School Closings

In my last post, I noted that we would be closing OSW for the time being in order to help everyone maintain social distancing.  While this does seem to be the gold standard for the prevention of communicable disease, there is some mixed messaging out there.  Yesterday, I received an email from one of our kids' schools which included the following:

"The Chester County Health Department (CCHD) is not currently recommending that schools or organizations preemptively close as a result of the COVID-19 outbreak. The reason they are not recommending school closures at this time is because:

• Children have not been shown to be a high risk group for serious illness from this virus. As much as possible, children should be allowed to carry on with their education and normal activities. 
• Closing schools may not be effective because some children may congregate anyway at other locations therefore not reducing risk. 
• Closing schools may result in children staying home with alternative caregivers, such as elders, who are more vulnerable."

I want to address this point by point, while first acknowledging that the CCHD is trying to do its best at keeping people safe, and is doing so at a time of uncertainty about how COVID-19 spreads, its case fatality rate, and how bad it could be.



The first point of the email actually carries some subtext: that kids aren't going to spread COVID-19.  Let's dispense with that first.  Any of us who have been around kids know that they touch everything, and what is on their hands gets everywhere.  Take a couple of minutes to watch this video involving an experiement with "Glo-germ", a product that aims to educate people about this very point.

So, if kids are exposed to COVID-19, it seems to make sense that whether they are infected or not, they are capable of spreading it.  Dr. Arthur Reingold, an epidemiologist at UC Berkley says in a CNN report:

"We have to assume that they can spread it. They're incredibly efficient at spreading other respiratory viruses like influenza."

An analysis of data from China acknowledges the fact that whether kids have symptoms or not, their role in transmission is not clear:

"Data on individuals aged 18 years old and under suggest that there is a relatively low attack rate in this age group (2.4% of all reported cases). Within Wuhan, among testing of ILI samples, no children were positive in November and December of 2019 and in the first two weeks of January 2020. From available data, and in the absence of results from serologic studies, it is not possible to determine the extent of infection among children, what role children play in transmission, whether children are less susceptible or if they present differently clinically (i.e. generally milder presentations). The Joint Mission learned that infected children have largely been identified through contact tracing in households of adults. Of note, people interviewed by the Joint Mission Team could not recall episodes in which transmission occurred from a child to an adult." [italics are mine - TN]

Note that the report also says that cases in kids were largely found via contact-tracing through adults.  The fact that kids might not be at serious risk for this illness does not mean that they can't infect others.  Witness Typhoid Mary who carried typhoid to her dying days, but was asymptomatic.

The second point made in the email is that kids will likely congregate elsewhere, and as such still be affected.  Even if this is true, the numbers congregating will likely be smaller.  In Pennsylvania, the typical class size of an elementary school class is 22.4 students.    I have yet to see a gathering other than school, a birthday party, or an Easter dinner at the grandparents where my kids have had that many people around them.  Therefore, closing schools, or at least cancelling classes means that there are fewer opportunities for contact.

The other implication is that kids will perhaps go to the mall or to the movie theater or some such.  If we're talking elementary school kids, then it's unlikely that they would get to such places without parental help.  Hopefully the parents would know better.  In Italy everything is closed except critical services (grocery stores and the like).  In Ireland, schools, childcare facilities, and museums are closed.  In Estonia, there are multiple closures as well.  If, on the other hand, we are concerned about mixing in smaller groups, this is perceived by many experts to be less of an issue.

School closing seems to be more the norm than the exception.  A number of these countries have fewer cases than in Pennsylvania.  Source: https://www.theguardian.com/world/2020/mar/12/how-do-coronavirus-containment-measures-vary-across-europe

Finally, there is the point about putting caregivers to kids at risk.  At the schools my kids go to, I know for a fact that many of the teachers are over 50 or 60 years old.  If older adults are more at risk, and kids are good at spreading germs, then exposure to the kids puts them at risk on a daily basis.  What about putting grandparents at risk?  It is possible that in some cases, working families may have no option but to send the kids to their grandparents in order to allow the parents to keep working.  However, in such cases, it may also be true that the grandparents live close by (in our case 2 blocks away), and kids may be seeing their grandparents on a regular basis anyway, and that therefore, the risk is no greater than in everyday life.  Our family has decided that the kids should interact with grandparents via Skype or Hangouts, and that in-person interactions at this time are just not worth the risk.

The bottom line here is what I mentioned in my previous post: to flatten the epidemic curve, measures need to be taken before everyone is sick.  We know it's coming, and we need to stop fooling ourselves that life can go on as normal.  Italy, despite a botched start, provides an example for what ultimately needs to happen:

Movement has been limited to urgent medical or professional need. All shops are now closed, except for pharmacies and those stocking food; companies have been ordered to shut non-essential departments; a wide range of venues - from theatres to schools and hairdressers to museums - are closed.

Our kids are home from school at the current time despite the fact that the schools have not officially closed.  We have voiced our concerns to the schools that they are choosing a dangerous path in remaining open at this time.  Our hope is that if enough parents communicate these sentiments, the schools will be forced to reconsider their limited responses to the pandemic.

In closing, let me point to another great resource on this topic.  This page gives a whole lot of context to the COVID-19 outbreak and has a lot of good numbers with interpretations, although at the time of this writing, some of those numbers are dated.

Stay well,
Sifu Tim

Update: As of the afternoon of March 14, Pennsylvania Governor Wolf closed schools in PA.