• Russell Hill

An upcoming decision on schools

“Back to School” usually signals relief for parents, but dismay for teens and younger children. Traditionally, it marks the end of lazy summer days and the beginning of a more regimented, scheduled lifestyle. But not this year. This year, it is a time of significant uncertainty for parents and children, healthcare providers and policy makers, school administrators and teachers. Like other activities and events, COVID-19 has upended seemingly simple and accepted practices, stirred more debates, and created quandaries for parents, physicians, and policy makers about whether reopening schools is the right thing to do or not.

What’s to be done? When adults need to work to provide for their families, they may have few options for either school or caregivers--or worry that any option could put their children at risk. COVID-19, once thought to strike mostly those over 65 or persons with compromised health conditions, now seems to sicken young adults and children as well. And even if they are not ill themselves, asymptomatic children can be carriers who infect other unsuspecting parents, grandparents, or neighbors. 

Parents, schools and communities are faced with seemingly impossible choices. Hastily constructed school distance learning plans were implemented in the Spring with hopes that Summer and Fall COVID-19 infections would be controlled. Are their plans better today? Areas in the state and the country that appeared unscathed previously, now face critical health threats.  Have some locations become what infectious disease experts are calling “superspreaders”? Are schools likely to become superspreaders if reopened? The answer is “we don’t know.” There is so much about this virus that we simply don’t know at this point. 

Currently, school districts in Nashville and elsewhere around the state have decided to offer only virtual courses at least until Labor Day.  Other school districts are offering hybrid, remote, and traditional learning environments.  Given the tradeoffs, what will work best? Given what is unknown about COVID-19 and its transmission and treatment, what’s a reasonable course of action for schools and parents in eastern Tennessee to keep children safe and still meet educational goals? 

First of all, as a physician, it remains unclear how staggered starts, small groups, and separation will limit transmission. For instance, recently a rural Missouri summer camp that took all of the expected precautions--masks, social distancing, temperature checks--still had 82 young campers become infected with COVID-19 after only a few days and the entire camp was soon closed. 

Second, can we expect elementary school children to practice social distancing at all times, wear a mask at all times, and wash their hands each time they touch their face while at school? As a father of four children ages 4 to 10, this seems unlikely. Despite stressing these health habits, my kids forget. It only takes a few “forgetful children” for the virus to spread. Thankfully, children are the least likely to be affected severely by this infection.  However, they may serve as a vector by increasing the risk to parents, grandparents, and neighbors.

Across the country, state and local leaders grapple with reopening schools  despite increasing infection rates and with the threat of losing federal funding. Ultimately when the option remains available the decision falls back to families. Just how much that puts children at risk is still widely unknown.  The percentage of children that are asymptomatic carriers is thought to be high, however exact numbers are difficult to identify. Asymptomatic children are also very unlikely to be tested.

The bigger questions of how this affects teachers and administrators at schools remain unanswered as well.  In some school districts around the country, teachers are suing school districts to prevent schools from reopening too soon. The CDC has established some broad guidelines that advise schools not to reopen when “infection rates” in an area are in a “red zone.” Currently, Hawkins, Greene, Carter, Sullivan, and Washington counties are all in the “red zone.” 

While some European countries have successfully implemented rules when sending children back to school, it is too soon to say how effective these rules actually are in preventing the spread of COVID-19.  In Korea, despite strict social isolation policies, required masks, and available hand sanitizer;  infection rates have recently surged and consequently delayed  school reopenings.

A group of doctors, health care workers, and teachers in Tennessee have recently formed a coalition called ProtectMy Care and cautioned against reopening schools too soon. Dr. Amy Gordon Bono, a primary care physician, spoke on behalf of the group at a July 22 press conference and offered this perspective:

“We should not rush to reopen our schools without a cautious and comprehensive community plan to reduce the spread of the coronavirus. More than half of Tennessee counties have an unacceptable rate of coronavirus transmission. Our state is now experiencing the worst we have experienced under the coronavirus reopen schools is insane and irresponsible.”

National and local leaders fearing economic losses should evaluate carefully their priorities. Public health guidelines should protect the innocent and most vulnerable  including our children, their teachers, and their caregivers.  In medicine, our primary goal is to save lives and prevent or end illness. While it could be argued that at times that doctors do this to a fault, it is the historic, prevailing public opinion. Let’s not jettison it too soon or too quickly. While we would all like to get back to normal as soon as possible, reopening schools too soon is both bad medicine and risky public health policy.

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