Using Data and Modeling to Understand the Risks of In-Person Education.

Abstract

Naimark and colleagues1 use a simulation model calibrated to the COVID-19 pandemic in Ontario, Canada, to estimate the association of opening kindergarten through grade 12 (K-12) schools with total infections across the city. They projected that schools opening was associated with a much smaller impact than other community-based nonpharmaceutical interventions (NPIs). This research adds to a growing body of literature addressing the risk of COVID-19 in K-12 schools and the association of in-person school with the trajectory of the pandemic.2 In March of 2020, COVID-19 shuttered schools across the world. Despite heroic efforts by educators and families to pivot to online learning, students were often limited by a lack of devices, adequate internet service, and adult support at home. Many students simply vanished from schools altogether. The resulting educational gaps exacerbated preexisting racial and economic disparities. In addition, even children with the resources needed to attend online learning experienced the loss of noneducational services provided at school, such as food, mental health services, and detection and reporting of abuse. The lack of in-person schooling has been associated with adverse physical and mental health outcomes, including both obesity and undernutrition, depression, anxiety, substance use, suicidality, and physical and emotional abuse. School closures have threatened access to vital services for children; before the COVID-19 pandemic, 35% of adolescents who received mental health services received them exclusively in the school setting.3 The economic impact has been devastating as well, with women bearing a disproportionate burden. Balancing the educational needs and emotional well-being of children with the risk of COVID-19 for educators, staff, students, and families is not straightforward. Although children are at lower risk for severe COVID-19 illness than adults, Black, Latino and Latina, and Indigenous children have experienced more severe COVID-19 than White children in the US. Asymptomatic or mildly symptomatic children may carry infection home and place household members at risk. Educator and staff safety is also critical: 25% to 50% of US educators have at least 1 risk factor for severe COVID-19, and the risk of COVID-19 is higher among Black, Latino and Latina, and Indigenous educators than White educators,4 as for all US adults. With these competing risks in mind, a debate about whether schools could reopen safely in the context of a still-ongoing pandemic took hold in the fall of 2020. This debate quickly became politicized, fueled by the early absence of empirical data to answer 2 fundamental questions: First, are students, educators, and staff at greater risk of acquiring COVID-19 infection by being physically present in school? Second, does opening schools increase the spread of COVID-19 in the community? Let us address the first question of whether students, educators, and staff at greater risk of acquiring COVID-19 by being in the building than they would be if they were not at school. With ongoing community transmission, it is expected that adults or children bring COVID-19 into the schools. How often such introductions occur is a function of current community COVID-19 incidence rates and out-of-school activities and exposures. Most early US data from the 2020 to 2021 school year focused on the risk of these introductions, such as national or state dashboards that report school-associated cases (ie, any student or adult associated with a school who receives a diagnosis of COVID-19).5 Such dashboards have generally demonstrated similar or lower risks among children and adults who have been present in school buildings, compared with general population rates. A more important component of this question is, with mitigation measures in place, such as universal masking, physical distancing, cleaning of surfaces, hand hygiene, and adequate ventilation, what is the risk that someone who enters a school building with COVID-19 will transmit it to another + Related article