It could have gone another way.

Perhaps like this: The state could have lifted the stay-at-home order more gradually, and people could have stayed home, or away from each other, for the greater good. Bars could have stayed closed. Testing and contact tracing efforts could have been more widespread, and equitable. Other decisions affecting adults — their ability to get back to work, to vacation — could have considered the consequences.

Instead, here we are now, asking a question few thought possible just months ago: What would it take to get the state’s youngest generations back in school?

Few agree on how to define what would make schools ‘safe’ — we certainly can’t wait for a vaccine, many say — and there’s little precedent in the U.S. for how to return to schools amid a pandemic that’s raging unabated in many communities. There’s also disagreement among the public about how and whether buildings should open. But the one thing nearly everyone working on the issue — such as epidemiologists and pediatric researchers — agrees on is that schools shouldn’t open until community spread of SARS-CoV-2, the new coronavirus, is brought under control.

In Washington, guidance from officials has been shifting, with the onus ultimately left on school systems. In June, state schools chief Chris Reykdal told districts they should expect to reopen. This month, with incidence rates sprinting upward in a majority of counties, Gov. Jay Inslee strongly urged, but didn’t mandate, that many districts keep buildings closed.

BACK TO SCHOOL?

This story is part of a series about what it’s like to go back to school during a pandemic.

Public health officials warned in July that King County schools should stay closed barring a swift turnaround in coronavirus transmission, something that was possible only if everyone in the community restricted their activity. That didn’t happen. 

We can’t blame schools for this — they weren’t open, said Dimitri Christakis, director of the Center for Child Health, Behavior and Development at Seattle Children’s. “And yet, the solution seems to be: Let’s not reopen schools. How about we stop all the things that are going on that are driving the rise?”

“There’s been so much emphasis on what schools need to do,” said Saskia Popescu, an infectious disease epidemiologist at George Mason University. “It doesn’t matter if you invest millions of dollars in each school to make it safer … if you have a community that has high transmission it’s not going to make a difference.”

Christakis is a member of a committee on a leading scientific panel that recently urged schools to reopen for K-5 students and those with disabilities. Young learners had it particularly rough when buildings closed in the spring, and schools provide crucial services such as meals, extra academic assistance and mental health support. Schools are also a respite from tumultuous homes or from the streets for students who are homeless.

“Safety is actually now the most crucial question,” said Christakis. “It’s actually doubly important because the fundamental premise for saying we’re not going to reopen until schools are safe begs the question: When will that be or what will that take?” 

Back to ‘school’: Even the basics are complicated, so how can teachers and students get on track?

Many school districts across the nation that have opened in the past two weeks have taken a different course than Washington and allowed for in-person instruction despite high incidence of the virus. A number of these districts in Georgia, Mississippi and Indiana are already dealing with students and teachers testing positive for the illness.

Epidemiologists and many policy experts agree that schools shouldn’t reopen unless certain criteria are met. For one, the percentage of people who test positive should be below 5% in a given community. If the rate is too high, this suggests that only the sickest people are being tested and many people with the virus are going undetected. Another factor: the number of people with the virus should be less than 75 per 100,000 people (some experts say 25 per 100,000) over two weeks, a metric that helps gauge whether systems such as schools would be overwhelmed by the virus.

If too many people are infected in a community, including children, “you can’t get it under control and you also can’t tell where spread is happening,” said Casey Lion, assistant professor of pediatrics at the University of Washington. Contact tracing becomes inefficient and unmanageable under these circumstances, she said, since it’s hard to know where infections are originating. 

But these thresholds alone aren’t enough: there’s another set of questions that are tougher to answer:

  • What is a tolerable level of risk of transmission between students and their teachers? Who gets to make such a decision?
  • Would schools shut down if one person in the building was infected?
  • What would it cost to upgrade school systems — such as ventilation systems — to make them safer?
  • How will people’s perception of risk vs. the real risk influence decisions to return to schools?

When in-person instruction begins, district officials need to be proactive and test students, teachers and staff and follow through on any positive results with contact tracing.

“Without those things in place then it is going to be a riskier proposition to open up the schools no matter what,” said Dr. Ryan Malosh, an infectious disease epidemiologist at the University of Michigan.

School administrators also have to consider what to do when someone who has been at school tests positive or shows up sick. Does the entire school shut down for a couple weeks, or if the school is using a cohort system, does that group shift to remote learning for a couple weeks?

“Those are the kind of things that hopefully people have thought about before they get into it, because the last thing you want to do is have an outbreak and not be ready for it,” Malosh said.

And there’s this: mounting evidence suggests that, in general, children can transmit the virus. The research isn’t definitive, though, and it’s still unclear if younger students are less likely to pass it on than their older peers. And while most children don’t get seriously ill, more are getting infected: nearly 100,000 tested positive in the last two weeks of July, says a new report from the American Academy of Pediatrics and the Children’s Hospital Association.

In rare cases, children can have extreme reactions. At least eleven kids in Washington have been hospitalized with Multisystem Inflammatory Syndrome in Children (MISC-C) since May. The syndrome causes swelling, a rash and a high fever and affects the gut, heart and kidneys.

Adults who work in schools are also susceptible: Any re-opening plan must take teachers and staff into account and make sure that districts have enough substitute teachers when they go out sick, said Dr. Nava Yeganeh, a pediatrician and infectious disease specialist at UCLA.

“We have to make sure that every staff member, every teacher, has appropriate personal protective equipment,” she said.

Until there is a vaccine and effective therapies, schools are going to have to operate differently. More teachers will have to be hired to accommodate smaller class sizes, protective gear and COVID-19 diagnostic tests will have to be added to school budgets and ventilation systems might have to be updated in some schools. Washington districts have begun submitting claims to the state for COVID-19-related costs they’ve incurred since March. The 27 districts that have filed claims so far are requesting nearly $3.5 million in federal CARES Act funds.

“We need to step up and figure out a way to make sure they’re appropriately funded so they can open,” Yeganeh said.

Before any of that can be put into place, she added, people need to think about children and schools and do what is necessary to blunt the new coronavirus’ spread.

“Schools are the beating heart of our communities,” she said. “We need to really prioritize our children and their interests before our own, which means masking up, avoiding crowded areas and really getting community spread under control for our children.”