The Medical Case for Reopening Schools after pandemic

As a parent, I selfishly want schools to reopen. I want this mainly so that I can work without the fear of my children interrupting my Zoom calls. As a physician, I think this can not only be done safely, but after reviewing the available evidence, I have come to firmly believe reopening schools is the right course of action, not just for individual kids but for the community as a whole.

To begin with, COVID just doesn't seem to be much of a pediatric disease. Mortality data for France, Germany, Italy, South Korea, Spain, the United Kingdom, and the United States showed 44 deaths of children from COVID in a several month period. In that same time period, the normal number of deaths from all causes for kids in this age group was more than 13,000. Less than 2 percent of known COVID cases have been in children, and children who do get it generally only get mildly ill. Even kids who get sick with the mysterious and much talked about hyperinflammatory syndrome, a tiny minority to begin with, tend to recover. So closing schools may be worth considering in order to protect the adults who work in schools, but it doesn't really seem necessary to protect children.

With this in mind, the next question to ask is: Are adults really at risk of getting COVID from children, either their own children or children they work with as teachers, custodians, and cafeteria staff? We have evidence that children are low risk, both to one another and to adults they come into contact with. In an article in the journal Pediatrics, Benjamin Lee and William Raszka, pediatric infectious disease specialists at the University of Vermont, look at the available literature on this topic. They found multiple case reports of children exposing but not infecting up to hundreds of individuals in school settings. Household contacts of infected children don't appear to be at risk either: Very few transmissions, when examined, appeared to be from child to adult. This would suggest that children are not only of low risk to one another and to their parents, but also to teachers.

Another useful thing to look at is what's happening in schools that have already reopened. Israel has been facing outbreaks of COVID in schools, but their schools opened up with little or no physical distancing measures in place due to capacity issues. Israel also has poor adherence to mask laws, so what is happening may just be reflecting what is happening in the community more broadly, rather than something specific to school itself. Unless we have data demonstrating that children are getting COVID at school and transmitting it to vulnerable adults, the school outbreaks in Israel still should not lead us to close schools here.

After looking at the risks, we need to consider the benefits of reopening schools. School serves important functions besides learning. What we have learned so far during the pandemic is that the effects of being out of school will fall disproportionately on those who are already disadvantaged. My own children, I believe, will be OK. It will be a struggle for me to find child care and it will take many hours of Khan Academy to make up the math they will surely miss, but even with pay cuts, I still have a doctor's salary and high speed fiber internet. But many kids are not that lucky. At the Title I public elementary school my son attends, many of his classmates live in public housing and get free school lunches. Some are the children of refugees who don't speak English. What will a year of this do to them and their futures? As a shift worker myself, I feel a kinship with the parents who work the night shift at McDonald's, but their problems far outnumber mine. Who will watch their kids when they wake up bleary eyed with only a few hours of sleep? Now they're also being tasked with teaching their elementary schoolers to add? Not only that, but schools provide speech therapy, psychiatric support for children with emotional and behavioral challenges, and nutritional support for the millions of families in this country living with food insecurity. Children stuck at home can be the victims of abusive family members with no possibility of escape or no unrelated authority figure to intervene, and children spending additional time on the internet for their schoolwork may be vulnerable to internet predators or sex trafficking. On a less tangible level, elementary school is where our children begin the path to being functioning adults, and the social impact of depriving them of that experience, with no identifiable substitute, could be catastrophic.

Worldwide, too, schools protect the vulnerable, especially girls. During the Ebola epidemic, many girls did not return to school after it reopened, and school closures made them vulnerable to sexual abuse and teenage pregnancy. At-risk children who drop out, in the United States or globally, may forever lose the chance for an education and be doomed to a lifetime of poverty. The consequences of school closures worldwide are far-reaching and potentially irreversible.

Besides all of these known, established roles of the school in the community, COVID has created the need for another one: the role of schools in disaster recovery. COVID is a disaster like no other the world has experience in our lifetimes, and children are particularly vulnerable to the effects of disasters. Damon Coppola, who advises the United Nations on COVID recovery, details the critical but often overlooked role of schools in recovery in the book Managing Children in Disasters. Restoring the infrastructure that protects children in a situation that causes them stress and anxiety is crucial for their well-being. But also, for the economy to recover, parents have to be able to go back to work, and public education is not just education but free child care. We've seen this before. After Hurricane Katrina, Chevron, recognizing the lack of federal funding to enable parents to go back to work, partnered with Mississippi State University to rebuild child care infrastructure. Free, public, K–12 education is a huge component of child care. As governors talk of rebuilding and restarting the economy, ignoring the role of public educational facilities in this endeavor is a crucial misstep. Rather than keeping schools closed or opening them partially, we should be discussing additional funding for additional staff and temporary buildings, to allow them to safely open full time with appropriate class sizes and adequate physical distancing.

Parents will quit the workforce without child care. And just as girls will disproportionately drop out of school worldwide, women will be the ones to quit their jobs when schools don't reopen. The setback for women's equality on both fronts, for perhaps even a year of closures, will take decades to rectify. The risk to children, parents, the economy, and progress in gender equality seems to outweigh the risk of schools being a major center of spread for COVID.

The other thing about reopening is that we can take steps to make it as safe as possible. For the more risk averse, we can still provide the option of online learning. Kids that are old enough to comply can wear masks. Teachers, since they are both higher risk if they do get it and at higher risk of giving it to one another, should wear masks always. Physical distancing should be enforced, although the American Academy of Pediatrics believes that 3 feet may be adequate, a recommendation that makes it easier to allow a school's entire population to continue to attend school every day. Children should be cohorted in smaller groups on the playground to enable reasonable tracing of contacts if a child or adult does test positive, and teachers should maintain strict precautions in interacting with one another (teacher appreciation breakfasts, for example, may need to go by the wayside for a little while).

For public education, especially, this make sense. To buy into the concept of public education, but perhaps for any school-based education, is to buy into a belief that we belong to a community that can only thrive with the participation of others. The environment is never tailored to the individual child but to the education of a community. Children with specific vulnerability to COVID, and children with high-risk parents, should have the option to stay home and continue to learn remotely. But for the vast majority, there is as yet no evidence that going back to school carries a great deal of risk, and we know that not going back to school could lead to a great deal of harm, maybe even a lifetime of harm, to individual children and the community as a whole.

As with everything else with COVID, we are constantly learning. If we start with schools open, and contact tracing indicates they are a huge factor in community spread, we will have to reconsider. But if we start with schools closed, or with limited in-person attendance, we will be forced to continue to assume that's the only safe path, as we will have no further data to tell us otherwise. Given the enormous cost of keeping kids out of school, even part time, the rational solution is to reopen. As with everything else with COVID, we have to make sound decisions based on what we do know, and right now, the available data mostly suggests that the risk to reopening schools is low and the benefit is high.