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First School

On the First Day of School, an Indiana Student Tests Positive for Coronavirus – The New York Times

As more schools abandon plans for in-person classes, one that opened in Indiana this week had to quarantine students within hours.

Credit…AJ Mast for The New York Times

One of the first school districts in the country to reopen its doors during the coronavirus pandemic did not even make it a day before being forced to grapple with the issue facing every system actively trying to get students into classrooms: What happens when someone comes to school infected?

Just hours into the first day of classes on Thursday, a call from the county health department notified Greenfield Central Junior High School in Indiana that a student who had walked the halls and sat in various classrooms had tested positive for the coronavirus.

Administrators began an emergency protocol, isolating the student and ordering everyone who had come into close contact with the person, including other students, to quarantine for 14 days. It is unclear whether the student infected anyone else.

“We knew it was a when, not if,” said Harold E. Olin, superintendent of the Greenfield-Central Community School Corporation, but were “very shocked it was on Day 1.”

To avoid the same scenario, hundreds of districts across the country that were once planning to reopen their classrooms, many on a part-time basis, have reversed course in recent weeks as infections have spiked in many states.

Those that do still reopen are having to prepare for the near-certain likelihood of quarantines and abrupt shutdowns when students and staff members test positive.

Of the nation’s 25 largest school districts, all but six have announced they will start remotely, although some in places like Florida and Texas are hoping to open classrooms after a few weeks if infection rates go down, over strong objections from teachers’ unions.

More than 80 percent of California residents live in counties where test positivity rates and hospitalizations are too high for school buildings to open under state rules issued last month. And schools in Alexandria, Va., said on Friday that they would teach remotely, tipping the entire Washington-Baltimore metro area, with more than one million children, into virtual learning for the fall.

In March, when schools across America abruptly shuttered, it seemed unimaginable that educators and students would not return to school come fall, as they have in many other parts of the world. Now, with the virus continuing to rage, tens of millions of students will start the year remotely, and it has become increasingly clear that only a small percentage of children are likely to see the inside of a school building before the year ends.

“There’s no good answer,” Mark Henry, superintendent of the Cypress-Fairbanks Independent School District near Houston, told trustees at a recent special meeting in which they voted to postpone the district’s hybrid reopening until September. “If there was a good answer, if there were an easy answer,” he said, “we would lay it out for you and everybody would be happy.”

Anywhere that schools do reopen — outside of a portion of the Northeast where the virus is largely under control — is likely to see positive test results quickly, as in Indiana.

A New York Times analysis found that in many districts in the Sun Belt, at least five people infected with the coronavirus would be expected to arrive at a school of about 500 students and staff members during the first week if it reopened today.

To deal with that likelihood, many schools and some states have enacted contact tracing and quarantine protocols, with differing thresholds at which they would close classrooms or buildings.

Because of the low infection rate locally, New York City, the largest district in the country, plans to reopen schools on a hybrid model on Sept. 10, with students attending in-person classes one to three days a week. Yet even there, the system might have to quickly close if the citywide infection rate ticks up even modestly.

On Friday, Mayor Bill de Blasio laid out a plan for responding to positive cases that would mean many of the city’s 1,800 public schools would most likely have individual classrooms or even entire buildings closed at certain points.

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Credit…AJ Mast for The New York Times

One or two confirmed cases in a single classroom would require those classes to close for 14 days, with all students and staff members ordered to quarantine. The rest of the school would continue to operate, but if two or more people in different classrooms in the same school tested positive, the entire building would close for an investigation, and might not reopen for two weeks depending on the results.

In California, where schools in two-thirds of the state have been barred from reopening in person for now, state guidelines call for a school to close for at least 14 days if more than 5 percent of its students, faculty and staff test positive over a two-week period.

Chicago, the nation’s third-largest school district, has proposed a hybrid system for reopening that would put students into 15-member pods that can be quarantined if one member tests positive. School buildings should close if the city averages more than 400 new cases a week or 200 cases a day, the plan states, with other worrying factors like low hospital capacity or a sudden spike in cases taken into account.

In Indiana, where the middle school student tested positive on Thursday in Greenfield, an Indianapolis suburb of 23,000 people, the virus began to spike in mid-June, and the caseload has remained relatively high. This week, Indianapolis opted to start the school year online.

The Greenfield-Central Community School Corporation, with eight schools and 4,400 students, gave families the option of in-person or remote learning. At Greenfield Central Junior High School, which the student with the positive test attends, about 15 percent of the 700 enrolled students opted for remote learning, said Mr. Olin, the superintendent.

“It was overwhelming that our families wanted us to return,” he said, adding that families needed to be responsible and not send students to school if they were displaying symptoms or awaiting test results. Students are also required to wear masks except when they are eating or for physical education outside, he said — and as far as he knew, the student who tested positive was doing so.

Anyone who was within six feet of the student for more than 15 minutes on Thursday was instructed to isolate themselves for two weeks, Mr. Olin said. He would not give a specific number of people who were affected at the school, but he said no teachers or staff members were identified as close contacts, and therefore none have been told to quarantine.

“It really doesn’t change my opinion about whether we should start or not,” Mr. Olin said. “If we get down the road and realize that we need to make some adjustments, we’re not opposed to that.”

He said that the district did not have a specific threshold for when it would close a school, but that it would likely do so if absences reached 20 percent. The state has not provided specific guidance to schools on when they should shut their doors, he said.

Some teachers in the district said the positive case on the first day confirmed their fears about returning.

“I most definitely felt like we were not ready,” said Russell Wiley, a history teacher at nearby Greenfield-Central High School. “Really, our whole state’s not ready. We don’t have the virus under control. It’s just kind of like pretending like it’s not there.”

One father whose daughter goes to the middle school with the positive case said he felt conflicted about his three children attending classes in person. Few people in the community are wearing masks, said the father, who asked not to be named because he worried that his family would face backlash.

“I have all these concerns,” the father said. But he has to commute at least an hour to work every day, so remote learning was not a good option for his family.

“It’s just a mess,” he said. “I don’t know what the answers are.”

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School Spring

Spring school closures tied to drastic decrease in Covid-19 cases, deaths – STAT

When state officials were deciding whether to shutter their schools back in March, the evidence they had to work with was thin. They knew kids easily catch and spread influenza — and that school holidays and closures have helped slow its spread. But they weren’t sure if the same was true for Covid-19.

Now, a study published Wednesday in the Journal of the American Medical Association shows that closing all of a state’s schools was associated with a drastic decrease in both Covid-19 cases and deaths. And the point at which officials made that call mattered: Those states that adopted the policy while few people were testing positive saw a correlated flatter curve of cases.

“It’s a nice study. It’s clear that coincident with closing down schools, the numbers improved,” said Helen Boucher, chief of the division of geographic medicine and infectious diseases at Tufts Medical Center, who wasn’t involved in the research. But she noted that we have to be careful about drawing overly broad conclusions from a single sliver of a sweeping shutdown strategy: “School closing didn’t happen in a vacuum.”

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It also still isn’t clear how likely kids of different ages are to get and pass on the virus, which makes it hard to tease out the reasons why school closures might have helped to shift the outbreak.

“It’s quite possible — and probable — that people changed their behavior because they thought, ‘Oh my goodness, there’s this new virus and it’s so scary they’re closing schools,’” said pediatrician Katherine Auger, associate chair of outcomes at Cincinnati Children’s Hospital Medical Center, and the first author of the new paper.

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“One thing we can’t tease out is how much of the effect was related to the virus spreading within schools, and the larger change in the community because now parents aren’t going to work,” she added.

The findings arrive amid a furor over school reopenings. This spring, the Centers for Disease Control and Prevention released guidelines about preventing viral transmission within schools, recommending that students be physically distanced, by placing desks 6 feet apart, for instance. For some schools, that seemed impossible, given the number of kids enrolled and the architecture of classrooms. That meant that at least some teaching would take place online, which contradicted the president’s rosy — and to many public health experts, risky — ideas about reopening.

After both Trump and Vice President Mike Pence criticized the guidelines and encouraged schools to reopen fully, the CDC released revised guidelines, which sparked fears that federal public health experts were caving under political pressure.

The new study doesn’t show cause and effect, only an association between school closures and case counts in an area. The authors warned it also can’t provide a blanket prescription for the fall.

“Our study took place at a time when schools weren’t doing things like masking,” Auger explained. “It’s really impossible to project the old way of schools into the future of schools, assuming they’ll be following the expert guidelines.”

To her, the work supports the “flexible and nimble” approach backed by the American Academy of Pediatrics. Having kids physically present in schools doesn’t just spur academic learning and the essential cognitive and emotional development that comes from social interaction, the organization stated. It also allows them to receive a slew of services, from free meals to adult eyes that might pick up signs of abuse at home.

But those benefits have to be weighed against the risks of Covid-19 for kids, parents, grandparents, and teachers — a threat best kept in check with rapid testing that much of the country cannot provide.

In the new study, Auger and her team compared reality — in which all 50 states closed schools in March — to a computer model in which everything else stayed the same while schools remained open. They calculated the time it would’ve taken for infections acquired in schools to be transmitted, and for those patients to then show up in hospitals and for a certain fraction of them to die.

Their projection found that, if schools had stayed open, there could have been roughly 424 more coronavirus infections and 13 more deaths per 100,000 residents over the course of 26 days.

Extrapolate that to the American population, and the country might have seen as many as 1.37 million more cases and 40,600 more deaths, explained Samir Shah, the director of hospital medicine at Cincinnati Children’s Hospital Medical Center and one of the authors of the paper.

“These numbers seem ridiculously high and it’s mind-boggling to think that these numbers are only … in the first several weeks,” said Shah. “That’s bonkers.” He warned, though, that those numbers should be taken with a grain of salt. While their statistical model attempts to pinpoint the impact of schools staying open or being closed, the method can’t actually establish any sort of causal relationship.

The authors realized that their estimation of how long it might take an infection picked up in a school to turn into a symptomatic case of Covid-19 might be off, and wondered if that might influence their results. When they changed those time lags, though, they still found a significant correlation between closing schools and decreased caseload and mortality.

To Steffanie Strathdee, associate dean of global health at University of California, San Diego, that was what made this study convincing. “This study was taking imperfect data but doing a very elegant analysis,” she said. “If we were wrong, what’s the other extreme, would it change the results? If these kids infected parents, but it took a little longer or a little shorter, what then?”

The bottom line, she said, was that strategies such as school closures do seem to make a difference when it comes to the risks of Covid-19.

Auger’s team also analyzed whether the timing of school closures was correlated to a change in cases and deaths. “States who closed schools before their Covid numbers were high had the largest effect,” she said.

While kids seem to be less likely to get sick than adults, there is some evidence that schools can be important sites of coronavirus transmission. Younger children appear less likely to pass on the virus than tweens and teens, though more research is needed to fully understand the various risks.

Shah, meanwhile, warned that people reading the study should not forget about the risks of interruptions to schooling. “We can quantify the risk of Covid. It’s much harder to quantify the risk of being absent from school for a prolonged period of time,” he said.

Both he and Auger emphasized the importance of tailoring strategies to the needs and coronavirus risks within each family and community, and that better, quicker testing would allow for a safer back-to-school strategy. “It’s a real challenge, and I think that our study is one very important piece of the puzzle in how we think about this,” Shah said.

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children School

With Children in School, Study Suggests, Expect Transmission – Newser


(Newser)

We may have been kidding ourselves about the likelihood of children spreading the coronavirus. A major study conducted in South Korea shows that children under 10 do give the virus to each other and to adults less often than other age groups do, the New York Times reports. But it does happen. And particularly worrisome as schools prepare to reopen is the finding that those ages 10 to 19 spread the coronavirus even more often than adults do. This study contradicts some research, but a Harvard expert called the earlier work flawed. The South Korean study, which included contact tracing, “is very carefully done, it’s systematic and looks at a very large population,” he said. “It’s one of the best studies we’ve had to date on this issue.”

One theory for why the youngest spread the virus about half as often as adults is that children exhale closer to the ground, away from adults. And they exhale less air. There are few answers about why older children are so infectious. It might be because they often combine the physical size of adults with the lack of hygiene of young children. “We can speculate all day about this,” one expert said, per the Times, “but we just don’t know.” Even without definitive answers, an epidemiologist said, children would have to be found to not transmit the virus at all for it to be completely safe for them to gather. “Putting them together in schools, having them mix with teachers and other students will provide additional opportunities for the virus to move from person to person,” he said. An infectious disease expert warned: “There will be transmission. What we have to do is accept that now and include that in our plans.” (Read more coronavirus stories.)



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