OK some thoughts on the fraught situation with schools and the pandemic. There’s been quite a few good opeds on this recently. I hope to add something useful below 1/goodnessknows
Point 1: all kids are not alike. Older ones transmit like adults. It’s hard to say that high schools *drove* the surge in Israel following wide reopening but it is easy to say they didn’t help haaretz.com/israel-news/.p… 2/n
Point 2: household studies of transmission in kids are biased. Because if you detect your index cases by looking for symptoms, you’re not going to catch the kids who are less likely to have symptoms as index cases. Duh. Did I mention non-symptomatic transmission is a thing? 3/n
Point 3: schools are hard to study because we closed them quick, and at a point when we didn’t really have good testing. So what did happen is hard enough. What *would* have happened is even harder 4/n
(btw pls note that statements that “there was an introduction to the school without transmission!” are not so helpful. The overdispersion means we expect that a lot of people won’t transmit. We need better population data not anecdotes) 5/n
So this is what I think. Consistent data from household studies suggest that younger kids are less likely to get infected, and that if they do they are less likely to transmit. But that’s not enough… the contacts kids make in schools are different 6/n
This is where this study comes in – it is mostly a comparison of Finland and Sweden. Two countries with very different approaches to the pandemic. Both shut down High Schools and colleges. But Sweden kept schools for younger kids open. folkhalsomyndigheten.se/contentassets/… 7/n
I’m not so interested in the data about the younger kids in this; as the report says they are probably massively underestimating infection in children given the fact that testing was diverted to severe cases elsewhere in older cohorts. As like - everywhere? So ignore that 8/n
However that can’t explain the fact that people working with those younger kids were no more likely to be infected than people in the general community. I should point out that for Sweden, this has been a pretty high risk in the community - the per capita mortality is high 9/n
It should be noted that Sweden has had a rather high force of infection in the community, and a resulting high per capita mortality rate. This just suggests that this was not *specifically* driven by schools for younger kids. Which should be comforting-ish 10/n
Older kids on the other hand seem to transmit like adults. And adults that moreover have trouble social distancing. Really, who’da thunk? This is really important for colleges. I cannot support in person instruction in the fall. 10/n
So a thought. Younger kids struggle with remote learning because you know, they can’t read yet? Maybe prioritize them for in person learning. Focus the online stuff on kids who get the tech and might even enjoy it 11/n
Older kids? I know it will be really hard but this is the age group most likely to contribute to illness in the community, and to be ill themselves. Not easy but limitations will be necessary. Including among age groups less likely to party in dorms 12/n
In general personally I’d recommend online only, as much as possible for age groups that can read - after a few weeks to bond with teachers, ideally outside. Happy to have this view improved by actual educators. All i know is infectious disease. 13/n
I understand that Cambridge and Boston Public Schools (@cambridge_cpsd and @BostonSchools) are considering a ‘hybrid’ teaching model in which kids alternate, with half the class in schools half the week and the other half the other. I think this is flawed. Here’s why 14/n
When these kids are not in school, what happens to them? Their desperate parents will seek childcare, quite reasonably. And in doing so introduce new contacts through those carers. New contacts = more opportunities for transmission into the schools. Which is er... bad? 15//n
And you know what - because they are outside the school system you can't even bring them into whatever brilliant testing regimen you can put in place. Wonderful 16/n
Biggest question – what happens when things get bad again? We expect that they will at the very least get worse. So little grown up, informed, thoughtful input put into practice - though I know there are a lot of grown up, informed, thoughtful people offering themselves 17/end
