At first, they proceeded cautiously. Then, one by one, Washington’s largest school districts began announcing decisions to close. By Friday, the state’s schools — all public and private — had no choice: by the governor’s orders, all schools will close through at least April 24.
Gov. Jay Inslee’s decision to close schools is extraordinary in scope — together, Washington schools serve more than 1.1 million students.
Schools across several other states and countries hit hard by the new coronavirus, such as Japan, Italy and China have opted to close, too. In most of those cases, officials have used science to justify their choices.
When Inslee first urged Washington schools to plan for the possibility of long-term closures on Wednesday, he said his office was looking closely at emerging research that hints children are relatively immune to the virus’s worst effects, but remain capable of transmitting it. On Thursday, he was more pointed: “Health professionals have told us that closing schools could create a significant cut in the peak number of ultimate infections,” he said.
But it’s still unclear whether these measures will slow the virus, or decrease the number of people who ultimately fall ill. The Centers for Disease Control and Prevention, which is regularly updating guidance for schools, has said that short-term closures likely won’t work; closures lasting more than eight weeks may have some effect, though regular hand-washing and social distancing are likely to be more effective at mitigating the virus’ spread.
Many say it’s better to be safe than sorry, but these questions are particularly important given the societal and economic costs of school closures: Schools provide children critical services outside the classroom, such as hot meals, health care and care before and after the school day.
Children are known to be powerful vectors for the flu, and most research pointing to the effectiveness of school closures focuses on influenza outbreaks, experts say. But because the coronavirus known as SARS-CoV-2 is so new, available data on both transmission and infection in children is scant.
“It is unclear at the moment whether school-age children are efficient in transmitting the virus,” said Qifang Bi, a research assistant at Johns Hopkins Bloomberg School of Public Health, who is conducting epidemiological research on SARS-CoV-2 and the disease it causes, COVID-19. “We clearly need more studies on that.”
This complicates questions about how well school closures will combat the virus’s reach.
Early reports suggest the death rate is 1.4% to about 2%, with most of the severe cases and death resulting in elderly adults and those with certain preexisting health conditions. On Thursday, Washington’s Secretary of Health John Wiesman said that 2% of the state’s positive cases of COVID-19 are in people younger than age 19.
Overall, few children are getting seriously sick: In a February study of more than 44,000 cases of COVID-19, children 9 and younger made up less than 1% of cases, and zero died. The research raised questions about whether children were getting infected at all, or whether symptoms in children are so mild that they aren’t getting tested.
An unpublished study out last week offered new clues: children 9 and younger are just as likely to get infected as adults if they’re exposed to the virus, the researchers found, though they don’t get seriously ill.
The research was conducted in a small sample and hasn’t been peer-reviewed. But it expands our understanding because it included both COVID-19 cases and people the cases came in contact with — family members, friends and others — which allowed the researchers to calculate infection rates more accurately.
“I hope it’s useful information,” said Justin Lessler, a co-author with Bi on the new research, and an associate professor of epidemiology at Johns Hopkins. “I realize that people are very frustrated now with our lack of knowledge about the virus and how that compares to the timeline for when they’re trying to make decisions.”
What these preliminary findings mean for school closures depends on public officials’ goals, he added. “Our information is saying kids are just as likely to be infected as adults so we know that the virus is getting in the schools,” he said.
If you want to freeze the virus’ spread, you shut down schools to get as “close to eliminating it as possible,” he said. “If you are just trying to slow down the epidemic, you might be willing to accept some transmission in schools because you want to have a sustainable policy that works longer term.”
In the case of influenza, closing schools hasn’t historically affected the number of people who ultimately get sick, analysis from several studies suggest. But school closures do reduce the number of people who are sick at the peak of an epidemic, said Caitlin Rivers, an epidemiologist at Johns Hopkins Center for Health Security.
Bringing that peak down is important, she said. “The goal right now is to reduce the number of people who are sick at any one time to make sure we have the capacity to provide the very best health care for everyone who needs it,” she said.
Inslee’s sweeping decision raised big questions about equity, an issue he said he considered. Homeless students, children from low-income homes and those with disabilities will be hardest hit by the mandatory closures, since they are more likely to rely on schools for meals and health care, among other supports. But ultimately, Inslee said, his decision to close schools isn’t driven by a specific infection rate.
“There isn’t any percentage I can give to you,” Inslee said Thursday, when he first announced closures in three Washington counties. “This is going to be a judgment call.”
It’s unclear whether the virus has reached an inflection point here. But Inslee’s directive aligns with arguments from researchers who say it’s critical to preempt outbreaks in individual school communities; once a school has a known case, it may be too late.
“The reality is: if you are a physician, and I am, and you are a pediatrician, and I am, and you are a parent, and I am, you are most always going to err on the side of caution,” Howard Markel, professor of pediatrics and director of the Center for the History of Medicine at the University of Michigan, told The Seattle Times.
Markel’s research on the 1918 influenza pandemic suggests that closing schools was one of the “most effective firewalls against the spread of the pandemic,” he wrote recently in The New York Times. “Cities that acted fast, for lengthy periods, and included school closing and at least one other [nonpharmaceutical intervention] in their responses saw the lowest death rates.”
Others caution that now is not the time for debate among experts. “Now is the time to really be asking, ‘how we can support our local school leaders?’,” said Meredith Honig, professor of education at the University of Washington. “We’re in a crisis,” she said. “We should just really slow down and not rush to give advice, because there’s no ‘winning’ advice here.”
Before Inslee’s directive on Friday, some families had begun taking preventative measures on their own.
Julia and David Gage, who live in Bellingham, took their two elementary school daughters out of school earlier this week after following news about the virus’ spread in Washington, and after experiencing the recent death of two close relatives who passed from other illnesses.
Julia called a physician friend who convinced her she wasn’t overreacting.
“I was thinking, let’s just try to contain this a little bit,” Julia said. “If they are in school, there’s no way you can stop that.”
Seattle Times writer Hal Bernton contributed reporting.