Featured, Revolutionary HIT August 3, 2020

Is it Safe to Reopen Schools?

by Barry P Chaiken, MD

Our country now faces the most significant public health crisis in more than a century. The COVID-19 virus has upended our lives and put all of us at risk for illness. As we approach the Fall, our thoughts turn to our children and their need to return to school. We know that attending school not only affords our children with an education that they can use throughout their lives, but also socialization with their friends and teachers. This is an important part of their path to adulthood. In addition, for many children school represents the opportunity to obtain proper nutrition as part of both breakfast and lunch programs. Developing minds requires good nutrition.

And let’s not forget the need for parents to return to their jobs and earn needed income to provide for their families. This is an important side benefit of schools reopening.

The COVID-19 pandemic has disrupted our children’s access to school and its associated benefits.

While we all want our children to return to school, we also want them to be safe. But how do we know that it is safe for our children to be in school? When should our school districts open schools? What guidelines should they follow to protect our kids? When should they close down to prevent harm to teachers and students?

Before I suggest some key indicators to follow to address these questions, let’s go over a few facts.

There is no cure, prophylaxis or vaccine available for COVID-19. Our doctors have learned better ways to treat COVID-19 patients with the drugs they have at their disposal, but none of these treatments are a cure.

  • Approximately 40% of individuals infected with COVID-19 are completely asymptomatic. There is no way for them to know that they have the infection unless they have been tested. While asymptomatic, these same individuals are highly infectious to others.
  • Individuals who eventually develop symptoms consistent with a COVID-19 infection are infectious at least 2 days before the onset of symptoms.
  • Children, particularly those over the age of 10, although less likely to develop symptoms of the infection, are just as infectious as adults without symptoms.
  • The SARS-CoV-2 virus that causes COVID-19 illness is highly infectious. It persists for hours in microdroplets that hang in indoor air for long periods of time.
  • Rapid tests, sometimes referred to as point-of-care testing, have not been proven to be reliable, and in some cases deliver results equal to if you just flipped a coin.
  • We currently do not have enough testing capacity to test as many people as we need. This has led to some physicians to ration testing to those patients where tests can make a difference in patient outcomes. Therefore, many patients who should be tested are not tested. In addition, due to the huge volume of tests, there is significant backlog in running the samples. This has led to a delay in test results from the optimal 24-48 hours to 4 to 7 days. This delay makes the results essentially useless as a public health tool to prevent the spread of the virus.

Although these facts about the pandemic sound as if reopening schools is an impossibility, that is not the case. Let’s take a moment to consider what metrics need to be tracked to allow schools to be reopened safely.

Each school district must be considered as its own entity. There is no one solution that fits every state, county, or school district. Yes, there are guidelines we all must follow, but based upon those evidence-based guidelines, we can safely mange the opening of schools. Here are some of the key indicators that educators must follow to open schools safely.

First, should you even consider reopening schools? No one metric should be used to make this decision. It is a combination of:

  1. Trend up or down in number of new cases,
  2. percent positive rate in your state, county, or city, and
  3. Geomap of new cases.

If these three indicators show a pattern of disease spread that is out of control, meaning rapid increase in new cases in your school district, then reopening schools is a risky proposition. It is likely that some of the students will be asymptomatic carriers of the virus and have a high probability of spreading it to their classmates and teachers. In turn, those classmates will return to their home and invariably infect their family members. This will start a cycle of infection that will further the aggressive spread of the virus throughout the community. So, reopening schools when the virus is already raging in the community is not a good idea.

Well, when is it safe to reopen schools? If the trend in cases is on a steep decline, the positive test rate is either very low, meaning under 3% or on a steep decline, and a geomap of new infections show that they are not concentrated in your area, then reopening schools should be considered.

Now, if schools are reopening, what should we track to ensure that it continues to be safe for students, teachers and their families? In addition to those metrics I have already mentioned, all students, teachers and staff should be asked to complete a questionnaire daily, asking them if they have any of the symptoms of infection, such as fever, cough, runny nose, those symptoms consistent with a cold or the flu. Those surveyed should be asked if anyone they live with is showing such symptoms. Children or staff that show any of these symptoms, should be isolated from others and be tested for COVID-19.

All persons who are isolated must be tracked as to the progression of their illness and the results of any COVID-19 testing. If possible, their contacts should be followed to look for spread of the virus.

If too many students manifest symptoms and test positive for COVID-19, and there is evidence that virus spread is increasing in the community, then the school district has no other choice but to close schools.

With the incidence of new cases so high across the country, it is very difficult for many school districts to reopen safely now. But the reality we are experiencing, will not last forever. At some point we will have better control over the virus. At that time, we will need to monitor these metrics I have already mentioned to keep the virus under control and reopen schools. We will use the proven public health methods of case tracking and contact tracing to stop the spread of the virus. And we will one day, hopefully soon, have an effective vaccine. At that time, with most of the country vaccinated, we will be able to reopen our schools with the knowledge that our children can obtain their education in an environment safe for them and their community.

For up to date metrics to track COVID-19 in your community, go to http://covidactnow.org

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