Letter to the Editor: New Support for In-Person Learning from United Nations and Brown University School of Public Health

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Thank you to Bill Knox, Abigail Hafer, Anne Caron, Dave Caron, Clare Shawcross, Andrew Van Praagh, and Catherine Van Praagh for reaching out with published references relating to statements I have made at BoH meetings about fully opening Bedford schools.  I have been enormously frustrated by the lack of public dialogue — and review of published, peer-reviewed data — in the decisions being made for the hundreds of Bedford school children being deprived of the in-person education we all value so highly.

Relative to my statement:  “Schools can stay open perfectly safely in communities with very high COVID numbers ” new evidence was reported in yesterday’s Globe report about Massachusetts budgeting millions of dollars for SARS-CoV-2 testing in schools:  “The effort follows the lead of a handful of districts, including Watertown, Wellesley, and Salem, which have been routinely testing students and staff since the fall.  Watertown has administered more than 6,400 tests, which as of Thursday had uncovered nine positive cases among students and five among staff.  That’s very few cases in a community where the two-week positivity rate is 5.1 percent, putting the community in the red.”   This information not only supports my view that surveillance testing is the best, and probably most cost-effective, safety approach for schools to take, it highlights the now global experience that schools are not fueling the pandemic, and education of children should receive the high priority it deserves
A United Nations University report, Nov 2020, summarizes “…the current evidence to support physical distancing in schools”  https://collections.unu.edu/eserv/UNU:7856/n2020-11-19_IIGH_PB_Physical_Distancing_at_School_v2.pdf   “School closures related to COVID-19 have affected nearly 1.6 billion (90%) children and adolescents worldwide.  Even where remote learning has been provided, the physical closure of schools has demonstrated a range of negative social and health consequences for children and adolescents, affected learning outcomes, wellbeing, and exacerbated inequities.” The report is replete with references from health protection agencies worldwide, with many countries suggesting 4.5-foot social distancing for older grades, none for younger grades.

An even more recent report from Brown University School of Public Health, December 2020, “Schools and the Path to Zero:  Strategies for Pandemic Resilience in the Face of High Community Spread”  https://globalepidemics.org/2020/12/18/schools-and-the-path-to-zero-strategies-for-pandemic-resilience-in-the-face-of-high-community-spread/
provides even stronger, newer evidence for keeping schools open in all communities:  “In July, we published guidance for school leaders making decisions about school re-openings that offered a tiered structure for thinking about risk at different levels of community spread. We recommended that schools be closed once the average daily case rate rose above 25 cases/100,000 people, at the county level. Since July, our scientific understanding of COVID has increased significantly, as has our understanding of degrees of risk in schools, and we can now recommend that schools be open even at the very high levels of spread we are now seeing, provided that they strictly implement strategies of infection control. Evidence supports the view that student, staff, and educator risk can all be brought to acceptably minimal levels with robust infection control practices when implemented in a collaborative and transparent way among all stakeholders, including educators and other school personnel, administrators and district leaders, families, and students.”   The report goes on to recommend 3-foot social distancing for lower grades, and 6 foot for staff and upper grades.

Since this is not my first pandemic, (in 1985 I began studying transmission of HIV infection and advocating for HIV testing) I have anticipated some of the confusion associated with a new virus invading our species, including the political overtones that ensue, and realize that, in the end, only facts, not opinion, should prevail.  The all important decisions about school closures and/or classroom quarantines should be made with input from all stakeholders, including parents, teachers, health experts and elected officials.  The circumstances surrounding the two-week closure of Bedford High School that occurred in late October, 2020, should be publicly reviewed to determine if that same decision would be made now with additional understanding about infection risks within schools.

The first reference cited in the Knox et al., Letter to the Editor is to a fall CDC guidance document  (https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/indicators.html), that begins with the statement:  “It is critical for schools to open as safely and as quickly as possible for in-person learning.”   The CDC guidance document includes a table of community indicators as an estimate of the risk of transmission of SARS-CoV-2 infection in schools.  The goal of the table is to allow school decision-makers to appropriately prepare for the maximum risks of “in-school” disease transmission so the schools can remain open.  “Expecting and planning for the occurrence of one or more cases of COVID-19 in schools can help respond immediately to mitigate the impact to allow the school to remain open for in-person learning.”    Under “Purpose of Indicators” , the CDC explains:  “The two measures of community burden (positive SARS-CoV-2 tests/100,000 persons in 14 days) should be used to assess the incidence and spread of SARS-CoV-2 in the surrounding community (e.g. county) and not in the schools themselvesCurrently, CDC does not recommend using these core indicators as measures of burden within the school.”  Therefore, the goal of this CDC document is to help school decision-makers plan responses to infected students/teachers/staff so schools are not shut down, assuming community infection metrics could be “worst-case scenarios.”

The next cited reference in the Knox, et al., Letter is to DESE guidance is from last summer, and their guidance has changed multiple times since then.  My conversation with a DESE administrator last week confirmed they now believe fully opening schools for in-person learning is critically important, and are hoping that SARS-CoV-2 testing options will provide the necessary safety to staff and parents that have been demanding 6-foot distancing protocols.

The National Academies of Science July 2020 report cited in the Knox, et al. Letter was written last spring, before useful school experience data was available.

The European Center for Disease Prevention and Control (ECDC) references cited in the Letter (https://www.ecdc.europa.eu/sites/default/files/documents/COVID-19-in-children-and-the-role-of-school-settings-in-transmission-first-update_0.pdf) states:

“Key messages•    There is a general consensus that the decision to close schools to control the COVID-19 pandemic should be used as a last resort. The negative physical, mental health, and educational impact of proactive school closures on children, as well as the economic impact on society more broadly, would likely outweigh the benefits.  •In surveillance data, among childhood COVID-19 cases, children between 1-18 years of age have lower rates of hospitalisation and death than do all other age groups.  •School closures can contribute to a reduction in SARS-CoV-2 transmission, but by themselves are insufficient to prevent community transmission of COVID-19 in the absence of other non-pharmaceutical interventions such as restrictions on mass gathering.”

And lastly, the Lancet article quoted in the Knox et al., Letter (https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30882-3/fulltext) describes data collected from several school districts in England early last summer, before more robust data were available.  The article states:  “Rates of SARS-CoV-2 infection and outbreaks were very low across all educational settings… Staff had higher rates of individual SARS-CoV-2 infection and outbreaks than students.”  It goes on to point out the near absence of student to student spread in their data set.

Thank you again to Bill Knox and colleagues for public dialogue about reports and data relative to the pandemic we are all struggling through.  Collective, collegial public dialogue that involves all stakeholders, including elected officials, a characteristic of Bedford Town Government for many, many years, will result in far better decisions for Bedford’s schoolchildren than decisions made without public input.

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