Monday, July 20, 2020

United States Schools Should Only Reopen When It's Safe

We had a very long school board session last week in Dublin, CA. They’ve been about 4-6 hours consistently over the last year, not just from COVID. My wife watches most of them. It’s like reality TV. There are characters, plot lines, and rivalries. Our local school board is in turmoil as half of our town is newer construction on the east side of town and half of the town lives in established neighborhoods from the 1980’s and prior. We’re building a 2nd high school because our existing one has 3k kids and growing. The east side of town wants to keep the tax money flowing into new construction of schools in the east, such as the new high school. The west side wants a balance of investment as our existing schools are older and need renovation.

Last week the school board revealed a change in plans to not reopen our schools for in-person learning. The prior plan-of-record had each family choose among three fully supported options:
* In-person 5 days a week
* In-person 2 days a week, remote 3
* Full remote
You could choose to move towards more remote later, but you could not move towards more in-person until the school board’s assessment of what it takes to keep school safe changes. The updated plan is for full remote learning for everyone for the 1st 6 weeks of the school year, and likely beyond that. I believe this is the best solution right now given the safety risks to kids and staff.

I believe it’s important to establish guiding principles for how to address school during COVID-19. Here are mine:
1. Prioritize safety over inconvenience.
2. Public health experts define safety.
3. Do what works.

My views are impacted by my wife’s work as a nurse in San Quentin prison for the last month part time. About 2 months ago they had zero cases. Then there was a botched prison transfer where COVID-positive prisoners were brought in due to incompetent testing and transfer protocols. Within a short time there was a huge outbreak among the 4k prisoners. San Quentin prison went on full lockdown with prisoners unable to leave their cells except for very stringent protocols. They try to minimize any ability for prisoners and staff to interact to minimize the chance of spreading. The positivity rate is now 59% (see below) despite going on lockdown with a much lower positivity rate. When you are indoors with infected people, COVID-19 will spread. Just as it did on cruise ships, restaurants, buses and church choir practice. Gatherings indoors are not safe without many precautions. You don’t have to be within 6 feet.

Here is a fascinating map of how COVID-19 spread from one dining session in a restaurant in China where they did extensive contact tracing. Note that the air conditioning airflow impacted who got infected and who didn’t. It wasn’t strictly based on distance alone.

This diagram created from using Closed Circuit TV cameras in Hunan China shows how a bus passenger was infected with COVID-19 despite not boarding the bus until 30min after the infected passenger had got off the bus.

South Korea just reported a study indicating children 10 years and older spread COVID-19 just as well as adults.

I understand the reasons why many people want our schools to open to onsite teaching. I want to do it as soon as it’s safe, which I don’t think it is now. For example, the recent Economist article “Let Them Learn” has basic facts wrong. They suggest a policy with remote-only learning does more harm than the risk of COVID-19. The Economist claims do not make sense in the context of this new study from South Korea.

The South Korea shows that 10 year olds and above are just as likely to spread the disease as infected adults, and therefore I believe the Economist claim is wrong to say that since kids aren’t “especially likely” to spread it more than adults and therefore it is safe. The Economist's claim about school staff from Sweden not getting COVID-19 at higher rates in other jobs is not comforting. We do not want school staff and volunteers to contract COVID-19 from school at all. We cannot have family members getting infected by kids. If the staff and volunteers don’t feel it’s safe, then many of them won’t return and we cannot have schools be effective without healthy staff and volunteers.

There are models that are known-to-work, such as Taiwan. Taiwan has children in schools and their economy is largely back to normal. Their response involves a collection of measures including strict quarantine protocols for those crossing the national border, widespread mask wearing with enforced fines, widely available cheap and frequent testing with fast results (say 48 hours and under), and contact tracing.

Meanwhile in the United States we are not enforcing quarantine during border crossings. We do not have widespread testing that gets results under 48 hours. We do not have a culture of wearing face coverings or national government guidance to temporarily step up face coverings to get the virus under control. Our outbreaks are currently too large to do effective contact tracing. If we want to make schools safe and stay safe, I believe we need to have a national plan that addresses these problems. Thinking about school as an isolated scenario from other parts of life doesn’t make sense.

Some politicians are trying to force schools to reopen. I am confident that regardless of political affiliation, families of school-age children will resist the push to send their kids to school given the COVID-19 risks. It just doesn’t make any sense right now. We should adopt policies known-to-work by other advanced countries and recognize that we can have a thriving economy and schools only we put in place a system that suppresses the virus and keeps our people safe.