This op-ed by Westyn Branch-Elliman, MD (Infectious Disease, BIDMC) and Kathryn Stephenson, MD, MPH (Center for Virology and Vaccine Research, BIDMC) for US News & World Report, presented the debate about reopening K-12 schools for full in-person learning during the COVID-19 pandemic, and argued how waiting until it’s “safe enough” is clearly defined, the benchmark may be elusive – and remain just around the corner for the foreseeable future.
US News – February 3, 2021
‘Safe’ Schools Is a Moving Goal Post During COVID-19
AS THE DEBATE ABOUT reopening K-12 schools for full in-person learning during the COVID-19 pandemic rages on, many are advocating waiting “until it is safe.” The problem with this position is that unless “safe enough” is clearly defined, the benchmark may be elusive – and remain just around the corner for the foreseeable future.
We have gotten good news recently about the safety and efficacy of different COVID-19 vaccines. Over the past month and a half, two vaccines have been authorized, and large-scale immunizations are underway. With additional vaccine approvals potentially on the horizon, the news on this front is undoubtedly positive.
On the flip side, manufacturing and distribution take time, and COVID-19 vaccines will need to be rationed for months. Though states make the ultimate call, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices has recommended prioritizing in various stages health care workers; residents of long-term care facilities; essential workers, including teachers; people with high-risk medical conditions; and older adults. That equals over 200 million people in the U.S.
While state policies will vary, it is likely the first vaccine doses will be doled out to teachers in most parts of the country during the February to April timeframe – undoubtedly promising news. However, it is important to remember that based on the data available today, there is a four- to six-week lag from the time of first vaccination until a person has maximum protection. In other words, a teacher vaccinated in April may not achieve vaccine-induced protection this school year.
For children, the timeline is even longer. Trials in children are still underway, and an authorized vaccine for children is unlikely until this coming summer – at the very earliest. Furthermore, it’s not yet been proved whether the current vaccines in use in the U.S. can fully prevent asymptomatic infection or secondary transmission of the coronavirus, making it less clear what value they would have to schools themselves, even when children are eligible to be vaccinated.
In light of all of this, we have to make decisions about where we are going to draw the line about when schools open – or don’t.
What does “safe enough” mean in the context of reopening schools? We have learned a lot since policies were designed and implemented this summer, but we have not adapted plans to meet up-to-date science. In Massachusetts, the Department of Elementary and Secondary Education examined data and concluded that, with mitigation measures in place, school districts should maximize in-person learning – including in regions with relatively high rates of community spread. Officials in New York City and elsewhere have allowed at least some form of in-person education as well.
Most recently, the Centers for Disease Control and Prevention said evidence indicates that schools are not a major source of spread, provided precautions are implemented. We also know from hospital settings what conditions lead to staff-to-staff transmission and how to prevent them, and we can implement similar measures – such as limiting the amount of adults in break rooms and instituting mask mandates – to protect both school staff and students. Still, many school districts across the country are deploying remote or hybrid learning structures rather than full in-person education.
Given what we know now, we must have a larger conversation with community- and state-level stakeholders to define what we all mean by “safe enough.” Is it when essential health care workers are fully vaccinated (late spring?) Is it when teachers are fully vaccinated (hopefully by the summer)? Is it when vulnerable populations are fully vaccinated? Is it safe enough when students are vaccinated (a long way in the future)? How do we manage vaccine hesitancy? How do we adjust if there are new variants in circulation, and our vaccines are less effective than we’d hoped? We must have a benchmark for what people expect, and how everyone is defining “safe enough,” so that we are all able to plan.
The reality is that everyone has a different level of risk tolerance, and therefore a different threshold for “safe enough.” Even with a vaccine, it is important to acknowledge that for the foreseeable future, risk may be low but not zero. For at least this school year and the next one, vaccines will not be a magic solution – they should be seen as one more tool to use among the layers of mitigation we have at our disposal.
We also need to recognize that COVID-19 cases are not the only potential outcome tied to in-person classes: The absence of in-person school holds educational and other consequences as well. Students have fallen behind academically and achievement gaps have increased. The share of mental health emergency department admissions among children has increased, with childhood obesity likely doing the same. Working women, in particular, are suffering.
How long are we willing to allow this to continue? What is our timeline? Through the end of this academic year? Through the next? The one after that? Even with safe and effective vaccines within our grasp, “perfectly safe” may be more like a pot of gold at the end of the rainbow than something we are going to be able to achieve over the next year, or perhaps even two years.
We all need to come back to the drawing board and rethink school closing and opening policies and when our kids can return full time to the classroom. We need to recognize that if our benchmark is COVID-19 eradication, our children might be waiting for years.
We must view schools as the essential venues for children that they are, and accept some level of COVID-19 risk – and weigh that risk against all of the other harms of keeping schools closed.
We cannot keep moving the “safety” goal post further down the field. Our children’s future is at stake.
Editor’s note: The views expressed here are the opinions of the authors and do not necessarily reflect the views of their institutions or the federal government.