Or rather, where it sheds. 
Your opinion of the AAP’s articulations is duly noted.
No question that rational policies for dealing with students who turn positive are needed. If the school had in fact “closed again in . . . one day” because a single student tested positive that would have been irrational. Of course that is not what they did. They quarantined close contacts. Close contact is in fact within 6 feet for 10 to 15 minutes or more, but many schools will apply it to complete classrooms due to that “abundance of caution” bit. It is one of the reasons why it is best to keep kids in cohorted groups as much as possible.
The new study is not demonstrating anything new. It was noted in the op of this very thread back quoting an article published at the start of May! And it remains that there is little transmission by these kids despite that.
@Dagobian is exactly right on the weirdness Morrison’s claim and not only for that reason (which is a very valid one). “Not the lungs”? How does she know that? Viral load is checked nasally because that is where is is easy to check and certainly many larger droplets like originate there. But for many viruses the lower respiratory tract is the source that matters.
The divergent distribution of ACE receptors in children compared to adults (possibly resulting in low lung viral loads while nasal loads are comparable to adults), coupled with the lesser degree of lung volume and force per exhalation, may be part of the answer to why they have such poor transmissibility.
Also in support of that speculation, adults sick enough to have their lungs getting sampled may have high viral loads in their lungs without much in their noses.
Uh, I’m wondering now if you ignore for some reason that a lot of what was published in favor of kids not transmitting this as much as adults came also from preliminary studies. One should notice that studies that pointed at children being more capable of transmission were also preliminary. Still, the low levels shown was why me and others did agree that in the case of elementary school children one should consider opening, with separation and other safety features in place.
The issue I have here is that what Heffalump_and_Roo was pointing here was another study that says that transmission from kids is very possible. Dismissing early studies was plausible then but dismissing new studies and evidence as “things that are not new” is not scientific, just as one study is not good to set policy, having some confirmation in follow up studies does not justify a dismissal, it actually means that there is then more confidence to say that the risks are higher for infections at schools, higher than the ones proposing that schools should open have been assuming.
It is fair to say there are a number of studies and they give conflicting information. But it is also fair to say that the studies quoted by DSeid have tended to be higher quality studies. Personally, I have no idea if schools should open in States with a high level of new daily cases. And my thoughts have no bearing on their decision. But it is striking how different coronavirus is from influenza in regards to pediatric reservoirs.
You misunderstand the point of this not being new information - Nasal carriage being as high in children as in adults is not preliminary information at this point; this newest study only further confirms what has already been seen. That’s not dismissing it. Fairly low transmissibility by younger children is also not preliminary information at this point; it is also quite well established, even if the exact level of low is not pinned down. I don’t know of anyone who would argue that transmission from kids is not “possible”. Most everyone believes it must occur to some degree. I don’t know who virologist Stacey Schultz-Cherry hears, maybe the same “lots of people saying” that Trump hears, but I don’t hear anyone claiming that “kids don’t get infected.” We know they do, apparently less often than adults, much less often sick when it happens, and with much less transmissibility, but they get infected. In fact, given high nasal viral loads, it IS surprising that they do not seem to shed in a way that spreads the bug effectively, like they do influenza. Shockingly so really.
Ever since I first read of the earliest surprising observations in February that transmission from children was not being seen, I’ve been stating that determining the actual degree that kids do and do not transmit should be a very high priority item. At that point I was thinking less about opening schools (which hadn’t yet been closed) but just informing the assumptions of the models. Studies to pin it down better are in fact in progress but take time.
Those are strange theories considering that having a smaller lung capacity and being short don’t stop them from being major vectors of other respiratory illnesses.
And that was a point I mentioned too, we do not really know at what rate kids will infect adults. That, with the added reason of the rate of infection increasing in many locations and inadequate testing in the US, should not lead one to be so confident about opening schools right now.
New research suggest that SARS-Cov-2 does not transmit well, if at all, on surfaces. Influenza and rhinovirus do transmit on surfaces, even if that is not their primary method of transmission. It may be that children’s lack of hygiene does little or nothing to increase the contagiousness of Covid, while it is a known risk factor for the flu.
What might be the implication of this? If I’m understanding it right, would it imply that sneezing (or even coughing?) really can’t spread the disease in the way that it has spread, and that spread really comes almost fully from exhalations? I’m trying to understand the differences between infections, or viral load, in the upper and lower tracts.
Or, could it be that they actually do ‘shed in a way that spreads the bug effectively, like they do influenza’? I’m always hesitant to accept ‘shocking’ observations at face value, unless there is a really good reason.
Let’s start with re-stating that the experts committee do not recommend all schools in all places under all conditions. The Harvard one was the best at giving reasonable specific guidance but all agree varying local conditions would make different approaches the more prudent approach.
It sure would be nice to have precise numbers in hand before all decisions. Rarely (ever?) do we have that. We certainly do not have it for ANY of the choices that have to made regarding what gets opened and what gets closed, be that schools, or distribution centers, or parts of the food chain, or retail. Yet choices must be made. We do not know precisely how low the risk is but we know it is low, and that the harms of closure are large.
That is a very interesting question isn’t it?!
To my thinking (and I think I have stated this somewhere on this forum before) it entwines with the unusual degree that among adults it is a very few that do the majority of the spread, mostly in events that are loud with singing or yelling or chanting. That’s the super-spreader bit that it seems like 10% of all adults infected are responsible for 80% of the spread and 70% of those infected never spread it to a single other person. Those 70% very likely also include many with high nasal carriage, but they do not spread. That 10% is some combination of a subgroup that is capable of very effective transmission (by some combination of their biology and behaviors like unmasked yelling and singing or even talking very loudly), and their being at events that enable it.
It definitely overlaps with the implication from those finding that much of the spread would be stopped if we could limit the impact of those super-spreaders.
Does the distribution of ACE2 receptor expression (and thus variation of viral load levels in the lower respiratory tract) vary not only between children and adults but also between adults? Is it the subgroup that has high viral loads in their lower respiratory tract, who are able to yell, sing, chant, whatever out large volumes from deep within their lungs, given efficient venues, who do most of the spread?
And if so what does that imply?
In any case kids, especially 11 and under, may not all always be in the 70% non-spreader group, but they do appear to very rarely, if ever, be in the 10% super-spreader group.
The choice that should be made, based on current evidence, is to close schools in many parts of the USA until the rate of infection lowers, when testing is more available for schools, and proper funding for equipment is available.
Key Points:
- With just a few weeks remaining before schools in the U.S. are scheduled to reopen, and the federal government encouraging in-person schooling, there remain many questions about the risk COVID-19 poses to children and their role in transmission of the disease. Indeed, other countries have not reopened schools with the levels of community transmission found in the U.S., coupled with its insufficient testing and limited contact tracing.
- Our review of the latest available data indicates that, while children who are infected with COVID-19 are more likely to be asymptomatic and less likely to experience severe disease (though a small subset become quite sick), they are capable of transmitting to both children and adults.
- What remains unclear and where evidence is still needed is: whether children are less likely to be infected than adults and, when infected, the frequency and extent of their transmission to others. There is some evidence for an age gradient in infectiousness, with younger children less likely and older children more likely to transmit at levels similar to adults.
- While other countries that reopened schools have generally not experienced outbreaks in school settings, almost all had significantly lower levels of community transmission than the U.S. and greater testing and contact tracing capacity. Moreover, several disease clusters connected to schools and children have been reported.
- Taken together, the evidence indicates that where there is already widespread community transmission, as in many areas in the U.S., there is clearly a risk of further spread associated with reopening schools. The risks of reopening need to be considered carefully in light of the recognized benefits of in-person education.
Most countries that have reopened schools have not experienced outbreaks but almost all have had significantly lower rates of community transmission than the U.S. and higher testing and contact tracing capacity. In many countries around the world, schools and daycares have reopened following a period of lockdown. So far, most have not seen cases surge after re-opening. For the most part, the lack of a surge in cases and the ability to control any outbreaks in most countries that have re-opened schools is in large part explained by their significantly lower levels of community transmission at the time schools re-opened compared to much of the U.S. now, as well as their greater testing and contact tracing capacity.
At the same time, school associated outbreaks have occurred in some countries. Not all countries have avoided school-associated outbreaks. For example, schools in Canada, Chile, France, and Israel have reported outbreaks, sometimes significant ones, necessitating re-closure of schools in some cases. Israel, in particular, has had several outbreaks at schools after reopening, including an outbreak in a high school where 13.2% of students tested positive for coronavirus as did 16.6% of staff and school-based cases have been linked to increasing community transmission. The country reopened when it had significant fewer cases, cases per million, and positivity rate than the U.S. does today (see Table 1); it reopened its entire school system with few social distancing or other mitigation measures.
“Many”, “some” … not much help to decision making in very specific locations. What it is NOT is all open or all shut or even all having to be completely one or the other. The choices that should be made is not in isolation of other community-wide mitigation decisions but as part of consistent processes that prioritize starting with opening those things with the most benefit to least risk of harms as can be best determined. I hope we can agree to that much. We may disagree on how essential in-person education is, especially for elementary students, on how much harm is caused by closing schools, and exactly where in that benefits/harms spectrum school opening ranks, but that general approach really should be uncontroversial.
Have you read the Harvard Global Health Institute document linked to previously here?
It is the sort of rational specific guidance that districts should be reading and utilizing.
Well thanks for showing all that you do miss things to make very bad counter points. I already reported that I did read it. And I even noticed that like climate change deniers, a lot of the proponents of opening schools do miss what a paper/study reports. They also do mention what to do when conditions are red. What they pointed out is being followed… by most districts in the USA that are not opening schools with students present until things that they point out in documents like the Harvard Global Health Institute one are met.
Education Week is tracking and sharing reopening plans of a sample of school districts across the country. As of July 29, 11 of the 15 largest school districts are choosing remote learning only as their back-to-school instructional model, affecting over 2.8 million students.
And one should notice how you attempt to dismiss what the Kaiser Medical group reported. One has to notice that schools take them more into account than a poster on a message board.
Dude, it’s just that your mention of it really seemed like the mention of someone who actually hadn’t read it.
The bipartite nature of this country seems to allow for no nuance.
Schools can be opened up in ways that take more risk than they should and they can be kept shut causing much more harm than is necessary. It is NOT true that wanting to avoid one means one is in favor of the other. Or that the existence of one means the other is a fantasy.
Okay you want point by point.
Where does the NYT gets a “generally agreed” expert consensus that school systems are all or none based on the single metric of positivity 5% or less. Nothing I’ve seen anywhere than there although I am sure someone says it. 10% is more often used when positivity is the key metric being followed. NOT what the only expert consensus with specific guidance with metrics I could find states - yeah that Harvard one (which uses incidence metrics with 10% positivity as a check on the possibility of undercounting). Which your responses still don’t seem to indicate any reading of. Funny that their basis for pulling that 5% number is this line in the article:
G’head, follow the link. To Harvard’s Global Health Initiative! Gaddamn! So maybe go with that source actually says should be the metrics used?
But heck run with it. Would you assert that the not ten largest, often suburban districts, with less than that positivity rate should open fully?
The Kaiser article. NOTHING in it that demonstrates any risk at any specific level. A claim that children are “capable” of transmitting is no duh, but again the evidence is that children do so rarely, and the evidence that “older children more likely to transmit at levels similar to adult” only exists for symptomatic children in close household contact circumstances. Only stating that it is not PROVEN there is no risk, so some risk can be speculated to exist. Documenting in fact that across the world there have been fairly few episodes of relatively contained local flares of cases with “Israel in particular” which they note occurred in a high school in the context of having “reopened its entire school system with few social distancing or other mitigation measures.” Which proves that if you really work at it, throwing the highest risk kids in with no mitigation, with a teacher coming in sick and not wearing a mask, in close contact with other staff and students in crowded quarters, you can have a local flare, which even then can be suppressed before it causes much harm.
Like I said,this shows again that you did not read what I typed before, I did granted that elementary schools could be open, and even middle schools. Provided that items like testing and contact tracing, that are mentioned as factors needed to opening schools in the document that you thought I did not read, are in place.
Meaning that, as pointed before, it is more likely that you did not read fully what Harvard’s Global Health Initiative pointed out.
This BTW is one item that I think is missed constantly from the Harvard guideline, that as noted before regarding other guidelines, is not a law:
While this guide to risk levels uses daily new confirmed cases, it is important that this metric be triangulated with others for full confidence in its reasonableness as a guide. The most important other measures are: case trend as an estimate from the new deaths trend, new COVID hospitalizations, in each case with a seven day rolling average, and test positivity (percentages of tests that come back positive). Death and hospitalization data points will reveal where case counts are low only because testing is low; where such undercounting is apparent, jurisdictions should not rely on case incidence to assess risk but only on death and hospitalization metrics. Increases in test positivity above 10% are also an indicator of a strong likelihood of under counting.
Looking at Arizona, the levels in test positivity stopped going up, but they are still over 18%, and more than 2000 cases per day are reported, we get that when one notices that the CDC reported more than 16000 new cases in the last 7 days. According to Harvard, we are very deep into the red zone and according to their guideline then:
Risk Level Red: Stay-at-home orders in place; all learning remote for all learners; districts, states, and federal government invests in remote learning
The point is that even if we do consider the guideline as definitive, it is telling us that indeed, many states can not open schools yet, other places with less infections can consider hybrid solutions or more support for testing and contact tracing once the rates of infection are lower.
Nice catch. I didn’t notice that. I thought they closed the entire school. Now it will be interesting to see if there are any outbreaks of people that they missed in their contact tracing efforts.
As I noted in my post, it’s more confirmation of the German study. So yes, this is just more evidence from a different angle that the viral load in children are at levels that can rival adults.
One speculation for the low transmission rates is that schools have been closed since nearly the start of the pandemic so there wasn’t much opportunity for children to transmit the virus on a bigger scale. As I also noted in my post, it would be better to have more concrete evidence in a study instead of speculation about reasons for the transmission rate.
. . .
Just to clarify where the quote comes from. It’s from Juliet Morrison, a virologist at the University of California, Riverside. She’s currently an assistant professor studying the virus. She’s currently teaching a class on host responses to viral pathogens. Here’s more from her about Covid-19.
In weighing whether a snippet of a sentence from a paragraph in an unrelated study on whether there is airborne transmission from back in April 2020 vs. someone who specializes in the coronavirus on the results of a current study, people can decide for themselves how much weight to give each.
Is there a cite to give some evidence for this, or even just a basis for your conclusion?
Some evidence to the contrary is here, earlier quoted in post 535.
Some of these studies are the studies DSeid has been quoting and relying upon.
CDC new report: SARS-CoV-2 Transmission and Infection Among Attendees of an Overnight Camp — Georgia, June 2020
bold added
This next article is a personal story of one school principal with no good options. One of the teachers in his district died, two others have tested positive. If he doesn’t open the school, he’ll lose funding 5% funding which is a lot for them. If he does open the school, he’s sure that more people will die. He also knows most of the students personally and knows which ones are suffering in their own way. He also knows which ones live with elderly relatives who could die. He talks about the teacher who died and how she did everything right with social distancing and meeting every requirement. But she still got sick and took it back to her family. Now the teachers are afraid after seeing what happened to her. Any decision he makes will cause suffering, he’s sure.
In a podcast, Andrew Yang interviewed Emily Oster, who is a professor at Brown University and economist. She has a website about Covid where she tries to quantify the data about Covid. called Covid Explained.
In this clip, she makes the case for the benefits of schools. One statistic that I haven’t seen before is that in one piece of software that is used by schools to track online student progress, that after the shutdown, online learning decreased in affluent schools by something like 30% but in poorer schools, the decline was 70%, so her case is that online learning will affect those people from poorer schools much more.
The entire interview is here. If you’ve been reading this thread, there’s not a lot new here. They talk about some flexible approaches that school districts could take but they doubt that the districts will. The opening quote is about her opinion that schools should be the first to open and the last to close, taking precedence over beaches, bars and restaurants.
Exactly correct. Each district by its own realities.
Arizona is way Red. 33/100K and likely undercounting given high positivity rates. By the guideline’s death rate hack they’d put them at a likely real rate of over 90/100K. Red starts at 25.
More so those places that cannot open schools at this point, like Arizona, should be shutting down across the board . School closure would only be effective as part of that layered response. Not opening schools in limited manners with mitigation but having retail and restaurants open with those rates would be silly, like wearing gloves that you rub your eyes and nose with it sometimes makes people feel like they are doing something but really isn’t. Like trying to fill up the ocean by pissing at the shore.
H&R we’ve covered that “evidence to the contrary” before and yes it shows that the very few symptomatic children found as primary cases in South Korea (they were able to find 43 of them in the whole country) seemed to spread it as effectively as adults did in close household contact circumstances. Do you think that informs about the infectivity of the majority persistently asymptomatic older children? Clearly yes a symptomatic older child is capable of transmission … I’d extrapolate to a pre-symptomatic one. Hence more caution is indicated than with younger children.
As for the Georgia overnight camp:
a. Lots of overnight camps have been running. Personally I am surprised that this is the only one with an identified outbreak (of mostly asymptomatic infections). To me the fact that so many of them have been running and this is the only one so far reporting an outbreak is the surprising thing.
b. Circumstance specifically was a counselor who became ill upon arrival in a crowded camp in which kids were not masked and young adult counselors had been told to, with lots of camp singing and chanting in crowded often closed conditions.
c. No way to know how much spread was counselors to kids and how much between kids. MIGHT have been kid to kid to some degree or another. MIGHT haver been superspreader counselor spreading to many kids. Can’t say one way or the other. Might. Might not. It really does not inform unfortunately.
d. Is this crowded, close, unmasked, chanting and loud singing by kids and young adults, kids all sleeping together in poorly ventilated cabins, circumstance very informative to you about controlled classroom conditions?
I don’t have time this minute to listen to a podcast but the bits you quote are what I have heard elsewhere. Yes closures will increase inequities, hurting all but poorer schools worse and the more affluent will have the means to recover faster. 100% agree that “that schools should be the first to open and the last to close, taking precedence over beaches, bars and restaurants.”