1. Schools are now known to be likely centers of community spread for COVID-19, for example: in Israel (another source), in China, in Hong Kong, in Texas daycare centers, in South Korea, in North Carolina daycare centers, in Georgia daycare, in NC schools, in Illinois, French schools, in New York daycare centers, in Mississippi schools, in Indiana Schools (on first day back!), in Atlanta, GA (preparing for school to open!!!), in Atlanta (after opening), another school in GA, in Mississippi, again in Mississippi, now in 71 of 82 counties in Mississippi, in Florida, MUCH MORE in Florida (through an accidentally published report!), in North Carolina AFTER VP Pence and Education Secretary Devos visited to promote reopening schools, in UT childcare facilities!
2. Making children wear masks, stay away from each other, wash their hands obsessively, have their temperatures checked and similar measures (per CDC guidelines) will dramatically impact the quality of the learning and overall experience of students. Put in other terms, compliance with safety rules is inversely proportional to the value of being in school. Peer pressure will likely further reduce compliance over time
3. Students physically going to school involves much more risk than just being in classrooms. While it’s hard to imagine students sitting 6 feet apart from each other while wearing masks (ALL THE TIME) and not flaunting these rules, the process of going school involves much more:
- riding busses (this excellent article explains why this is really hard to get right)
- using shared bathrooms (flushing toilets can make bathrooms COVID-19 super spreaders)
- athletic activities (challenging in school environment)
- using libraries or shared computers (great source on what it will take to make these safe)
- hallways, elevators, stairways and cafeterias are all high risk (all it takes is one sneeze from a kid eating lunch to aerosolize and spread COVID-19) — see my article arguing against opening office spaces for much more detail about the challenges of safely using indoor spaces (including HVAC issues)
- carpooling to avoid riding busses (which is illegal now in some countries due to COVID-19 risk)
- school healthcare services — like nurses, where schools have them (~25% of public schools have no nursing support, 60% have no FT nurse — also excellent article about the already overwhelemed role of school nurses) will have an impossible task — to screen, isolate, treat, contact trace students and staff quickly enough to prevent spread (there are no national contact tracing models, training or resources — though some organizations are trying to help)
4. There are a lot of high risk people in American schools. For example, the average teacher is 42.5 years old while ~29% of teachers are 50 or older (another source). Like the general population, many teachers have co-morbidities which can dramatically increase their risks from COVID-19. Of course, this also applies to the families of students — many of whom are also high risk individuals (like parents and grandparents). Even professional athletes can suffer permanent injury!
5. School age kids do get sick from COVID-19 (some requiring hospitalizations, some experiencing long term issues- including elite college athletes , another source, another source, another source, another source), even if they dying at much lower rates than other age groups. We don’t know yet all the health implications for people who survive (this study may keep you up at night) and the psychological damage children will suffer from losing (maybe even cause) a teacher or family member to die. Also, because they tend to show milder symptoms, they may be more likely to unknowingly spread the virus (though there is still lots of ambiguity about how many adults have been infected by kids — here’s another source and another and another bigger study and the controversial, but often cited French study suggesting children don’t spread COVID-19 and a new study suggesting they carry MORE of the virus). And, it seems highly likely that asymptomatic carriers can spread COVID-19. NEW — asymptomatic children may actually be capable of spreading COVID-19 for even longer than adults (i.e. they could be super-spreaders).
6. Major universities have already decided to dramatically reduce, delay or eliminate in person classes or even hold them outdoors (Harvard, Stanford — satire version here, University of Delaware) as they haven’t figured out how to go back to normal yet. And, one that tried to keep students on campus during the spring semester is being sued for doing so after many students became infected. Here is a large study by The New York Times suggesting significant spread on college campuses has already happened. In GA. Here is a The Daily Tar Heel editorial that sums up reopening well (note- includes some profanity). UNC Chapel Hill is now 100% online this fall semester. NC State found 2 major clusters. More in NC. Notre Dame is closing campus due to huge surge in COVID-19 cases. Michigan State University just announced all remote classes, Alabama has massive COVID-19 outbreak with over 500 COVID-19 cases. Ames, Iowa City (where Iowa State is based) now has more new infections than anywhere else in the world. Now University of Wisconsin is moving online after an outbreak of COVID-19.
7. Schools are already under-funded, under-resourced and faced tremendous challenges before COVID-19 (excellent source outlining top issues here). Teachers aren’t trained, equipped or resourced to act as healthcare workers (some are even evaluating whether to return in the fall at all). School nurses aren’t setup to take on the role of school epidemiologists AND healthcare providers (they already have nearly impossible jobs). Take a look at the overwhelming volume and ambiguity of guidance they’re getting. Schools will still have to deal with the flu — which tends to spread quickly and likely will have similar symptoms — further complicating the issues of preventing spread. Further, school buildings are being urged (without funding) to upgrade HVAC systems which have little or no filtering today and limited outside ventilation
8. As children return to school, employers will be pushing for and/or expecting employees to return to offices (which aren’t safe) which will further increase the likelihood of students catching COVID-19 at home and bringing it to school
9. COVID-19 is out of control in the US. While other countries have developed plans to reopen safely, the US blew the opportunity to do this by failing to manage infections (another source). We’re nearing truly catastrophic levels of infections and hospitalizations in some states (FL, TX, AZ) and others are likely to get there soon (FL may be even worse than reported as ICUs run out of space). Rural America is starting to suffer even worse CFR levels. If we got it under control, we could reopen schools carefully.
10. There are no national guidelines on if, when and how to shut down schools due to COVID-19 spread or even more generally how to ensure student and staff safety. The CDC “Considerations for Schools” document could be helpful, but is not mandated or funded and its recommendations are impractical for many public schools. This document issued by the Trump Administration about reopening America (not just schools) also has suggestions, but depends on capabilities and decision critiria we don’t have or aren’t following today — like fast and readily available testing, contact tracing and phase gates (here is an example of Texas reopening too much too soon) that aren’t always followed. Here are New York City’s guidelines.
11. There are some malignant actors pushing schools to reopen to push their agendas of destroying public schools in the US (another source). COVID-19 presents a cynical opportunity to push public schools beyond their breaking point to make them easier to defund and replace with for-profit schools (particularly online schools), religious schools, private schools and home schooling
12. The US still doesn’t have sufficient testing, PPE, contact tracing and other key systems necessary to manage community spread EVEN IF schools do a perfect job, follow all guidelines and identify potential infections quickly
13. Herd immunity is neither proven (it might not work at all) nor palatable (the amount of suffering would be extraordinary) so pushing kids back to school with the (unstated) goal of hastening herd immunity is absurd (see Sweden)
Note: since first publishing this, I’ve updated some parts as new information is available — mostly adding links to new studies or examples. Below are some other useful links (with descriptions):
School Covid Dashboard (by 15 year old MA student): https://www.covidschooltracker.com
Excellent, but depressing op-ed in Washington Post by an Arizona School Superintendent
Powerful, long-form, comprehensive overview of why COVID-19 is so out of control in the US in The Atlantic (audio version is excellent, though about an hour)
Association Between Statewide School Closure and COVID-19 Incidence and Mortality in the US study by JAMA (Journal of the American Medical Association)
Wonderful Lion in The Classroom Analogy
German schools find NO evidence of COVID spread in schools (counter-example to links above)
Very scary article about Texas (and other hurricane-prone states): I Was a Military COVID Planner. Trust Me: Texas Is in Deep, Deep Trouble
Example of teacher’s association guidelines to fill gaps in federal/state guidelines
Teacher’s union in Florida suing state to limit reopening plans (may be a useful precedent for other states)
In case you’re still on the fence about the unique devastation caused by COVID-19, here is one of thousands of first-hand accounts by an MD living this day to day in a hospital treating COVID-19