The decision to open schools is more than a medical issue.

One of the most frequent requests from readers of this blog is my opinion on opening schools in the fall. I have been reluctant to do this because that decision is based less on medicine and science than on the social contracts education has made between governments, teachers, parents, and students. This dynamic sets up a unique conversation on opening schools that is not consistent even for different schools in the same community. 

Before trying to focus on the scientific and medical issues involved in opening schools, I felt more background needed to be provided on the social and logistic issues involved in opening schools. Today in the New York Times, an Op Ed piece written by two senior physicians and a public health expert from the University of Pennsylvania tries to addresses many of the logistic issues related to opening schools. 

While I might disagree with some of the finer points in the article, it does a very good job at giving an overview of the complexity of the logistics. It looks not just at classrooms, but also at the many activities involved in the school day. The article presents a table (shown below) that outlines the major activities of the school day and gives various options that might reduce the risk involved in each activity. 

The authors feel that no school can open safely in a community with significant numbers of COVID-19 cases. They set their threshold at fewer than 75 confirmed cases per 100,000 people cumulatively over the previous seven days and a COVID-19 positive test rate below 5 percent. That currently eliminates 38 states from the possibility of opening schools. Even if one accepts this criteria, they point out that mathematically about one in 1,300 people could return to school with a case of the coronavirus, meaning in a school of 350 students, faculty and staff would have a one-in-four chance of encountering an individual with Covid-19.

I think it’s important to read this article to gather a perspective on the complexity of school opening. To be quite honest, I’m not sure that any school system could actually address all of the issues raised by these authors and still be able to open this fall. Importantly, there has to be some type of decision on what level of risk parents, teachers, and administrators are willing to tolerate, and the implications for COVID-19 infections in the larger community. This risk decision would likely be different in each community and vary dependent on the status of COVID-19 infections currently present in a community. 

In future blog posts I can discuss the scientific and medical issues related to COVID-19 infection and school children. I can also address transmission of the virus within the school environment and the likelihood of either children or teachers acquiring a school derived COVID-19 infection given the COVID-19 environment within a community. 

Before we discuss any of those issues, however, I think it’s important to understand the complexity of the environment in schools and why no medical opinion could resolve the issues facing these communities.