The global coronavirus disease 2019 (COVID-19) pandemic continues to unfold. Since its causative virus – severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) – was first detected in Wuhan, China, in December 2019, it has spread to over 191 countries and territories. So far, over 100 million cases have been reported, and 2.1 million have lost their lives. In the U.S., the numbers are especially sobering; to date, 25.5 million have been infected and over 425,500 have died.
As the U.S. continues to grapple with surging cases and the complex logistics of mass vaccination, is the country in a position to fully re-open its schools for in-person learning? Researchers at the Centers for Disease Control and Prevention (CDC) think so – notwithstanding a few very important caveats.
The team has published an analytical overview of school-based SARS-CoV-2 transmission and its associated risks in the Journal of the American Medical Association, which offers practical guidance on measures schools can take to safely re-open their doors to students.
The researchers recommend that stringent regulation of physical distancing and mask-wearing, as well as the suspension of activities observed to increase school-based transmission, will be crucial to the safe operation of in-person instruction in U.S. schools. They also endorse stricter community-wide regulation to allow the urgent and essential support public schools offer to recommence.
School closures and the COVID-19 pandemic
On March 11, 2020, the World Health Organization (WHO) declared the SARS-CoV-2 outbreak a global pandemic. By March 25, just two weeks later, all kindergarten to grade 12 (K-12) public schools in the U.S. had closed for in-person instruction and moved online.
While it was observed quite early on in the pandemic that disease is often mild or asymptomatic in healthy children and younger adults, the close-contact nature of in-person schooling was considered by many governments, including the U.S., a transmission hazard and a potential reservoir for viral spread.
School closures, alongside a cocktail of other non-pharmaceutical interventions (NPIs), like mandatory mask-wearing, physical distancing, and travel restriction measures, were implemented in different fashions, and with varying stringencies, in many parts of the world. These were aimed at mitigating the virus’s spread while research into safe and effective therapeutics and vaccines were ramped up. In the U.S., the general approach to NPIs has been relatively light, but one fairly unilateral measure in the early pandemic was school closures.
Since March 2020, however, huge gains have been made in SARS-CoV-2 vaccine development and roll-out, with two of the innovative, new mRNA candidates now being administered in a phased priority approach in the U.S. – starting with those with underlying health conditions, the immunocompromised, and frontline healthcare workers.
Moreover, more research has emerged detailing the relatively low-risk schools pose in viral transmission compared to other forms of community-based spread. The researchers cite a few case studies from both the U.S. and Europe with new findings that suggest school-based transmissions could be rarer than initially thought.
In the fall of 2020, 11 school districts in North Carolina with more than 90,000 students and staff were open for in-person education for 9 weeks. During this time, within-school transmissions were very rare (32 infections acquired in schools; 773 community-acquired infections) and there were no cases of student-to-staff transmission.“
The researchers suggest that where strict regulatory measures have been observed in schools – like consistent and universal mask-wearing and physical distancing – viral transmission has been correspondingly low. They cite a separate report just published by the CDC that supports this. Using data from 17 K-12 schools in rural Wisconsin with high mask adherence (4876 students and 654 staff), a team of researchers found that COVID-19 incidence was lower in schools than in the community. “During 13 weeks in the fall of 2020, there were 191 COVID-19 cases in staff and students, with only 7 of these cases determined to result from in-school transmission.”
Professor Eric Topol, a Cardiologist at the Scripps Research Institute in La Jolla, Californa, U.S., has described the report's findings as "good news".
Topol has been a prominent and widely-followed commentator on the pandemic since its emergence.
Furthermore, the researchers found certain school-based activities – like athletics and team-based exercises – have played a larger part in school-led outbreaks than others, indicating that a suspension of these could also contribute to SARS-CoV-2’s management in schools.
According to the researchers, a more effective management of community-based transmission outside of schools that reduce transmission when COVID-19 incidence is high – “by restricting indoor dining at restaurants,” for example – would also allow schools to more safely re-open.
What are the implications?
The dilemma governments and public health authorities in the U.S. (and elsewhere) now face at this crucial point in the pandemic's trajectory is a dynamic balancing act between adequately managing the virus while offsetting the devastating social, emotional and economic impact of NPI measures.
This thorny and complex issue has had governments oscillating between tightening and relaxing various NPIs at various points in the pandemic so as to balance the uneasy relationship between the primary devastation of the virus on public health, on the one hand, and the painful socio-economic ramifications of NPIs on the other.
An increasingly pressing issue herein is education in general and school closures in particular. Chiefly because, as the researchers point out, essential academic and pastoral support is provided to many pupils by their public schools.
Decisions made today can help ensure safe operation of schools and provide critical services to children and adolescents in the US. Some of these decisions may be difficult. They include a commitment to implement community-based policies that reduce transmission when SARS-CoV-2 incidence is high (e.g., by restricting indoor dining at restaurants), and school-based policies to postpone school-related activities that can increase risk of in-school transmission (e.g., indoor sports practice or competition).”
As the pandemic is far from over, and mass vaccination remains a distant prospect in even developed nations like the U.S., difficult decisions must be made about which areas of society and the economy can resume more usual activity without exacerbating the current crisis. Schools and in-person teaching sits at the nexus of this complex issue, especially given that many students in the U.S. are unable to access essential services facilitated by their schooling.
- Margaret A. Honein, Lisa C. Barrios, and John T. Brooks. (2021). Data and Policy to Guide Opening Schools Safely to Limit the Spread of SARS-CoV-2 Infection. Journal of the American Medical Association. Published online January 26, 2021. https://doi:10.1001/jama.2021.0374, https://jamanetwork.com/journals/jama/fullarticle/2775875
- Falk A, Benda A, Falk P, Steffen S, Wallace Z, Høeg TB. (2021) COVID-19 Cases and Transmission in 17 K–12 Schools — Wood County, Wisconsin, August 31–November 29, 2020. Centers for Disease Control and Prevention. MMWR Morb Mortal Wkly Rep. ePub: 26 January 2021. doi: http://dx.doi.org/10.15585/mmwr.mm7004e3external, https://www.cdc.gov/mmwr/volumes/70/wr/mm7004e3.htm?s_cid=mm7004e3_w#suggestedcitation