How safe is it for elementary schools to meet in person?

Parents and teachers have been in a Catch-22 for months, weighing the long-term risks of denying students in-person learning against the health risks associated with surging coronavirus case counts that could impact the classroom.

While many U.S. children returned to classrooms in some capacity this fall, the nation’s record numbers of new cases and deaths have educators and families wondering about the viability of keeping schools open — and the plan for returning all schools to more traditional in-person instruction. 

President-elect Joe Biden described his plan to balance the need for in-person elementary schooling with the dangers of the COVID-19 pandemic in a Dec. 3 interview with CNN.

"We can safely open those elementary schools where — the highest risk of people transmitting the disease, number one," Biden said. "Number two, we can make it safe for teachers if we invest in what needs to be done, number one, sanitizing the schools, number two, making sure that they have ventilation, number three, making sure there are smaller pods of children, meaning you need more teachers."

It’s unclear what Biden meant when he mentioned "the highest risk of people transmitting the disease." The Biden team did not clarify his remark.

Biden’s general point was that schools can safely reopen if they space out children in small pods, ensure proper ventilation, and sanitize. 

Public health experts told us that the gist of what Biden said is generally correct, but that keeping schools open also entails some risks. 

Although the best available evidence seems to show that COVID-19 poses less danger to children, additional research suggests that they can still be infected by the coronavirus and spread it to other people. The degree of safety would also vary from district to district depending on rates of community transmission.

As of Nov. 30, Education Week found that 11 states, the District of Columbia and Puerto Rico had ordered full or partial school closures. In other states, school closures are often handled on a district-by-district or school-by school basis. Globally, schoolchildren have returned to school with mixed results, much depending on the guidelines in force in each community.

The benefits of in-person learning are manifold, especially for younger students. Researchers have found that the switch to digital education has already hampered student development, with grades falling sharply over the course of the pandemic. Distance learning has also worsened educational disparities as students of color and those in high-poverty communities fall further behind their peers due in part to a lack of reliable internet access. 

In addition, the risk of reopening elementary schools is not as great as it might seem given the way the coronavirus tends to spare young children. According to Sara Johnson, an associate professor of pediatrics at Johns Hopkins Medical School, children younger than 10 years old are far less likely to be infected by COVID-19 than older children and adults. They are also less likely to transmit COVID-19 to other people, and less likely to be asymptomatic when they do have it. 

"Overall, evidence suggests that the schools that have reopened with public health mitigation measures in place have avoided some of the significant in-school spread," Johnson said. 

As evidence, Johnson pointed to three studies that suggest young children are much less likely to catch the coronavirus and that schools can prevent transmission if proper mitigation strategies are in place. One of these studies concluded that children ages 12-17 were twice as likely to get infected as were children ages 5-11. In addition, recent research from Spain found that school reopenings did not seem to cause spikes in community transmission. 

However, Johnson noted, "it’s incredibly important to point out that there’s always a risk of transmission. Some small number of kids can and do get pretty sick from COVID."

A September study published in Science based on extensive contact tracing in India found evidence of young child transmission to adults and to other children, and another study traced a coronavirus outbreak to an overnight camp in Georgia, where the median age of campers was 12. The study notes that the camp had adopted some mitigation strategies but had not enforced mask use or ensured proper ventilation in buildings. 

As a result, the elementary school reopening debate hinges on a difficult but unavoidable risk-reward calculation: Do the significant benefits of in-person learning outweigh the danger that some children will transmit the virus to their peers and parents? 

Many public health experts say yes, provided that schools are funded to implement proper mitigation strategies such as ventilation, mask use and distancing. 

Cindy Prins, a clinical associate professor of epidemiology at the University of Florida College of Public Health and Health Professions, noted that a complicating factor is the difficulty of rigorously enforcing these mitigation strategies. Mask use and distancing, for example, are difficult to enforce during lunch time when young kids are gathered together, she said. 

On the other side of the debate, some public health experts, like Texas A&M University-Texarkana virologist Ben Neuman, believe that the potential risks of keeping schools open are still too great. Neuman said the limited data make it difficult to justify any kind of in-person gathering during the pandemic given the potential consequences. 

"In a situation like COVID-19 where there are still so many unknowns I would argue on the side of caution, which would mean arguing against any activity that brings members of different households into contact for long periods of time, including in-person school," he said. 

Public health experts told us that one crucial component of safely holding elementary school in person is monitoring the rate of community spread and shutting down again once rates reach dangerous levels. 

The higher the community transmission rate, the higher the likelihood that COVID-positive students show up at school. And the more infected students there are, the less likely it is that mitigation strategies will prove effective at combating further spread. 

"In lower transmission settings, it does seem that mitigation efforts … (are) pretty effective at limiting in-school spread," said Dominique Heinke, a postdoctoral research fellow at the Society for Epidemiologic Research. "But if there are 10 positive cases in a classroom? The chances of there being enough virus in the air to infect others increases and mitigation measures might not be enough."

The inflection point of community transmission — the rate deemed too high to safely keep elementary schools in session — is still an open question. However, Johnson said, it’s probably higher than epidemiologists thought earlier in the pandemic. 

"We have seen schools open with higher levels of transmission than some of those benchmarks and we still don’t see onward transmission," she said. "It’s likely that there’s an inflection point at which the calculus becomes less favorable to keeping schools open, but it seems to be higher."

To keep schools open in districts with high community transmission rates, Johnson said, those districts might try to drive those rates down through other public health measures, such as closing bars and restaurants.