Alex Foster
Foster, M.D., M.P.H, is a pediatrician, epidemiologist and director of a public health training program at the OHSU-PSU School of Public Health. A parent of two Portland Public Schools students, he lives in Portland.
Public health includes the protection and promotion of health and environments that assure healthy living, and it encompasses much more than prevention of coronavirus. That perspective is important to consider in the debate over reopening schools. While containing the spread of COVID-19 is one goal, it must be balanced with the social, emotional and educational needs of children at a critical time in their development.
With the right precautions, Oregon schools should have the flexibility to fully re-open to students this fall.
As the public health science on coronavirus has developed, the data suggest that children who contract COVID-19 are usually not severely sickened and, by extension, may not be major spreaders of the virus to adults. As outlined in the American Academy of Pediatrics’ recently released guidance, the goal for schools should be to have students in school as much as possible. Recent modeling published in Nature Medicine shows a minimal effect on community transmission with physical re-opening of schools – in stark contrast to modeling if this were a flu pandemic. These data show that keeping teachers and staff safe is not at odds with a physical return to school. While precautions are still necessary, the alternative of keeping schools closed may have worse repercussions, yet there seems to be little discussion of this.
Many school districts are talking about – at best – a partial reopening, in which students attend school a couple days a week and engage in distance learning the other days. Unfortunately, partially open schools will unintentionally but systematically perpetuate the achievement disparities that exist in our schools for low-income communities, communities of color and children with special needs. They may lack computers or reliable internet access to engage in distance learning. Meanwhile, families with more resources can hire tutors and are more likely to have the job flexibility to provide greater parental guidance than someone in a lower-paid job. Schools will try their best as they have with addressing food insecurity, but families will still face greater difficulties.
Partially open schools may also have greater implications for women’s careers than men’s careers, given societal norms about who would more likely stay home with kids – a step backward in gender equity. It also forces working families to find additional options for care when students are not in school – potentially private child care or shared arrangements with neighbors or even grandparents. Thus, in a hybrid model of education, children are not just going to one school in a relatively stable class, but two or three environments and cohorts – this has clear downsides to infection control.
School fulfills the social and emotional needs of children. It also provides a critical point of contact for developmental screening, mental health support and child abuse surveillance that are nearly impossible to do virtually.
There is clearly a need to protect teachers and staff, as a significant proportion of teachers are older and may be at increased risk for falling severely ill. Given the emerging data on children, the schools should be relatively low-risk environments, provided hygiene, masks, and physical distancing from other adults are in place, as described in the state’s guidance. Opt-in options could also be considered for in-person teaching to protect those at higher risk.
Oregon’s effort to use science to inform our response to COVID-19 has been laudable. In that mindset, our children and teachers need a revised Ready Schools plan that takes into account the actual risk by age and relaxes the physical space requirements that force the hybrid model. The state should also allow districts to use local COVID-19 community transmission data to inform re-opening, rather than a hybrid model across the state as functionally implicated with current space requirements. While it may seem frightening, fully physically re-opening schools with a focus on promotion of students’ learning while protecting teachers is the best step to take for the greater public health.
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July 19, 2020 at 08:00PM
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