Uh, I already cited a paper that the CDC used too that showed that the science is not supporting you when scientists advise to not open schools when the rate of infection is high.
BTW, on this pandemic, at least in Arizona, the difference I got from students has been that many do worry about their parents or grandparents. Yes, they are not so tied to the computer to do assignments. But the point from Left_hand_of_Dorkiness is that students are less likely on this pandemic to go out. Again, because unlike previous closings, the students do worry much about parents or elder folks.
Dseid, back in late March you predicted we’d have somewhere south of 100k deaths in the US, because you thought we’d follow the same curve as the rest of the world. And for a while, it looked like we would. But then we lost the political will to take the reasonable precautions those countries did: we violated our own safety protocols, we rushed, and COVID came roaring back. Now we are at double your old estimate, not because you underestimated the virus, but because you overestimated the competence of our institutions.
Well, I thonk you’re doing it again. Yes, countries who have demonstrated they are able to control the virus have been able to open schools relatively safely. But there’s a feedback loop there: it was safer to open schools because there was less virus, and there was less virus because they demonstrably knew how to control the virus.
The US seems to be the opposite. The virus is uncontrolled here. If we open schools, we won’t do it smartly, we won’t take the precautions we should. We won’t respond to outbreaks in a way that limits their impact. We won’t have health-care for those impacted. What makes me confident about this? We’ve literally fucked up every other thing we’ve done so far, and nothing has changed. There’s no coordinated response between federal, state, county, city, and school district (literally 5 layers of government who have a say). There’s no funds. There’s no consensus.
Quit thinking this will play out like it has other places. It doesn’t seem to, because we have a crisis in leadership. That’s as relevant as the science.
I am curious what you think a town with, say, 2,000 teenagers will be like if only 500 of them are left completely unsupervised during the daytime. My wife and I thought about this and burst into bitter laughter.
I mean, that’s basically what’s already happening right now in a lot of places. We are in summer break and there are still a lot of parents working during the day, even now. There are likely a few thousand high school students in my district that are currently unsupervised for much of the day.
Do you think that those strict controls should be for all districts across the country … even including those with stable/dropping and/or low rates of infection, with positivity rates under 10%, and hospitalization rates stable to dropping and plenty of capacity?
Overall right now by broad region:
US West - new cases daily average over 7d is stable for over 2 weeks, positivity rates dropping and now about 8%, hospitalization rates fairly flat at 4.28/m
US Midwest - new cases on a fairly shallow upward slope but still under 125/m, positivity rates under 6%, hospitalization rates pretty flat at 3.75/m
US Northeast - new cases flat and under 45/m, positivity rates under 2%, hospitalization rates flat to dropping and under 2/m
Now South? New cases with just a week of being flat after a steady rise on now over 310/m, positivity over 12%, hospitalization rates rising currently 11.7/m.
Of course in each region, in each section of each state numbers will vary. There are even in the South states and districts within states that have good numbers, and in the Midwest ones that look bad.
@GIGObuster agreed for those districts with high and/or significantly rising rates of infection, especially when interpreted along with consideration of positivity rates and hospitalization rates.
@MandoJo, as to your fear - what we can say is what we know:
schools being closed has no evidence of being a particularly effective mitigation tool, specifically in regards to decreasing broad community spread to adults (this even for influenza in which kids are highly contagious and with high infection rates);
children are at relatively low risk of getting significantly ill with COVID-19;
many countries have opened or kept open schools without major negative impacts on broad community spread;
elementary school aged children seem to catch and spread the germ relatively poorly;
school being closed has very significant negative impacts on children directly;
schools being closed has significant negative economic impact at the levels exceeding many industries labelled as “essential”
We don’t know lots of course. “No evidence of” ≠ “Evidence proving not”. Like with all elements of opening proceeding with some degree of caution is prudent, and the clearly we know enough to know that more caution is needed with older children than with younger ones. But also like with all elements of opening decisions should be made based on likely benefit over risk based on what is known to date. Compared to other items the proven harms of ongoing closures are large (especially for the younger grades) and the benefits of closure speculative (especially for the younger grades).
FWIW I completely agree that we have a crisis in leadership that begins at the top but is not limited to it. That fact does not change what we do and do not know however.
Q: There seems to be a lot of variability in how schools are managing this. What are the different approaches schools can take—and have taken in past epidemics—and how might they help?
A: I’d like to emphasize the difference between reactive and proactive school closures. Reactive is when a school decides to close when a student or parent or staff member is sick. Most people don’t argue with that. If the pandemic is at the school, you would want the school closed.
There have been a number of studies that have looked at reactive closures. These analyses, including a paper in Nature in 2006 using math models [of an influenza pandemic], typically find that such reactive school closures for a moderately transmissible pathogen reduces the cumulative infection rate by about 25% and delay the peak of the epidemic [in that region] by about 2 weeks. When you postpone the peak, you also typically flatten the epidemic and space out your cases. This has value. It means that the incidence on any given day is lower, so we don’t overburden our health care system.
I’d really, really like to believe this rosy view, but the statistics say otherwise. The NYT says
Eighteen states set daily case records in the past week, and 40 have had 14-day increases in cases per capita.
Those 18 states are Alabama, Alaska, California, Hawaii, Indiana, Kansas, Kentucky, Minnesota, Mississippi, Missouri, Montana, New Mexico, North Carolina, North Dakota, Oklahoma, South Carolina, Utah and West Virginia.
Deaths are also rising: Friday was the fourth consecutive day with more than 1,100 reported U.S. deaths, which are trending upward in 30 states.
And more than 150 prominent scientists, doctors, nurses, and others have signed an open letter urging leaders to shut down the country and start over. Again, I prefer your sunny take on things, but I have to go with the public health and infectious disease experts from Harvard, Columbia, Yale, Brown, the University of Chicago, Rutgers, Northwestern, and a slew of others who signed the letter.
Yup … models run. (Although even the actual Nature paper model found that school closures would have “little impact on overall attack rates”, more on peak rate) Actual real world evidence though? The review of it was discussed here. Generally, reductions of influenza transmission during closures mainly occur among children not in adults, and even that not consistently.
It is in the pandemic toolkit because given the huge degree of attack rate and contagiousness of kids it should work for influenza, not based on much actual evidence.
Those ARE the statistics, the actual numbers in different regions, not a rosy view. Source. The point being made is not that they are wonderful - they are not -but that they vary greatly by broad region, by state, and by section of state.
Here, for example, is in Illinois by section of state. Northeast section (Chicago and it suburbs) new cases slightly increasing but under 70/m. The Southern increasing more steeply and over 173/m. That said all Illinois regions with positivity and hospitalization rates at state Phase 4 levels … for now.
Conclusions School closures appear to have the potential to reduce influenza transmission, but the heterogeneity in the data available means that the optimum strategy (eg, the ideal length and timing of closure) remains unclear.
As pointed before uncertainty is not a friend for someone that is so sure that opening schools is not going to add to the increase infections when the infections are increasing in a community.
I worked for nine months in a nationally-renowned clinical research center. My job was basically paper-pusher, but I also took minutes for the monthly meetings at which new study proposals were considered; and I proofread IRB statements (Institutional Review Board, basically the protectors of subject rights) for researchers.
I’m imagining submitting a study proposal that says, “The subjects for our experiment will be children and government employees. We will compensate the parents of the children by offering to maintain their childcare arrangements if their children participate in the study. We will compensate the government employees by offering to let them maintain their employment if they participate in the study. Risks to subjects include permanent neurological damage, permanent damage to the heart and/or lungs, and death. Our initial study will involve a cohort of approximately 1 million subjects in our state. Fellow researchers in other states are conducting similar studies of similar cohorts with similar compensation offers.”
This proposal might have trouble getting IRB approval.
One thing we know is that we can’t use the course of the disease in other countries as a guide. They peaked and went down; we are riding a series of surges in the season when it was supposed to be lowest. We cannot assume that the relatively low impact of school openings in those countries is incidental to their general competent management of the issue, or that we will suddenly become competent managers. In many, many districts, it will be the absolute worse case scenario: kids with no masks, crammed into classrooms, no ventilation. Those are the choices. Close schools, or have that. Because we can’t seem to get this right. We are profoundly failing.
I feel like you are on the Titanic, talking about how all those other boats crossed the Atlantic just fine, but ignoring the big hole in the side of THIS boat.
Are you so confident in the science that you feel ok opening schools in all grades, in all areas, with minimal, imperfectly applied precautions? Because there’s no point about talking about the ways it could be safe. We aren’t in that world.
That’s a good point – I feel like one of the problems here is that everyone (including our local school board) is talking as if it’s all or nothing – in particular, either we open for all grades or no grades, even though the science does seem to show right now that older kids are much more likely to spread covid-19.
Would it make any sense (in a hypothetical world; NO WAY this would go over in the real-world US, I imagine) to have a phased reopening where we open up kindergartens first… then wait for 2-3 weeks, look at community spread… then, if there’s not as much community spread… opening up first grade… and maybe only open up to age 9 or 10 or so until the numbers are much lower.
Ugh, there’s no way that people in the US would go for that given how the phased reopenings of businesses went. I’d be much more comfortable with that, though.
It wouldn’t have to be that painfully slow. Start with k-6 open and phase in middle/high schoolers as numbers permit. I honestly don’t get objections based on how many adults will interact in the lower grades. It will not be higher than other essential service jobs by any means.
I think teachers think it will be. They are concerned that children won’t follow safety protocols, from wearing masks properly to not licking things. They worry they won’t be provided with sufficient PPE. They worry that they won’t be able to preserve anything like 6 ft of distance, unlike other essential workers. They worry that being in contact with a smaller group for long periods of time is worse than incidental contact with larger groups.
They also tend to think that the service they provide is not as essential as basic infrastructure, like groceries or utilities or Healthcare. Most see teaching as more important than restaurants, bars, gyms, but think those things should be closed, too. They believe they can do a MUCH better job with distance learning this time, with more structure and support. They admit there will be a gap, but not enough to justify the risk.
Do you understand now? You don’t have to agree, but when you say you don’t understand, it suggests you think teachers are unreality just being disingenuous or lazy or stupid.
I think they are wrong, not disingenuous or lazy. I don’t think it’s right, useful or healthy to force under 13 year olds to wear masks and socially distance. Smaller classes, sure. Temperature checks for sure. Give teachers N95 masks.
Yes, if you can’t trust your government to give those minimal requirements, I understand hesitation. Totally.
