Thoughts on School Reopening

Hello, friends and families…!

In this blog entry I will NOT tell you if it is OK for your child to return to school for remote, in-person, or hybrid learning. Any article that gives you specific advice about this may be well intentioned, but will rarely apply to your individual situation, and will be based on information that is going to be out of date by the time you read it.

I AM, however, going to review some important points to keep in mind when you juggle the pros and cons of any individual decision that you make for your family, and I think that will be helpful. Just like deciding about surgery, it will ALWAYS come down to weighing the risks and benefits of any given path. When I’m helping parents decide about an operation, I often hear “we just want what’s best for our child”. But it’s very rare that a situation is clear enough so that there is only one reasonable choice. The decision almost always comes down to balancing personal risk tolerance and a wide range of intangibles. That’s why it’s not usually my job to tell my families WHAT to do, but to help them understand the tradeoffs so that they can make those decisions themselves.

With that said, here are some things to keep in mind when you are making a decision about school in the era of COVID-19.

1) I probably don’t have to tell you this, but any official recommendation, government regulation or organizational decision about school reopening is NOT only considering the medical aspects of the situation. Economic, political, parenting, regional and developmental concerns are always going to be a big part of what you are told, and that’s reasonable. From a purely medical point of view, the “safest” thing to do would for everyone to stay in full lockdown until a vaccine arrives, but virtually no one is seriously recommending that. So don’t discount those factors, but be aware of their impact and relative importance.

2) Most people making these decisions are working in good faith, and trying to get the best possible outcome. It’s easy to vilify school administrators and other parents by assuming the worst underlying motives. But the majority of people who actually have the responsibility of making community decisions are trying to strike the right balance. Give them the benefit of the doubt, hear them out and consider the tradeoffs that they are dealing with before forming your own opinions. Be open to new strategies to minimize school risks. For example, one such idea is pooled saliva testing which is to be used by the SUNY system. This is much cheaper and less invasive than traditional testing methods, and it will allow schools to rapidly shut down new outbreaks before they spread widely in the community.


3) There are a large number of controls - administrative, infrastructure / engineering, epidemiological and personal - that can be incorporated into an in-person reopening plan. It’s beyond the scope of this email to discuss them all, but here is a good summary. Not every school needs to adopt every possible control, but this should give you an idea about the kind of things that you might be asked to consider. Try to understand the goals that are reasonable for your child's particular situation, taking into account the time, place and current community infection rates. Keep this passage in mind:

“Given the uncertainty, reliance on an effective vaccine to solve the return-to-school problem is unrealistic, and other strategies that may at first glance seem too difficult or too expensive must be developed and implemented. If the position adopted by society is: ‘not until it is completely safe,’ then we have to recognize that the kindergarteners who left their elementary schools in March of 2020 may never see the inside of those buildings again. This is not feasible. Thus, we really need to shift the conversation from ‘perfectly safe’ and ‘only if there is vaccine’ to ‘how can we do this as safely as possible?’ and ‘what resources do we need in order to achieve this common goal?’“

4) The people who know more about COVID-19 than anyone else in the world never heard of it 8 months ago. This is a new virus, and we are learning about it daily. Beware of anyone who is absolutely certain, who doesn’t qualify their advice with words like “as best as we know right now”, or who makes definitive statements about the long term effects of infection. Watch out for people trying to score cheap political points by comparing someone’s prior and current statements, and claiming “hypocrisy” or “flip-flopping”. For something new like this, it is always important to follow current developments and continually refine policy and practices. Don’t be like the guy that Stephen Colbert was describing when he said: "He believes the same thing Wednesday that he believed on Monday, no matter what happened on Tuesday.”

5) Having accurate, current data about the number of local infections is CRUCIAL in running any sort of school plan, and that has to be monitored regularly. Plans for in-person education can change overnight - you can see that with the early opening and reclosing of several college campuses. As schools open, we are getting new data about the rate of infection in children, which must be watched closely as this process continues. Some recent information suggests that infection rates are actually rising faster in children than in adults. However, this data set covers all patients under ager 18. There is other evidence that toddlers have exceptionally low infection rates, despite being - as this article describes them - "mask licking germ bombs".

6) The American Academy of Pediatrics has a document outlining its recommendation for school reopening. In general, they recognize that there are serious downsides to remote learning including the challenges of effective teaching, the loss of the social aspects of school, and the inherent inequality of online classes, especially for underserved communities. So if in-person education can be done safely, that's better for kids. But they also stress the point that there is no one single answer for all times and places. Increasing evidence that children can be asymptomatic for weeks and spread the virus has to be incorporated into any school plan. While the AAP’s initial recommendations strongly advocated for in-person classes, these recommendations have been revised as it has become clear that more study is needed. This passage is from these guidelines:

“To be able to open schools safely, it is vitally important that communities take all necessary measures to limit the spread of the SARS-CoV-2. School policies must be flexible and nimble in responding to new information, and administrators must be willing to refine approaches when specific policies are not working…the AAP strongly advocates that all policy considerations for the coming school year should start with a goal of having students physically present in school. Unfortunately, in many parts of the United States, there is currently uncontrolled spread of SARS-CoV-2. Although the AAP strongly advocates for in-person learning for the coming school year, the current widespread circulation of the virus will not permit in-person learning to be safely accomplished in many jurisdictions.”


7) As parents, we are used to meticulously planning our children's lives far into the future. COVID-19 has shown us again and again that this is not always possible. Of course, we still need to anticipate challenges and make decisions, but we need to be much more comfortable with contingencies and accept the fact that things can change rapidly due to forces beyond our control. As the old joke goes: "How do you make God laugh? Tell him your plans."

8) The mitigation practices that have helped us get the virus under control in New York City over the past few months are vital, and need to be continued, especially as schools reopen and socialization outside of school increases. Masks work. Hand hygiene works. Social distancing works. Our overall rate of positive test results has recently stayed around or below 1%.

Unfortunately, there is no book that will tell you exactly what to do in every situation - we all use judgement in deciding what to do when. Masks work, but most people don't wear them inside with their immediate family members who are taking precautions when away from home, or when eating at an outdoor restaurant with adequate separation from other tables. On the other hand, for example, we might wear them when outside with a more distant family member who has been traveling from areas with a higher infection rate.

Even if your family remains vigilant, if your child spends a significant amount of time indoors and/or without masks with someone from another family who isn’t so careful, you can reverse all of those hard won gains. Ideally, your child's social life will be built around families that share your concerns and attitudes, so that you can safely maintain the socialization that is so vital for healthy cognitive and emotional development.

As infection rates have fallen, so has our attention to detail. The virus isn’t gone, and the cold weather will probably make transmission more likely. Stay strong, watch the numbers, listen with an open mind, and take care of each other.

And as always, I’m happy to chat or email with any of you about your individual concerns.

Best,

Mike Rothschild