As school districts across the United States consider whether and how to restart in-person classes, their challenge is complicated by a pair of fundamental uncertainties: No nation has tried to send children back to school with the virus raging at levels like America’s, and the scientific research about transmission in classrooms is limited.
The World Health Organization has now concluded that the virus is airborne in crowded, indoor spaces with poor ventilation, a description that fits many American schools. But there is enormous pressure to bring students back — from parents, from pediatricians and child development specialists, and from President Trump.
“I’m just going to say it: It feels like we’re playing Russian roulette with our kids and our staff,” said Robin Cogan, a nurse at the Yorkship School in Camden, N.J., who serves on the state’s committee on reopening schools.
Data from around the world clearly shows that children are far less likely to become seriously ill from the coronavirus than adults. But there are big unanswered questions, including how often children become infected and what role they play in transmitting the virus. Some research suggests younger children are less likely to infect other people than teenagers are, which would make opening elementary schools less risky than high schools, but the evidence is not conclusive.
The experience abroad has shown that measures such as physical distancing and wearing masks in schools can make a difference. Another important variable is how widespread the virus is in the community overall, because that will affect how many people potentially bring it into a school.
For most districts, the solution won’t be an all-or-nothing approach. Many systems, including the nation’s largest, New York City, are devising hybrids that involve spending some days in classrooms and other days online.
“You have to do a lot more than just waving your hands and say make it so,” said Dr. Joshua Sharfstein, a professor of the practice at Johns Hopkins Bloomberg School of Public Health. “First you have to control the community spread and then you have to open schools thoughtfully.”
Though children are at much lower risk of getting seriously ill from the coronavirus than adults, the risk is not zero. A small number of children have died and others needed intensive care because they suffered respiratory failure or an inflammatory syndrome that caused heart or circulatory problems.
The larger concern with reopening schools is the potential for children to become infected, many with no symptoms, and then spread the virus to others, including family members, teachers and other school employees. Most evidence to date suggests that even if children under 12 are infected at the same rates as the adults around them, they are less likely to spread it. The American Academy of Pediatrics has cited some of this data to recommend that schools reopen with proper safety precautions.
But the bulk of the evidence was collected in countries that were already in lockdown or had begun to implement other preventive measures. And few countries have systematically tested children for the virus or for antibodies that would indicate whether they had been exposed to the virus.
Infectious disease specialists have been modeling schools’ impact on community spread beginning as far back as February.
In March, most modelers agreed that closing schools would slow the progression of infections. But wider measures, like social distancing, proved to have a far greater containing effect, overshadowing the results of school closings, according to recent analyses.
The risk of reopening “will depend on how well schools contain transmission, with masks, for instance, or limiting occupancy,” said Lauren Ancel Meyers, a professor of biology and statistics at the University of Texas, Austin, who has been consulting with the city and school districts. “The background community transmission rate in August will also be a factor.”