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Where we are now / July 23, 2020
Here’s another data point to add to the conversation on what school should look like this fall.

Just in from the Associated Press, in an article published Wednesday: “Only about 1 in 10 Americans think daycare centers, preschools or K-12 schools should open this fall without restrictions, according to a new poll from The Associated Press-NORC Center for Public Affairs. Most think mask requirements and other safety measures are necessary to restart in-person instruction, and roughly 3 in 10 say that teaching kids in classrooms shouldn’t happen at all.” The AP survey found eight percent of Americans believe schools should just go back to business as usual, 14 percent believe classes can resume with only minor adjustments, and everyone else thinks a quick return to the status quo is pretty much bonkers.

And who said Americans have lost their collective minds in the face of the pandemic.

Common sense is stronger in the United States than perhaps we’ve been led to believe, although the stubborn refusal of some folks to wear masks does argue the opposite. Setting that subject aside (for now), there seems to be an emerging consensus on what has to happen before schools can operate full bore in safe fashion, with five-day classes, a full menu of activities (football is probably farthest away from returning, but other extracurricular activities are not far behind) and without everyone having the ingest nerve pills to get through their day. Five words: Get the coronavirus under control.

Judging from the numbers all around the country, the months we spent secluding at home to “flatten the curve” and “crush the curve” was time wasted. By the time you read this, the United States will have surpassed four million reported cases of COVID-19, accounting for more than a quarter of cases worldwide. (The U.S. represents about four percent of the world’s population.) Our response has been such a fiasco that Americans are no longer welcome to travel to many countries that have successfully tamped down on the spread of the virus. Greatest nation in the history of the world or a pariah state? Don’t put that question on a survey of residents outside the United States; you won’t like the present-day answer.

The loss of “normal” school is collateral damage in a health crisis that has claimed 140,000 American lives and immiserated communities throughout the U.S. But the school piece still stings — a lot. Halifax County is lucky to have a school administration and workforce, teachers and staff, that is working extremely hard to make the best of a very bad situation, but we shouldn’t kid ourselves into thinking our children will get through this period of disruption without harm. That part is inevitable. What’s also inevitable is having to shut down schools quickly if we try to send kids and teachers back full-time amid rampant spread of the virus all around us. (Check the numbers in our North Carolina border counties and the Danville/Pittsylvania area. They’re ugly.)

A lot of interesting information has come out in recent days that should remind us to be modest about what we think we know about COVID-19, from a scientific and medical perspective. One argument offered by a handful of parents who attended the July 13 School Board meeting is that kids are at low risk of harm from the coronavirus (which, of course, fails to address the concerns of teachers and adult staff.) Not long after that trustees meeting, a large-scale study of children and COVID-19, conducted by South Korea researchers, found that “[c]hildren younger than 10 transmit to others much less often than adults do, but the risk is not zero. And those between the ages of 10 and 19 can spread the virus at least as well as adults do,” (The New York Times, July 18). “The findings suggest that as schools reopen, communities will see clusters of infection take root that include children of all ages, several experts cautioned.”

The study has been praised as one of the best of its kind, involving 5,706 South Koreans who reported Covid-19 symptoms in their households between Jan. 20 and March 2, and tracing of 59,073 other people who came into contact with these “index case” virus patients. (Compare the rigor of the South Korean study with our apparent inability to turn around covid test results in under a week, and the entire idea of “contact tracing” in the U.S., which has about as much foundation in reality as unicorns and leprechauns.)

A few weeks back, I read a very worthy piece by Boston University professor Benjamin P. Linas titled, “I’m an epidemiologist and a dad. Here’s why I think schools should reopen.” (His article can be founded at Linas, who has three girls ages 16, 13 and 10, made a well-reasoned case for returning full-time to school, balancing the risks (not zero, in his mind, but relatively low) with the rewards. One thing that made the piece so appealing was the author’s willingness to admit what he doesn’t know (in other words, what none of us yet knows for sure) and what could happen if the virus subsequently disproves our current tentative understanding of how the virus works. It bears mentioning, Linas came out for a full return to school before the South Korea study on children’s vulnerability to the virus was published

The conclusion of Linas’ piece however, just killed his entire argument for me. It deserves a long excerpt:

A great mentor of mine, Milton Weinstein at Harvard, is generally credited as being the person who introduced the field of medicine to the concept of rigorous decision-science. The central question to all decision-science is: “What should we do, given that we have imperfect information?”

Milt is fond of the expression “a decision has to be made.” His wisdom has never been more pertinent than it is today. We have to make a decision. There is no choice to do nothing, because either way — go to school or learn remotely — we are making a decision ...

When I look across all the data, I see an uncertain decision. First, I propose that the balance of data we have now suggests that we need to try to open schools in the fall. The risks of reopening are uncertain; the harm of staying home is clear.

If your school district cites the data above to you that “schools are safe,” ask your school board: What is the plan beyond reopening? What if we are wrong? How will your district know that things are going well (or not well)? Don’t let the conversation stop at “data suggests that schools are safe.” Don’t let the plan stop with “symptomatic people should call their doctor.”

If we are going to open safely in the fall, we must have the capacity to know — quickly — when an outbreak occurs. Israel is an important cautionary tale. When Israel closed down its schools again, it had only identified two school-based cases, yet in the end it discovered that more than 100 students had been infected.

To do this well, and to do it safely, we must have school-based Covid-19 symptom screening, testing, contact tracing, and isolation. “School-based testing” does not mean that the test themselves must occur in school buildings. “School-based testing” means that students and teachers can easily access a test by contacting the school, and that the results of those tests are sent directly to the school district in real time.

That seems straightforward, but it is not. The community does not yet have adequate testing, contact tracing, or isolation. Schools currently have nothing.

It requires building new capacity in schools for testing and contact tracing. It requires a budget. It requires a formal plan. Ideally, that budget should come from the federal government and be directed to states and ultimately school districts, as part of a national Covid-19 testing strategy. Realistically, given the lack of any such national plan, the funds need to come from individual states.

Building such infrastructure comes at a cost and many districts are already facing budget shortfalls. Districts that rely only on their existing testing infrastructure will not have the real-time information they need to make good decisions. Imagine a child has a fever and cough in October and is told by the school to call the doctor for a Covid-19 test. Results are typically returned in two days to the doctor’s office. After another day (or two), the data might make it to the school district. So it will take at least four to five days for the district to have any information.

We need testing within the school system to shorten the delay at every step of the process and reduce the turnaround time for the test to only a day. With that kind of time resolution, we can increase awareness of the situation at our schools, along with the ability to react appropriately. Without it, we are flying blind and gambling with the health of our children, teachers, and community.

“Flying blind and gambling with the health of our children, teachers, and community.” I trust everyone sees the problem with this idea of going back to school full-time when we have no contact testing, no quick test turnaround, and no real grip on a worsening public health crisis. The fall semester is set in stone; pray for better luck in the spring.

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