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In less than three weeks, students across North Carolina will return to school — although they may not actually be at school.
Parents and teachers alike face a choice with no good answers during the coronavirus pandemic.
Sending students to school comes with a risk of spreading the new coronavirus to people who are more likely to get seriously ill or die from the virus. Teachers and other school staff are also worried that they might contract COVID-19 while working and bring it home to their families.
These two problems with divergent solutions are coming to a head in boardrooms and living rooms throughout the state.
With most American schools closed as the pandemic took hold in the United States earlier this year, there’s little data on how the virus spreads in a school setting. But data elsewhere provides some guidance.
Recent research out of South Korea, where schools largely remained open as the virus spread, indicates that young children who did catch the virus were far more likely to contract it from another household member than to catch it at school and bring it home to family members.
Multiple studies show younger children are less likely to catch COVID-19, less likely to spread it to others and are far less sick when they do catch it.
Returning to in-person classes definitely involves increased risk. But experts say the risk can be mitigated substantially if students and staff wear masks properly and maintain physical distance, even in areas with moderate spread of the virus.
Who faces risk from in-person learning?
Who is at risk and who is not? Many people are asking those questions as the deadline to start school rapidly approaches.
More than half of North Carolinians have a health condition that makes them more susceptible to injury or death from COVID-19 — and this includes teachers and other school staff. For some, that’s advanced age. For others, it’s a health condition like high blood pressure or diabetes. For many in North Carolina, obesity puts them in the high-risk category.
However, strong evidence exists over many years showing that children — especially those in the elementary grades — learn best when attending school in person.
Children learn how to lead and socialize at school — and that relies on those unscripted, in-person moments with peers and teachers, said Dr. Elizabeth Cuervo Tilson, the state health director and chief medical officer with the N.C. Department of Health and Human Services.
“Humans are wired to interact with humans,” Tilson said.
“That is how, especially younger children, learn the best. … It is not just the verbal. It’s all the social cues, the body cues. That’s how we interact the best. And that’s the most healthy interaction.”
The benefits to in-person schooling are many, and such learning is necessary for the healthy development of young minds especially, said Eric Davis, chairman of the state Board of Education.
For teachers who fear a return to the classroom could mean serious injury or death for them or their loved ones, Davis said he and others are reviewing state policy with the state Office of Human Resources to review state and Board of Education policy.
“We’re trying to find the right balance between caring for our staff who themselves have their own condition, may be vulnerable or who are caring for family members in their own home who are vulnerable, while also making sure we have appropriate staff to teach and support our students,” Davis said.
“We certainly want to keep staff who are in those situations. We want to help keep them healthy. But we also need staff in our schools.”
More than 2-in-3 state residents responding to a recent survey said they were somewhat or very concerned about someone in their home becoming ill from COVID-19.
“This is an enormous time of stress for all of our families; schools are a critical place to provide some of that support,” Tilson said.
Teachers and other staff can also recognize problems and intervene early when they see students face to face, she said, be they family problems, learning disabilities or other troubles a child may face day to day.
Weighing COVID-19 risk of in-person school
Many people are currently weighing the risks.
“We know there’s risk everywhere,” Tilson said. “There is risk with people out in the community, there’s risk outside of the school right now.”
For schools that do have in-person instruction this year, Tilson said they have to follow strict guidelines — fewer students per class to allow for physical distancing and a mandate for everyone to wear masks, for instance.
“The health and safety protocols that we put into place are meant to dramatically reduce risk as much as possible within that school setting,” Tilson said.
Tilson said the risk of spreading coronavirus to another person next to you is about 13%. At a distance of 3 feet, the risk lowers to 2.5%. At 6 feet, the risk of transmission is lower than 1%. Add a face covering, and the risk is lowered by another two-thirds, she said.
“There was a really great case study that the CDC just put out (about) two hairdressers who were working, obviously within 6 feet of their clients,” she said, referring to the national Centers for Disease Control and Prevention.
“Both the hairdressers and the clients were masked, and of the almost 140 clients that they had extended contact with within 6 feet, not a single client tested positive. So, masks really can add a huge amount of protection.”
Growing evidence also indicates that smaller children are not considered primary vectors for spreading COVID-19, and when they do catch it, it’s from another family member.
Family members normally interact with young children far more closely than a teacher does. Family members share more of the same air in a home, whereas classrooms can allow students to be more distant from one another, Tilson said.
Davis said teachers and staff stressing the importance of wearing masks consistently will be critical.
“The first and most obvious challenge will be for staff and our students to wear their mask and to embrace that as a sign of caring for each other,” Davis said.
He spoke with a kindergarten teacher recently who said it would be a challenge to teach her class to wear the masks properly, but Davis added that teachers are “up to the challenge.”
Risks vary by location within North Carolina
Dr. Thomas Tsai, a surgeon and health policy researcher out of the Harvard School of Public Health, likened reducing the risk of catching the coronavirus to the safety measures we take when driving or riding in a car. We wear seat belts, license drivers and buy cars with airbags.
That same comprehensive approach to reducing viral spread — wearing masks, physical distancing and washing hands — is working in other areas of the world.
“You can’t view the schools in isolation from the overall overarching community,” Tsai said. “We need to get students back in school, but the way to do that is to control it in the community. That needs to be very clearly understood.”
The Harvard Global Health Institute recommends opening school to elementary-age students first, followed by middle school and high school, as long as people take precautions to limit viral spread.
Tsai said families with a young child — ages 9 and younger — were less likely to have COVID-19 than families with people ages 15-19, according to recent contact tracing studies out of South Korea.
Harvard Global Health Institute recently published a map that shows the viral spread as a rate per 100,000 and has recommendations to reduce viral spread to zero. Throughout North Carolina, the website says, accelerated viral spread occurred in recent weeks.
“Anybody in these counties with over 25 new cases per 100,000 people, those counties are the tipping point where the pandemic is out of control,” Tsai said.
The counties above that threshold in North Carolina as of late Monday are: Tyrell, Washington, Chowan, Cherokee, Caldwell, Wilson, Montgomery, Gaston, Stanly, McDowell, Robeson, Clay, Northampton, Mecklenburg, Henderson and Duplin.
“In those situations, I think it’s challenging to be able to reduce the rate of transmission adequately,” Tsai added, unless people reliably wear masks and remain physically distant from one another.
Schools in those areas, he said, should consider postponing in-person instruction until community transmission is lower.
He said schools in counties with fewer than 10 new cases per 100,000 should consider reopening schools as an essential public service.
“Those are the communities where you still have community transmission, but you can still gain control that you can still suppress in the community and do adequate testing and contact tracing and do adequate risk reduction through a funnel,” Tsai said.
If there is any good news, it’s that young children are less likely to be infected with COVID-19, are less likely to have significant symptoms and less likely to spread it to others, said Dr. Tom Belhorn, a professor of pediatrics and clinical director of pediatric infectious disease at UNC School of Medicine.
“Multiple studies have confirmed that,” Belhorn said.
Older teenagers, however, transmit the virus much like adults, he said.
Schools need to prioritize keeping adults safe so schools can remain open. Buildings with poor ventilation can be improved by opening windows or having some classes outside if the weather is decent, Belhorn said.
In school districts that do open for in-person instruction, teachers will face a first day of school unlike any they’ve seen before. Like tying their shoes or learning to stand in line, children also will have to be taught how to wear masks.
“I had a 3-year-old who nicely put a mask on her teddy bear,” he said of a recent patient. “She was not wearing one.”
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