As many school districts across the USA prepare to reopen campuses, some fear classrooms will become the next incubators for large coronavirus outbreaks.
Advocates for resuming school in person, including President Donald Trump, have repeatedly claimed that children pose less of a risk of spreading COVID-19 and that the benefits of returning them to the classroom outweigh the risks of keeping them home.
Such statements have been used by conservatives, as well as many parents, to argue for a prompt reopening of classrooms.
“We know that children get the virus at a far lower rate than any other part of the population,” U.S. Education Secretary Betsy DeVos said during a CNN interview in July. “There’s nothing in the data that suggests that kids being back in school is dangerous to them.”
The evidence suggests otherwise.
About 245,000 youth from birth to 17 have tested positive, according to the latest data from the Centers for Disease Control and Prevention.
Hundreds have transmitted the virus at summer camps and youth programs that have welcomed kids, often with the kinds of hygiene, masking and physical distancing rules proposed by many schools.
More than 300 cases have been linked to state child care facilities in California, 62 in Pennsylvania and 54 in North Carolina, according to data published by those states.
In Georgia, at least 260 people became infected in June at an overnight youth camp where the median age of campers was 12 and staff members 17, according to a CDC report. The first person – a teenage staffer – became sick two days after the first weeklong camp session. Officials started sending campers home the next day and closed the camp by the end of the week.
Test results were available for 344 camp attendees, the CDC reported. Among them, 76% tested positive.
Bright spots could be misleading
Although children account for 22% of the population, their share of coronavirus cases is just a fraction of that ratio – 7%.
Even fewer kids get seriously ill. About 6 out of 100,000 school-age kids are hospitalized with COVID-19 compared with the overall rate of 130 people per 100,000, according to the latest data from the CDC. Most children who are infectious never experience the symptoms commonly seen in adults, such as fever, cough or shortness of breath.
Some scientists worry that because kids are less likely to show symptoms, they are less likely to be tested and that the real rate of infection among youth could be much higher. Also, it’s unknown how effectively children might spread the virus to both kids and adults.
Elizabeth Pathak, a population health scientist and president of the Coronavirus and Kids Education and Tracking Project, said the limited data available to researchers and parents is likely a drastic undercount.
“We know that the majority of kids who are infected have no symptoms whatsoever,” she said. That means most children who are contagious never will be tested and might spread the virus to a vulnerable peer or adult.
“Unless you have a program where you are routinely and comprehensively testing people with no symptoms, you’re going to miss the majority of cases of COVID-19 in kids,” Pathak said.
Most states do not report how many schools, child care facilities or youth programs have been linked to outbreaks.
Several people who returned to school in the past week tested positive, including at least nine in Tennessee, six in Indiana, five in Mississippi and two in Kentucky, according to those school districts and health officials.
Jason Salemi, an epidemiologist and professor at the University of South Florida College of Public Health, said poor data collection and transparency mean he often can’t even answer simple questions about how coronavirus spread among kids.
“We knew the discussion to open schools was going to come,” he said, “and we need comprehensive and consistent data across states to make those decisions.”
School closings spared lives
A study published last month by JAMA estimated that closing schools in March reduced the rate of new COVID-19 cases by 66%.
That meant about 1.4 million fewer people becoming ill and about 40,600 fewer people dying over the 26- and 16-day periods studied. The mathematical model weighted its results based on community demographics and other shutdown orders.
“Policymakers were hopeful that closing schools would curb the coronavirus epidemic, but that wasn’t known,” said lead study author Dr. Katherine Auger, an associate professor of pediatrics at the University of Cincinnati College of Medicine. “We show that it actually did make a difference in cases and in deaths. That was a very important thing society did.”
Auger said the research, which has limitations as a modeling study, should not be misconstrued as proof that schools should never return to in-person instruction. Schools reopening would probably follow precautions that were not in place in the spring.
“It’s not just about education. It’s about other services schools offer,” Auger said. “We support families through our school system in this country. That is critically important infrastructure.”
The cost to childhood development and to working families who rely on schools as affordable child care is worth the risk of reopening classrooms in places with low levels of community spread, some experts said.
“This is going to be a local decision that needs to be made. And it might have to be made over and over again as changes occur in infection rates,” said Enriqueta Bond, who leads an advisory committee on reopening schools at the National Academies of Science and Engineering.
States have disagreed on whether to track outbreaks among kids as diligently as for other hot spots, such as nursing homes. Few state health departments share what they know about such cases with the public.
“Local health departments may identify outbreaks in these types of facilities during their investigations, but we are not tracking them at the state level or posting them to our website,” Michigan Department of Health and Human Services public information officer Lynn Sutfin said in an email to USA TODAY. “If there was an outbreak and public notification needed to occur, that would happen at the local level.”
In Arkansas, health officials said they are discussing how best to share outbreak information this fall.
“We track outbreaks in all settings, but school has not started,” public information officer Danyelle McNeill wrote. “We are working to determine how we will present this information once schools are back in session.”
The Arkansas Department of Human Services has tracked outbreaks in day care centers but has not shared that information with the public because “no one has previously asked us for that data,” spokesperson Amy Webb said.
Officials said it is against their policy to publicly identify the particular settings of any outbreak.
In contrast, Colorado reports the location of all outbreaks, including those at schools and child-centric facilities. Although the data does not separate cases into age groups, state officials report the number of “attendees” versus “staff” who contracted the virus.
“Our primary goal is to be as transparent as possible with our data while ensuring we’re reporting accurate information to the public,” the state Health Department wrote in an emailed response to questions.
Children will be at risk
Without better information about cases in kids, Pathak, the epidemiologist tracking cases nationwide, said it will be difficult to prevent large outbreaks that, inevitably, will result in severe complications or deaths for some children.
For every 2,381 kids who are infected, one will become sick enough to need intensive care, based on a study by Pathak and others that was published in the Journal of Public Health Management and Practice.
“Even though it’s a low rate, if you talk about millions of kids getting infected, you’re still going to have thousands of kids needing to go into the ICU,” she said.
Those risks are even higher for adults, especially those with underlying medical conditions such as diabetes, asthma or high blood pressure.
These are the risks that haunt Petal Cates, 16, of Charlotte, North Carolina, a high school student on the autism spectrum.
Cates said she has mixed feelings about her mom signing her up for remote digital school this fall.
On one hand, Cates misses her friends and wishes she could take driver’s ed. She said face-to-face experience is the best way for her to learn about managing her anxiety and responding to certain social cues.
On the other hand, Cates worries about her mom, Rose, a widow who uses a wheelchair and is at higher risk of complications from COVID-19. She doesn’t want to bring the virus home from school and get her sick.
“Until we have a vaccine, I won’t go. I don’t want to put my mom in danger,” she said. “There’s a lot of germs around school, and janitors hardly clean the bathroom.”
Rose Toth-Cates worries about her daughter’s quality of education in online classes and the social development provided by in-person schooling.
She said she would encourage Petal to return to the classroom on three conditions: if the rate of community transmission was much lower than it is today, if the school reduced class sizes and if masks were mandated.
“I would risk it,” she said. “I feel like this is stealing her high school experience.”
This article originally appeared on USA TODAY: COVID-19: Back-to-school plans fuel fear of spread in children, adults