Coronavirus: Following the herd on school closures
Is the rush to close schools really necessary?
The decision to close all schools last Friday came after the British government switched from a policy of containment and delay to rapid mitigation and suppression. This was executed in accord with a plan that was modified to accommodate the escalating scale of the rate of infection, based upon the modelling undertaken at Imperial College London that was published on 16 March.
Yet, according to the model, school closures had the least impact on the spread of infection and a marginal impact when combined with other measures. The modellers explicitly stated that their interest was not in collateral damage inflicted by widespread interventions, which would profoundly damage the economy and also result in massive “learning loss.”
The speed and scale of the UK response differs, to varying degrees, from approaches elsewhere. But the clearest contrast is with the localised responses in the USA, where no coherent and consistent message has emerged from the White House “coronavirus task force.”
The voice of the administration has been infectious disease expert Dr Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases (NIAID), who was brave enough to contradict President Trump publicly and often. However, Dr Fauci has been less of a presence in recent days, since Trump has begun to pivot to economic measures, informing Fox News that he hopes and expects to see churches packed with worshippers on his favourite day of the year, Easter Sunday.
The new thinking has been inspired in part by a persuasive New York Times op-ed by Dr David Katz, another infectious disease expert with a different perspective to that of Fauci.
Clearly, Katz drew inspiration from the UK’s actions and, as importantly, the Imperial College modelling. However, his recommendations run contrary to the conclusion of that report. He wrote of “herd immunity” and the illogic of sending children and young adults (including his own) home to their older parents and aging grandparents. He has advocated following data closely and moving to isolate and quarantine those who are most likely to suffer severe symptoms, directing resources at them rather than the 98% or more who will suffer moderate symptoms or none at all and will recover fully. In this way, the economy would remain healthy and businesses would be staffed adequately by those who have yet to contract the virus, or have recovered from it, even as those with the virus self-isolated.
Although herd immunity was swiftly disavowed by Boris Johnson’s advisors, there is a growing chorus of voices in the US public health community that highlights its fundamental importance to our ability to recover from this and not succumb to a second wave. These experts have questioned the wisdom of the rush to rapid mitigation or even attempted suppression across the country, which has been led by the state governors, lacking direction from the federal government. A clear message from the Imperial report, widely ignored, is that “introducing interventions too early risks allowing transmission to return once they are lifted (if insufficient herd immunity is developed); it is necessary therefore to balance the timing of introduction with the scale of disruption imposed and the likely period over which the interventions can be maintained.”
A clear message from the Imperial report, widely ignored, is that “introducing interventions too early risks allowing transmission to return once they are lifted”
Which brings us to Larry Hogan, governor of Maryland, who was the first to close all schools in his state following the first confirmed case of community transmission. There have been no exceptions for key workers, including medics. On 25 March, Hogan announced that schools would remain closed for a further four weeks. Teachers have now been instructed to move to a remote learning model.
In neighbouring Virginia, Governor Ralph Northam has announced that schools will not reopen this academic year. Parents have begun to question the rush to close now that they realize how protracted the closures will be. Two weeks into the statewide school closures the figures for infection (and deaths) on 26 March were 426 (4) in Maryland and 397 (9) Virginia. If one adds Washington, D.C., which the two states envelop, the total population for the region is 15 million.
State schools have not, in the past two weeks, been required to release any materials to support parents teaching at home. They are now rushing to provide something. Private schools have, to the contrary, been providing daily updates and instructional content, posting videos and sharing documents, as they look to preserve their right to retain tuition fees. The message from them is, “we don’t expect you to teach your own children.” But clearly they do.
Legislation requires that if school districts provide instruction to some students, they must provide instruction to all students, including those with special needs and learning disabilities. For that reason, Philadelphia schools are offering education to nobody, having concluded that it was just too difficult.
Remote learning works well primarily for gifted and highly motivated students, just as “telehealth” (providing healthcare services remotely) proves most effective for those with anxiety disorders or high-functioning autistic children. Both are largely ineffective for those with more profound cognitive disabilities and, therefore, are a waste of time for those producing content (i.e. teachers and therapists trapped at home with their own kids) and those expected to implement it (i.e. the parents). Schools are also bound to deliver on existing Individualised Education Plans – the US equivalent of the UK’s Education Health and Care Plans (EHCPs). That will prove impossible to achieve remotely.
Meanwhile, new reports and data are published every day on the virus itself. A study by the Singapore Population Health Improvement Centre, published online in The Lancet, has modelled five scenarios for public health interventions in the spread of SARS-CoV-2 (the cause of Covid-19): (a) no intervention; (b) isolation and quarantine for affected people and their families; (c) school closures + (b); (d) workplace distancing + (b); (e) all of the measures, i.e. (b) + (c) + (d). As one would expect, (a) proved least effective and (e) proved most effective at “flattening the curve.”
However, for those now pondering the value of herd immunity, and devising a better plan for the immediate and more distant futures, it is striking that, in line with the Imperial report, school closures are significantly less effective than workplace distancing, and only marginally more useful when combined with quarantine and isolation.
In other words, allowing people to work remotely or carefully while their children are permitted to remain at school, would still slow the spread significantly without killing the economy. None of the crisis public health modelling yet takes account of the long-term damage caused by prolonged school closures.
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