William Miller, MD
On Reopening Schools
Updated: Jul 20, 2021
President Joe Biden is requesting that Congress approve over $100 billion in the most recent COVID stimulus package to go towards reopening schools because it is important to our country. We can’t talk about reopening schools, however, without a discussion about safety.
We can’t talk about safety without recognizing that judging something to be “safe” is always a balance between the risks involved and the expected benefits to be gained. It is important to acknowledge that almost every activity we undertake carries some risks. Climbing a ladder to prune that apple tree in the front yard carries the risk of a fall that could result in serious injury and potentially life long debilitation. The simple act of driving to work along Highway 1 carries the potential risk of a fatal car accident. We accept these risks, which are real, without even hesitating to think about them because we are used to these activities and have grown comfortable with them. Without realizing it, we are weighing the benefits against the risks.
COVID and the risks associated with it, however, are new to our experience. Perhaps it doesn’t help that we are constantly bombarded with news about the pandemic and sensational stories of hospitals overflowing with COVID cases or reports of who the most recent celebrity is to get infected. I believe the combination of the newness along with the constant barrage from social media and news outlets has led us to overestimate the risks. To be clear, I am not saying that COVID is something we should dismiss. However, keeping things in perspective will help us make important decisions during a difficult time.
Here are some statistics that are helpful in assessing our individual risk of getting infected and if infected our risk of getting ill. Epidemiology studies have shown that the chance of transmission is only about 30% if a person is within 6 feet of an infected person for at least 15 minutes or more and without wearing masks. While this is significant from the perspective of transmission through a community, it also tells us that most people (70%) with an unmasked exposure will not become infected. If infected, most people (80%) never develop symptoms or if they do the symptoms are mild. The remaining 20% do get sick with about 1/3 of those requiring medical treatment including hospitalization. The overall mortality rate is about 2-4%.
Prevention strategies do work very well at reducing risk. Wearing a mask, frequent hand washing and social distancing have been proven to be effective in dramatically reducing the spread of this disease and is the cornerstone of plans to reopen schools. Limiting class sizes helps increase distancing between students and air purification and circulation methods add an additional margin of risk reduction.
Young children who are below the age of puberty have been found to be less contagious when infected due to a lower amount of the receptor on their cells that the virus exploits to gain entry. As a result, initial reopening is planned for kindergarten through 6th grade. Once overall community infection rates are lower, then reopening will be extended through high school.
Lastly, as a means of moving towards safer reopening of schools, teachers and other school employees have been prioritized in receiving the COVID vaccine above those at highest risk in our community, the group of people 75 years old and above. As a result, teachers who accepted this prioritized vaccination are expected to participate in reopening of schools.
On the other hand, there are risks of not reopening that must also be considered. Numerous studies have already shown that students are not doing as well with distance learning and disadvantaged families where parents may not be as tech-savvy are amongst the highest failure rates. Many families depend on children going to school for nutritious meals and for childcare to allow parents to go to work so that bills can be paid. Lastly, there has been a troubling upswing in teenage suicides that is being attributed to the isolation that students are experiencing with distance learning.
Jason Morse is the Superintendent for the Mendocino Unified School District and he expressed his concerns to me about the impact that school closure is having on children. “I see it in my own kids as well as the other children in our district. They are really struggling and not just with the challenges of using the internet for schooling, but because of the sense of isolation they are experiencing,” Morse said. “I am more worried about the social and mental wellbeing of our students than I am about anything else,” he added.
Both Ft. Bragg and Mendocino Unified School Districts are closely following the reopening guidelines from the California Department of Public Health and the Mendocino County Health Department. The School Board for Ft. Bragg will be holding a meeting on February 8th to discuss the possible reopening on February 22nd of grades kindergarten through 6th. The Mendocino School Board is considering April 1st to reopen.
Ft. Bragg got an early start on the steps of preparation for reopening. Becky Walker, Superintendent of Ft. Bragg Unified School District told me, “We fully recognize that school closures have impacted our students and community negatively. We are excited to reopen our schools as soon as safely possible. Our employees will receive their second dose of the Moderna vaccine on February 12. We hope to begin reopening grades K to 6 on February 22nd which will be ten days after our employees' second dose.”
Dr. Andy Coren, Mendocino County Public Health Officer recently put out a new set of health orders around reopening schools and in a press release on January 30th said, “We are now able to start the process of re-opening our schools, due to our efforts as a community to avoid gatherings, wear masks, and maintain social distance.” He went on to praise the cooperation of other local agencies by stating, “In addition to those efforts, we here at Public Health are thrilled that our efforts to vaccinate as many teachers as possible have been successful, with much assistance from the Mendocino County Office of Education, Mendocino County school districts, schools, teachers, staff, parents, community partners, rural clinics and Adventist Health.”
“We are excited about the prospect of having our students on campus once again!” said Walker. “Our schools have been preparing diligently to reopen following all the safety protocols and guidance provided by the health department.”