it’s probably ok to open schools: i was right edition

Global Epidemics, a public health website operated by Brown University’s School of Public Health, has an article that makes the sensible case that we can definitely have schools be open during the COVID epidemic as long as we follow some very reasonable health measures. This is a reversal of their prior position:

We recommended that schools be closed once the average daily case rate rose above 25 cases/100,000 people, at the county level. Since July, our scientific understanding of COVID has increased significantly, as has our understanding of degrees of risk in schools, and we can now recommend that schools be open even at the very high levels of spread we are now seeing, provided that they strictly implement strategies of infection control. 

What are the recommendations?

• universal masking (including while speaking)
• hand and bathroom hygiene
• achieving 4-6 air changes per hour of ‘clean’ air through any combination of ventilation and filtration (or outdoor classrooms)
• 3 ft social distancing for young learners at all levels of community spread
• 6ft social distancing for high schools when levels of community spread rise above 100/100,000 daily new cases; 3ft social distancing below that level
• robust quarantine policies and contact tracing practices
• and, where feasible, surveillance/screening testing, also discussed below under “testing.”

In other words, the Brown School of Public Health statement simply says that if schools follow basic social distancing/hygeine guidelines that we had back around April or May (hygiene, masks, modest physical distancing) and some new simple rules that we knew about around summer (air circulation is crucial), you can have in-person schools.

Some readers of this blog got rather upset at me when I suggested we open schools because they believed that schools would be hot houses of infection. The Global Epidemic website reviews to the literature to knock this one down:

There is a growing body of evidence that students are not at heightened risk from school re-openings (and as we said above, in-person schooling brings lots of benefits to students and families). A wide range of scientific papers find that both susceptibility and infectivity increase with age. A CDC report on Covid infections in children in the U.S. has found that between March and September 2020, children 12-17 years old have been diagnosed with Covid about twice as often as children 5-11 years old, while both groups’ infection rates have consistently been significantly lower than those of adults.

And how do infection rates compare with the community? Roughly the same:

Within the database, from September through November 2020, cases in schools largely mirror community trends: The cumulative percentage of in-person students who are assumed or confirmed positive for Covid is 1.2%, compared to a community case rate of 1.5% in the same areas during the same time frame. That said, these numbers capture a variety of different mitigation and testing methods across communities and schools and therefore provide only an initial impressionistic picture, warranting further analysis.

COVID is absolutely dangerous. However, most of the illness burden is shouldered by elderly people and people with underlying conditions. The elderly and people with risk factors should get most of our help. We shouldn’t shut down crucial services for young people who are low risk, especially if we can institute low cost and relatively easy to implement practices to reduce transmission.

Bottom line: Protect the elderly, release the young. It’s not hard and it works.

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