Thread by @epaley

There is huge pressure politically, economically, & socially to open school.

The APA, CDC, and most media are making homogeneous plans to address heterogeneous challenges;

We shouldn't seek intellectually thin, one-size-fits-all solutions.

economist.com/leaders/2020/0…

/1

Return to the classroom has huge advantages – it’s an inarguable point. It’s important to keep equity issues top of mind. There are also some very positive indicators that safe return to school is possible.

cdc.gov/coronavirus/20…

/2

However, these advantages have to be balanced against the risks. When considering grandpa’s (potential) premature death and mom’s (not unlikely) eight-weeks of incapacitation due to COVID. Remote school doesn’t seem so bad in that context.

/3

Again, a one-size-fits-all solution is a mistake.

Kauai, with no almost no cases, should send the kids to school.

kauai.gov/covid-19

Houston should probably hold off for a while.

google.com/search?ei=lmYg…

/4

As someone actively researching this for my kids, I’ve noticed endless discussion on mitigating risk in the classroom, without enough discussion on whether, where, and which kids should return to the classroom

/5

We also need to face the hard reality that school mitigation plans are helpful, but not really a protection against the virus. Masks, distancing, hygiene, cohorting are all good policies but likely won’t prevent spread if COVID if it is in your child’s classroom.

/6

COVID is an airborne disease:

nytimes.com/2020/07/30/opi…

Studies suggest simple cotton masks are effective at blocking infected droplets but offer less protection from aerosolized concentrations of the virus over a period of hours in a confined space.

medrxiv.org/content/10.110…

/7

And that concern doesn't even address mask and distancing compliance among school-aged children



/8

Airflow mitigation is great in theory, but impractical. Can we really open school based on room-by-room ventilation assessments?

theatlantic.com/health/archive…

Think of all of these school mitigations as SPF 10 – Good for some protection but not long exposure.

/9

Some open on time and close down if case numbers start to rise.

We should remember that this virus moves *really* fast.

Mass. shut down in March with <100 cases/day. Even with a near-total shutdown, new daily cases grew from 100 to 1,000+ within a week.

/10

Even if you’re happy with where your state’s numbers are today, it’s critical to remember that the public numbers trail reality by about two weeks

nytimes.com/2020/03/18/hea…

Two weeks is a lifetime of risk with exponential virus growth.

/11

Israel had very few cases in May. Schools opened in June. Within 2 weeks of opening, 244 students & staff tested positive. 6 weeks later, of 1,400 new cases, 47% were from schools. Now 2,026 students, teachers, and staff have it.

thedailybeast.com/israeli-data-s…

/12

Many argue that kids are less likely to get COVID, and have milder responses to it. While true, recently doctors were very surprised to see that ~10% of infants had severe responses in one population.

Do you like those odds for your child?

abcnews.go.com/Health/covid-1…

/13

There’s also a widespread belief that kids don’t transmit the disease.

Data from a YMCA in NYC seems to support that:

insider.com/how-the-ymca-c…

However, an NIH researcher admits we don’t have enough data to make sweeping conclusions:

smithsonianmag.com/science-nature…

/14

We should operate assuming that many kids will be asymptomatic carriers and infect parents/grandparents.

It’s also an interesting signal that dozens of medical experts seem ambivalent about the prospect of sending their kids back to class:

cnbc.com/2020/07/26/sho…

/15

So how should we proceed?

The 1st filter should be local conditions. If a county has a meaningful concentration of cases, e.g. >100/day & a rising rate, perhaps school should be closed. If a county has <20 cases/day & the rate is declining, return to school is much safer.

/16

The best way to prevent school outbreaks is to avoid having COVID in the classroom in the first place. Obviously, the lower the incidence of COVID in a community, the less likely it is to be in a classroom.

/17

I don’t know the right cutoff for concentration per population, but this is one of the most important debates we should be having right now and I'm not hearing much on this topic!

/18

The second filter might be age. Studies have shown that children over 10 are as frequently infected and contagious as adults. Perhaps elementary grades open first before high schools?

nytimes.com/2020/07/18/hea…

/19

The third filter - individual/family needs. Some kids have much greater need for the services that schools provide in person. Many parents need childcare to do essential jobs. Each child, household, and community has different needs.

Again, one size doesn’t fit all.

/20

Likewise, if a family has heightened risk due to age, immunocompromised conditions, chronic illness, or even obesity, then that child should stay home until local cases fall to very low levels.

cdc.gov/coronavirus/20….

/21

There are many important variables in this calculation.

Political concerns shouldn’t be the driving factor, but they are arguably the most influential at this point. We should try to change that conversation before political pressure drives bad outcomes.

/22

Yes, in-person school is way better, but this is a thin argument without considering statistics and safety. If we were discussing a polio outbreak in a specific community, I think we’d agree that the benefit of live schooling doesn’t outweigh the risks.

/23

It is important to remember that we’re only six months into this pandemic. We have no good data about the long term health impact of COVID.

/24

My take is that families with the ability, children without special needs, in communities that have some COVID concentration, should take their kids out of in-person school.

/25

This would reduce the probability of disease for those who do *have* to go to school, make distancing easier, and so on. Hopefully, this will only be a short term situation and all kids can be together back in school soon.

/26

To be clear, I’m not a doctor – just a concerned parent thinking out loud, hoping to spur on an important, yet vanishingly rare conversation.

Most COVID back-to-school dialogue is simplistic, ends with one-size-fits-all conclusions, and it shouldn’t. What’s your take?

/end

Another article that should raise concerns - children may carry COVID at high levels -

https://twitter.com/epaley/status/1288932016923332617?s=21