up to 22 days.

www-wsj-com.cdn.ampproject.org/v/s/www.wsj.co…

I know that there are concerns that many children receive free meals from schools & some parents will not be able to stay home to care for their kids.

I am not minimizing these valid concerns, but we should be able to come up with some workarounds, such as schools staying open only to provide food service. (This topic deserves a deeper conversation than I can devote in this thread.)

@NPR

@NPR

Here is an @NPR piece laying out the challenges in making school closures decisions. Not simple, but I am convinced that the risks of uncontrolled community spread trump the other concerns.

At any rate, the school pandemic plan for our school district seems targeted for something like the flu, and not something like a true, much more lethal and easily spread pandemic like #COVID19.

For instance, it does not even contemplate closing schools until we hit:

● Level four (high risk) widespread reports of confirmed pandemic illness within the
community and/or [local school district].

This makes sense to me for something like flu, but seems crazy for coronavirus, given what we have seen in places like China and Italy, and particularly when the testing for the virus in the US has been so poor (meaning there are likely many undiagnosed cases).

I have not widely surveyed school pandemic plans, but I would hope that public officials would reassess plans like this to see if they align with the risks of the current situation.

Here are some questions that come to mind in thinking through the risks posed by coronavirus and K-12 schools as transmission vectors.

What is the age breakdown of the population? Is there a high percentage of people over 50?

What are the health characteristics of the population? Is there a high percentage of people with diabetes, high blood pressure, asthma, or other underlying medical conditions?

Do the more vulnerable populations share housing with children? This seems to be a critical factor in whether a vulnerable person can self-isolate to protect themselves from the virus. If schools stay open, kids can transmit the virus even if they don't get very sick.

In San Antonio, for instance, a recent study showed that 36% of local grandparents are raising their grandchildren, meaning kids carrying the virus can transmit it to their caretakers and it is impossible for caretakers to self-isolate.

news4sanantonio.com/news/trouble-s…

A 2018 Pew Research study showed that more Americans are living in multigenerational housing then ever before (i.e., grandparents, parents, and children in the same house).

pewresearch.org/fact-tank/2018…

"The number & share of Americans living in multigenerational family households have continued to rise... In 2016, a record 64 million people, or 20% of the U.S. population, lived w/ multiple generations under one roof."

This statistic about multigenerational households is the key reason we should preemptively close schools until the virus is more under control.

I urge public decision makers to appreciate the gravity of the crisis and make tough decisions sooner rather than later.