Safely re-opening our schools

By the press time of this Op Ed, our county’s schoolboards will have voted on their plans to reopen schools. At my wife Sally’s encouragement, I had attended the Gettysburg Area School District schoolboard meeting on July 13 to share my opinion as a family physician of 35 years as well as an avid reader of the news and the medical literature regarding COVID-19. (Sally was a schoolboard director for 8 years.) I was disheartened by some of the opinions shared by others at the schoolboard meeting, as well as the disregard for our governor’s mandate to wear facemasks correctly when we are in public inside space. My concern for our community and the horrible impact that COVID-19 has had on our country has led me to spend much of my free time trying to understand what we honestly and currently know about COVID-19.

Michael T. Osterholm, MPH (Master of Public Health) and PhD, of the University of Minnesota is a national thought leader in infectious disease and most recently, COVID-19. He is the lead expert of CIDRAP, the Center for Infectious Disease Research and Policy. I have gained great respect for his evolving advice on all issues COVID-19, including his apolitical views on the reopening of our schools. As I listened to his latest podcast, “Reopening Schools, Part 2,” released on July 22, I contemplated this timely and controversial topic.

Osterholm begins by mentioning that many areas of our country are presently “on fire” with COVID-19. He explains that it would not be wise to open schools, for instance, in Florida at this point, some of which were scheduled to open within the following two weeks. Across the nation, if we do not reopen schools wisely, we will pay a huge price in long-term health and lives, and an even greater price in economic well-being.

First and most importantly, this should be about our kids and all who surround them. We should not allow our world view to blind us from what is truly important, the well-being of our children. Second, the virus is not going away anytime soon. We need to strategize as to how we co-exist with this virus in our environment in the least damaging way to everyone involved.

We should consider this a COVID-19 year of school. It is okay if we need a redo. Nearly everybody in the country may be in the same boat.

Osterholm emphasizes that we who disagree cannot demonize those who hold an opposite view on whether or how to reopen. In all honesty, I need to remind myself of this sage advice.

We must be flexible. We must be nimble on our feet. As the virus’s presence in our community changes, so should the plans for our schools change. Osterholm states that there is no “one-size-fits-all” plan, there is no magic pixie dust.

Surveys have suggested that one-third of parents need to have their children back in school due to their jobs. Many of these same parents are horrified that their children may get COVID-19 in school and bring it home. One-third of parents are saying “Please tell us what to do.” Although teachers want to teach, one-fourth of them have high-risk medical conditions, and nobody wants the transmission of the virus to come home from school.

Federal financial assistance is critical to provide school districts with the resources required to re-open as safely as possible. It cannot wait, that financial aid is needed now.

Osterholm does not have much confidence in studies thus far that suggest children are much less likely to transmit the disease. A recent study out of Seoul, South Korea, for example, submits that very young children were considerably less likely to transmit the virus than older children or adults were, but that children 10 and older were just as likely as adults to transmit the virus. Osterholm mentions other case reports, however, that have suggested transmission in the younger-than-10 age group.

We cannot expect a total absence of COVID-19 in our schools. We must make these environments as safe as possible. The two key recommendations—physical distancing and facemasks covering the nose and the mouth at least when physical distancing of six feet cannot be guaranteed—should be pre-requisites of every plan.

Our school districts need to have plans in place as to what happens when a student, teacher or ancillary staff becomes infected. We cannot expect teachers to be the testers and tracers for the virus. Local and state health department assistance is necessary to coordinate this effort.

Communities must come together and decide that we are in this as a community, and that we will try to protect each other to the best of our knowledge and abilities.

Osterholm spends a portion of the podcast comparing the priorities and recommendations of 14 different organizations from the American Academy of Pediatrics to the American Association of School Administrators to the American Federation of Teachers. Nobody provides the “magic bullet.” It does not exist.

On the question of when it is safe to re-open schools at a local level, he states that if transmission of the virus has been driven into the ground, such as in Maine, then schools may reopen safely with accommodations while watching local trends for new cases. He cautions that this situation might change in a heartbeat. If our local community is “on fire with the virus,” it is not safe to open schools. He recommends that there be a seven-day trend of five or fewer cases per 100,000 residents, and that number be stable or have been decreasing over the last 14 days. According to the New York Times database on August 8, Adams County’s present seven-day trend is 4.9 cases per 100,000. Osterholm also recommends that local hospitals have at least 25 percent open capacity.

To summarize, we should follow the evolving science of this new virus. We need to track its transmission locally and react appropriately with policy decisions and changes, we need to be flexible as the presence of this virus in our community may change, and most importantly, we need to be kind. Understand, we are not each other’s enemy, the virus is the enemy. It’s not a big ask: please wear a mask.

Dwight Michael, M.D., a family physician, is a member of the Gettysburg Area Democracy for America’s Healthcare Task Force.