Even as we take significant steps to distance ourselves from one another to “flatten the curve” of the coronavirus pandemic, one of the hardest decisions has been whether to close schools.
There are strong arguments on both sides.
The case for shutting down schools
The biggest concern of many experts is that if we get too many infections too fast, the number of sick people could overwhelm the system’s capacity to care for them. By slowing transmission in the population, we flatten the curve, and keep the number of people sick at any one time at a manageable number.
Adults can be given instructions on how to prevent person-to-person transmission, and can be relied upon to follow those instructions to varying degrees, but it’s almost impossible to get children, especially younger ones, to do so. If you have a child, you most likely rolled your eyes if you read my recent article about the importance of getting children to wash their hands rigorously, cough into their elbows only, and not touch their face.
Further, the school environment is well suited to spread disease. Students are often packed into small classrooms, where it’s impossible to sit six feet apart. They mingle and form other similar groups by changing rooms to go to different classes. They are put into one large room to eat together, sitting side by side.
It’s not just children that we need to worry about. Plenty of adults work in schools: teachers, janitors, food preparation workers and more. They’re all being put at risk by keeping schools open. Arguably they’re more at risk than many other workers at businesses that have already been shut down.
Closing schools can make a big difference in flattening the curve, evidence from past epidemics shows. A study in Nature in 2006 that modeled an influenza outbreak found that closing school during the peak of a pandemic could reduce the peak attack rate, or speed of spread, by 40 percent. Another study in 2016 in BMC Infectious Diseases found that, based on the H1N1 pandemic of 2009, closing schools could reduce the attack rate up to 25 percent and the peak weekly incidence, or rate of new cases, by more than 50 percent.
Even the Spanish flu pandemic of 1918-1919 provides some data. Comparing cities that took action with those that did not, researchers reported in a study in JAMA in 2007 that measures like school closings contributed to significant reductions in the peak death rate as well as overall deaths.
China and South Korea closed all their schools, and they’re seeing a significant flattening of the curve.
The case against shutting down schools
Children are a clear and present danger when it comes to influenza, and almost all of the research cited so far here is based on that. We don’t know whether the studies necessarily apply to coronavirus.
There is also the obvious downside of disruptions to education. Some schools can move to online learning, but not all are prepared. Not all students have access to the internet at home, let alone computers or devices with which they can actively participate in e-learning.
Missing half a semester, which is what many schools are looking at, is a significant hit to education. It will take many students a lot of time and effort to catch up.
There are also effects related to child care. Something like 1.5 million students are homeless in the U.S. For some, school is the only safe space. Many more can’t just stay at home alone. Unless parents can also work from home, and many cannot, children will either be left unsupervised or watched by others, perhaps grandparents. That is possibly the worst outcome because older people are at highest risk of serious illness and death.
We are also facing a potential health care worker shortage. If such workers are forced to skip work to take care of their children, that’s a problem.
Finally, there’s food. Almost 30 million children in America depend on the school lunch program. Almost 15 million depend on it for breakfast, too. If schools are closed with no steps taken to continue to feed them, they will go hungry.
All of these considerations made the decision to shut New York City’s schools highly contentious.
It’s not as if schools must close. They could change their routines. They could commit to increased physical distancing; more and regular hand washing; daily screening; and increased cleaning. Singapore didn’t close schools, and officials there are achieving remarkable success at limiting transmission.
A growing consensus
More and more schools have chosen to close in the past few days, reflecting a growing consensus that the benefits of closings outweigh the harms, especially since many of the harms can be mitigated.
A transition to e-learning is possible. So is making sure that parents receive paid sick leave so that children aren’t left with grandparents. It’s possible to provide child care to health workers or those at risk (indeed, many places are doing this). And it’s possible to make sure that food can be delivered or picked up by families that need it.
Many of the changes to make school safer are harder to do, such as cutting class sizes. Short of major structural renovations, we can’t prevent transmission from child to child, and then to adults, if schools remain open. We also can’t currently test the way we’d need to in order to target students who need to be quarantined at home.
The immediate goal is to flatten the curve so that the peak infection rate stays manageable. With better testing and screening, it’s possible to imagine keeping schools open and still protecting families. Failing that, and we in the U.S. have been failing so far, school closures and significant physical distancing are starting to look like the best bet.