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Hybrid schooling could be a public health disaster, some doctors warn

Custodians Brendon McIntosh and Jason Harrington washed down a blackboard at the Mildred Avenue K-8 School building in Mattapan in preparation for the reopening of school.
Custodians Brendon McIntosh and Jason Harrington washed down a blackboard at the Mildred Avenue K-8 School building in Mattapan in preparation for the reopening of school.David L. Ryan/Globe Staff

As communities throughout the state scramble to craft back-to-school plans that prioritize public safety and academics, some officials have lauded hybrid schooling — which includes some variation of both in-school and at-home learning — as a solution that seems to strike an ideal middle ground between the remote-only and full-time camps.

Boston Mayor Martin J. Walsh substituted the more kid-friendly term “hopscotch” while proposing a two-days-in-school, three-days-at-home hybrid model during a Wednesday press conference.

Call it hopscotch or hybrid or blended learning, but some infectious disease experts call it a potential public health disaster. Alternating schedules could cause children to ebb and flow within an expanded network, transitioning from home to school to child-care centers and thus having a greater risk of exposure or transmission.

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“You can see how these got off the ground because it sounds initially like a good idea, but like all things with this virus, you have to think really critically about it,” said Dr. William Hanage, an epidemiologist at Harvard’s T.H. Chan School of Public Health. “When you start to do that, you realize that hybrid schooling actually produces more networks by which the virus can spread.”

Hybrid models have emerged across the country as a palatable answer to a politicized and volatile dilemma, with an estimated 20 percent to 30 percent of the nation’s school districts planning to implement them, according to EdWeek, a publication covering K-12 education.

In Massachusetts, all school districts were required to create a plan for hybrid schooling, alongside two other plans: one for entirely remote schooling and the other for a full-time in-person return. Arlington, Bedford, Danvers, Plymouth, Norfolk, Shrewsbury, and Woburn are among the communities that have formally signed onto hybrid plans — at least for some students — while several other districts plan to start with remote learning and phase in hybrid this fall.

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At face value, hybrid plans provide students with some much-desired in-person instruction while lessening the burden on parents who are either working from home themselves or are essential employees who cannot work remotely. Meanwhile, hybrid plans limit class size and, seemingly, the risk to teachers of exposure.

But epidemiologists note that parents who cannot do their jobs remotely and those too busy to oversee at-home learning will still rely on external child-care solutions two to three days a week, further widening the child’s circle of exposure. With fully remote or all in-person learning, children are spending the majority of their time in one or two places with a consistent group. With a hybrid plan, that number balloons to three or more.

Dr. Helen Jenkins, a biostatistician with Boston University’s School of Public Health and adviser on the Cambridge Public Schools’ COVID-19 task force, envisions the most tenable solution as full-time in-person instruction for children with special needs or parents deemed essential workers and remote instruction for the rest of the student body.

For now, Cambridge plans to open in September with remote learning for students grades 4 through 12. In-person learning options will be available for students in preschool through third grade and students of all ages who either have special needs or are English learners.

What complicates discussions about back-to-school models is the relatively sparse information on the relationship between children and the coronavirus. Although severe and deadly cases of COVID-19 in children have been reported, most of those infected are asymptomatic. The dearth of data on adolescents and the virus is exacerbated by the fact that at many testing locations, asymptomatic people still cannot get tested, so many child virus cases aren’t detected or recorded. But a sharper focus on the virus and children has emerged after an outbreak infected hundreds of kids and staffers at a Georgia summer camp and as a result has impacted back-to-school discussions across the country.

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About 97,000 new cases among children were reported in the last two weeks of July, a 40 percent increase from the total number of cases before the period began, according to the American Academy of Pediatrics and the Children’s Hospital Association. Other research published in recent weeks suggests that kids, especially older ones, can be a driving force behind the transmission of COVID-19. And some researchers found children carry high levels of the virus’s genetic material in their upper respiratory tract, which means that they potentially could transmit the virus to at-risk people, such as teachers and parents.

“We’re trying to make decisions without reaching an actual understanding of what’s really happening,” said Jenkins on the need for more research on the virus’s effect on adolescents and how they transmit to others.

The potentially catastrophic implications of such limited research has led the state’s largest teachers unions to advocate for remote-only models for the start of the academic year. Both the Massachusetts Teachers Association and the American Federation of Teachers Massachusetts have expressed concerns about inadequate ventilation systems and space for social distancing, making even hybrid learning risky.

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The Boston Teachers Union, too, has pushed for a remote start to the school year with a recent survey of union members finding that two-thirds of teachers said they were at high risk for COVID-19 or live with someone who is.

But remote learning comes with its own set of problems, necessitating that parents provide or arrange for child care during the work week, thrusting teachers who may lack technological expertise online, and depriving children of socialization with classmates and teachers. Meanwhile, full-time in-person learning comes with obvious transmission risks, particularly in districts that lack the funds and infrastructure to create socially distant and sanitized spaces.

“This is no question one of the hardest decisions that we have to make going forward,” Walsh said of back-to-school plans in the Wednesday press conference.

Infectious disease experts agree: returning to school as virus cases continue to surge around the country makes it an especially thorny conundrum.

“There is no perfect solution, there are just some solutions that are less bad than others,” Hanage said.

And to him, the hybrid model is among the worst in the bunch.


Hanna can be reached at hanna.krueger@globe.com. Follow her on twitter @hannaskrueger. Felicia Gans can be reached at felicia.gans@globe.com. Follow her on Twitter @FeliciaGans.