Editor’s Note: This is the fourth installment in a series of regular columns on emerging science related to Covid-19 by Erin Bromage, an associate professor of biology at the University of Massachusetts Dartmouth. His research focuses on the evolution of the immune system and how animals defend themselves from infection. Follow him on Twitter @ErinBromage. The views expressed are his own. View more opinion articles on CNN.
This past week, I became really frustrated at the current status of the pandemic. It was over something silly.
I coach youth soccer. I love helping my players develop their skills and watching the joy they get from playing. After losing the entire spring season to the pandemic, I was thrilled when we were given the go ahead by the state to resume training our teams again. Training was a little different – physically distanced, no scrimmages, limited group size – but we were back on the field, in our happy place.
On the first day of training you could see in the players’ faces how excited they were to see their friends. How happy they were to have a ball at their feet. Nothing has changed in the last two weeks of training – they (and I) are thrilled to be there. And we all knew that this physically distanced training was just a blip in time. Massachusetts has done incredibly well at suppressing cases, and all the coaches (and I) believed that on July 6 the restrictions would be lifted, and normal training and games would begin.
But we didn’t get the green light. The state determined that some team sports, soccer included, were high risk for infection. Our return to real play has been paused, seemingly indefinitely.
Outdoors, the virus can dilute in the air, making activities somewhat safer. Soccer has some close-range interactions, but, because the players play a specific position, there aren’t that many interactions. And we have all heard that children are not as likely as adults to have adverse outcomes from infection.
The only one at higher risk for severe outcomes here is me … you know, the old guy. But coaches can distance themselves on the field. Coaches really don’t need players in a huddle. We can do this safely!
I was mad.
But then a trusted friend asked what if starting team youth sports increases infections in the community? What if those increased infections resulted in schools not being able to open because community transmission increased. Which one was most important to me? Schools reopening or youth sports?
My answer: I want both! I bet those of you out there who are parents do too.
This entire pandemic is a conundrum. There are no easy solutions – only trade-offs.
No matter the precautions we put in place inside a classroom, we cannot open schools if there is significant community transmission. Period.
Even in countries where daily cases are low, schools are becoming an epicenter of community outbreaks and the ripples of those outbreaks permeate throughout the community at large.
In Australia, where they were reporting only 10-20 new cases per day for most of June, an outbreak in a school spread among teachers and students, and then radiated out into the community. By July 9, the outbreak included 58 students, 21 staff and 14 households – a total of 119 new infections, with the number growing daily. This outbreak, and other clusters developing around Melbourne, shut down a city of 4.5 million people for the next six weeks to suppress the outbreak.
There is a similar story in Israel, where officials closed nine schools and quarantined nearly 7,000 people after the diagnosis of 244 students and staff infected with SARS-CoV-2, the virus that causes Covid-19 infections. Dr. Udi Kliner, the top Health Ministry official in Israel who testified to the Israeli Parliament on July 7, said, “Schools – not restaurants or gyms – turned out to be the country’s worst mega-infectors.” Members of Israel’s cabinet have suggested that a second lockdown of the country may now be unavoidable.
If we open schools but don’t open them safely, the ramifications are going to ripple throughout our communities – well beyond the playground.
We must start by lowering community transmission. We must get new cases in our school districts low, very low. The average public school size in the US is 576 students. If we are looking at a SARS-CoV-2 community-level incidence of 1-2%, as we are currently observing in some of our hotspots, then six to 11 students attending a typical public school will have an active infection, which could be passed to their peers and school faculty.
We must invest in our schools’ infrastructure. Decades of shrinking budgets and unfunded educational mandates have led to neglect of our schools’ buildings. This deferred maintenance, especially of schools’ HVAC systems, must be addressed immediately. The quality of the air inside our classrooms will help determine how efficiently the virus moves between susceptible individuals and in turn how many people become infected. We must prioritize improving air quality by bringing more fresh air inside our classrooms and upgrading the air filtration. We must make our buildings healthy!
The healthy-buildings approach to tackling Covid-19 in schools has been spearheaded by Dr. Joseph Allen at the Harvard T.H. Chan School of Public Health. Dr. Allen and his team published a guide to help schools reduce SARS-CoV-2 infection risks when they reopen. This is a must-read guide for school reopening committees. However, to implement some of these infrastructure suggestions laid out in the guide, capital investments are needed. The federal government has provided bailouts for businesses and individuals, but if we want the schools to reopen in the fall, it’s time to invest in our schools.
While there are community infections in your area, masks are mandatory. We know masks reduce emissions of respiratory droplets. Masks are our first line of defense in stopping the virus at the source. No one likes wearing them, but they are important in stopping transmission of the virus indoors. For young children, the comfort of the mask is more important than the type of mask. Find one that is comfortable and that your child does not have to readjust often. For older students and teachers, higher quality masks are a must – two layers of fabric are better than one and surgical masks are better.
Invest in faculty and staff safety. There are already enough teachers who worry about their health and will not return this year to our children’s classrooms. There is not a backup pool of teachers ready to jump into classrooms if our current teachers get infected. If teachers and staff get infected and sick, they will be out of the classroom for at least three weeks. Some will die. When people chose a career as a teacher they never agreed to put their lives at risk to teach our children during a pandemic.
We have to protect those teachers who choose to return. Faculty need basic infection control training, they need fewer students and more support from their administration, and they need to be provided with the proper personal protective equipment so they can do their job with minimal risks to their health.
There is a myriad of other things that need to be considered for school safety during a pandemic that are explained in detail in the CDC guide and the Schools for Health Guide. Of vital importance is the health of 56 million children being asked to go back into classrooms in the fall.
Sickness due to Covid-19 in school-aged children might be rare, but that reason alone is not enough to restart schools without having put in place all the protections needed to create a safe workplace. There is now research that shows schools are amplifying infection rates in the community and we must do our part to make sure that schools are safe for everyone who enters those halls.
This means we must pressure our local, state and federal leadership to provide the resources needed for safe schools. And we, even the youth coaches of the world, need to do our part to ensure that community infection rates are low enough to allow our children, and their teachers, to enter the fall semester with confidence.