WChicken state officials were deciding whether to close their schools back in March, the evidence they had to work with was slim. They knew that children could easily catch and spread the flu – and that holidays and school closures slowly helped its spread. But they weren’t sure if the same was true for Covid-19.
Now, a study published Wednesday in the Journal of the American Medical Association shows that the closure of all state schools was associated with a drastic reduction in both Covid-19 and in deaths. And the point at which officials made that call was important: Those states that adopted the policy while few people were testing positive saw a correlated fixed case curve.
“It̵7;s a beautiful study. It’s clear that coinciding with school closures, the numbers have improved,” said Helen Boucher, head of the geographic medicine and infectious diseases division at Tufts Medical Center, which was not involved in the research. . But she noted that we need to be careful that we draw very broad conclusions from one root of a closure strategy: “School closures did not happen in a vacuum.”
It is still unclear how likely children of different ages will get and pass on the virus, making it difficult to evoke the reasons why school closures may have helped change the outbreak.
“It’s quite possible – and likely – that people will change their behavior because they thought,‘ Oh my goodness, there’s this new virus and it’s so awesome that they’re closing schools, ’” she said. pediatrician Katherine Auger, associate president of outcomes at Cincinnati Children’s Hospital Medical Center, and the first author of the new paper.
“One thing we can’t let go of is how much the effect was related to the spread of the virus in schools, and the greater change in the community because now parents aren’t going to work,” she added.
The findings come at the heart of much of the school’s reopening. This spring, the Centers for Disease Control and Prevention issued guidelines on the prevention of viral transmission in schools, recommending that students be physically distanced, by placing desks 6 feet away. away, for example. For some schools, this seemed impossible, given the number of children enrolled and the architecture of the classrooms. This meant that at least some learning was done online, which contradicted the president’s concept – and for many risky, public health experts – of reopening ideas.
After both Trump and Vice President Mike Pence criticized the guidelines and urged schools to reopen fully, the CDC issued revised guidelines, sparking fears that federal public health experts thought. under political pressure.
The new study shows no cause and effect, only an association between school closures and a number of cases in an area. The authors have warned that they also cannot provide a blanket recipe for autumn.
“Our study was done at a time when schools weren’t doing things like masking,” Auger explained. “It’s really impossible to project the old way of schooling into the future of schools, assuming they’ll be following expert guidelines.”
For her, the work supports the “flexible and nimble” approach supported by the American Academy of Pediatrics. That children physically present in schools not only spur academic learning and the essential cognitive and emotional development that comes from social interaction, the organization stated. It also allows them to receive a large number of services, from free meals to adult eyes that can pick up signs of abuse at home.
But those benefits must be weighed against the risks of Covid-19 for children, parents, grandparents, and teachers – a threat to be better kept under control by the rapid testing that most of the country cannot provide.
In the new study, Auger and her team compared reality – in which the 50 states closed schools in March – to a computer model in which everything else remained the same while the schools remained open. They calculated the time it took to transmit acquired infections in schools, and for those patients to then appear in hospitals and for a fraction of them to die.
Their projection found that, if schools remained open, there could be approximately 424 more coronavirus infections and 13 more deaths per 100,000 residents during the 26 days.
It extrapolates that for the American population, and the country could have seen as many as 1.37 million more cases and 40,600 more deaths, explained Samir Shah, the director of hospital medicine at the Cincinnati Children’s Medical Center and one of the authors of the paper.
“These numbers seem ridiculously high and it’s mind-boggling to think these numbers are just … in the first several weeks,” Shah said. “That’s bonkers.” He warned, however, that those numbers should be taken with a grain of salt. While their statistical model tries to indicate the impact of keeping schools open or closed, the method in fact cannot establish any kind of causal relationship.
The authors realized that their estimate of how long it would take an infection collected in a school to change into a symptomatic case of Covid-19 could be turned off, and asked if this could influence their outcomes. When they changed these time periods, however, they still found a significant correlation between school closures and a decrease in carriage and mortality.
To Steffanie Strathdee, associate dean of global health at the University of California, San Diego, this was what made this study compelling. “This study was taking imperfect data but is doing a very elegant analysis,” she said. “If we are wrong, what is the other extreme, will we change the results? If these children infected parents, but took a little longer or a little shorter, what is?”
The bottom line, she said, was that strategies such as school closures seem to make a difference when it comes to the risks of Covid-19.
Auger’s team also analyzed whether school closure time was correlated to a change in cases and deaths. “States that closed schools before their Covid numbers had the biggest effect,” she said.
While children appear to be less likely to get sick than adults, there is some evidence that schools may be important sites of coronavirus transmission. Younger children seem less likely to pass the virus than teens and teens, although more research is needed to fully understand the various risks.
Meanwhile, Shah, warned that people reading the study should not forget about the risks of school interruptions. “We can quantify the risk of Covid. It’s much harder to quantify the risk of being absent from school for a long period of time,” he said.
Both he and Auger emphasized the importance of strategies for adapting to the needs and risks of coronavirus within each family and community, and that better, faster testing would allow for a safer strategy with the school. . “It’s a real challenge, and I think our study is one of the very important elements of the puzzle in the way we think about it,” Shah said.