As many schools begin opening this week, parents around the state are confronting a decision that few expected to face and most find agonizing: Is it safe to send children back into the classroom?
Amid ever-changing data about the still mysterious coronavirus, the decision becomes achingly personal, informed by a family’s tolerance for risk, faith in the school system, and such circumstances as whether a vulnerable person lives in the home.
“There’s no handbook for how parents are supposed to do this,” said Dr. Joshua A. Barocas, an infectious disease specialist at Boston Medical Center and father of two young children. “For all of the parental handbooks we received, there wasn’t one that said, ‘What do you do with your kid during a pandemic?’”
Despite the uncertainty, experts consulted by the Globe say the latest scientific evidence skews strongly in favor of sending children to school — provided two conditions are met: Transmission of the virus should be low in the surrounding community, as is the case in most Massachusetts cities and towns; and the school system should be wholeheartedly adopting safety measures such as mandatory mask wearing, physical distancing, and opened windows or outdoor classrooms when feasible.
“There are these horror stories coming from parts of the country that are still having high transmission [of coronavirus],” said Dr. Silvia S. Chiang, a pediatric infectious diseases physician at Rhode Island Hospital and assistant professor of pediatrics at Brown University’s Warren Alpert Medical School. “I’m afraid people will look at those and say, ‘Oh no, we can’t reopen schools until we have a vaccine.’”
But in fact, Chiang said, “If the community transmission of the virus is controlled, you can reopen schools safely. You should do it with precautions.”
About 70 percent of Massachusetts school districts are offering a mix of in-person and remote learning; most of the remainder will provide only remote instruction, and a handful are attempting full-time in person learning.
Children 18 and younger can get infected with the coronavirus, but it rarely makes them ill and is extremely unlikely to kill them. Although the data remain murky, infected children — especially those younger than 10 —appear less likely than adults to spread the virus to others.
When children do get COVID-19, studies show they are more likely to get it from an adult than from another child. The frightening syndrome associated with COVID-19 that can affect children — Multisystem Inflammatory Syndrome in Children — has so far proven exceedingly rare.
One tough fact remains: The COVID-19 risk can never be brought to zero.
But Barocas said the conversation has neglected the considerable risk to children’s mental and physical well-being, as well as their education, if they stay home.
“My kids are probably at higher risk for depression than they are for COVID right now,” he said.
Barocas and his wife have decided to send their children, ages 3½ and 7, to public schools in their Roslindale neighborhood next month when in-person learning is scheduled to begin. They weighed the relatively low transmission rates in the area, their children’s willingness to wash their hands and wear masks (“They live with an infectious diseases doc”), and the fact that both parents work and have limited time to oversee home schooling.
They concluded that the risk of their children getting sick or transmitting the virus to others was significantly lower than the risks associated with “sitting at home alone on the computer all day.”
But Barocas said it would be “not unreasonable” for another family to make the opposite decision.
The risk-benefit balance is especially stark for children younger than 10: Based on the evidence so far, these youngsters are the least likely to get sick from the coronavirus or to transmit it to others, and they have the most to lose if isolated from their peers at home.
“The harm of keeping children out of school is enormous,” said Dr. Cody Meissner, chief of pediatric infectious diseases at Tufts Medical Center. “It’s not only education — it’s socialization, starting at a very young age. Pre-K children learn how to interact appropriately with each other. If they don’t learn early on, it’s going to be a big problem.”
School closings are especially harmful to less affluent families, Meissner said. “Those students are not going to learn what they need to learn to get gainful employment in this global economy, and they’ll never catch up," he said.
Because transmission from child to adult appears to be rare, he said, “The risk to teachers is very, very low. The risk that a teacher is going to become infected with COVID-19 is higher when she’s in a supermarket buying groceries than it is while she’s in the classroom."
Jessica Tang, president of the Boston Teachers Union, disagreed. She pointed out that — unlike many schools — grocery stores don’t suffer from decades of deferred maintenance and don’t have documented air quality issues. Also teachers don’t work just with young children but also with special needs students up to age 22, with whom social distancing can be impossible, she said.
Teachers, Tang said, want to go back to school but worry about their safety.
“We’ve got to have verifiable assurances that our facilities are safe," she said. “The number one concern is air quality,” especially in aging buildings, some of which don’t even have HVAC systems or windows that can be opened.
In the United States, the school season is still new, and the health consequences of school openings have not been carefully tracked. But lessons can be drawn from experiences elsewhere in the world.
Take Israel. In May, the country seemed to have the coronavirus under control and decided to open all schools at once. Other parts of the Israeli economy also opened at the same time, increasing the likelihood that the virus would get around.
Small classrooms were packed with as many as 38 students. And then a heat wave hit. Sweltering students were allowed to remove their masks, and soon windows were closed to enable air conditioning to work. Within days, an outbreak started at a Jerusalem high school, spreading to homes and eventually other schools and neighborhoods, and forcing hundreds of schools to close, The New York Times reported.
Brandon L. Guthrie, assistant professor of global health and epidemiology at the University of Washington, has been tracking school openings around the world. “If you are going to reopen schools,” he told the Globe, “you need to have plans for how you’re going to limit the scope of spread. And you need to stick to those plans.”
In Europe, Guthrie said, schools reopened just as community lockdowns ended. “As you have more people interacting and going about their normal lives, there is still potential transmission,” he said.
And once there’s community transmission, cases will show up in schools. “That doesn’t mean you have transmission in the school,” Guthrie said. It remains an open question the extent to which schools contribute to the spread of coronavirus outside their walls, he said.
Still, the experience in Europe provides encouraging insights.
In the United Kingdom, when schools and preschools reopened for “mini” summer term in June after the height of the pandemic, very few cases occurred.
In an Aug. 6 report, the European Centre for Disease Control and Prevention concluded that coronavirus transmission within schools is uncommon and found little evidence that schools drive transmission within a community.
With precautionary measures in place, Denmark did not see major school outbreaks or an increase in disease transmission when schools reopened. In Sweden, where schools stayed open throughout the pandemic, teachers were at no higher risk of getting infected than people in other occupations.
In the United States, some lessons can be drawn from other types of gatherings for children.
Adequate precautions were not taken at an overnight camp in Georgia last June, where maskless campers in unventilated cabins engaged in “vigorous singing and cheering.” Nearly half the 597 adults and children who attended tested positive for COVID-19.
By contrast, only three cases were reported among 1,022 people who attended four overnight camps in Maine where there was testing, isolation, and other precautions.
Last week, the Massachusetts Medical Society said it supported “the safe and equitable return of as many students, teachers, and support staff as possible to in-person school settings.”
Still, parents will find no clear lines or black-and-white answers. Even the best safety efforts are bound to be fallible, said Barocas, the Boston father and doctor.
“These are kids,” he said. “They’re going to pull their mask down, they’re going to wipe their noses with their hand.” Accepting that the risk can never be zero, he said, the best anyone can do is reduce the likelihood of disease transmission as much as possible.
Felice J. Freyer can be reached at firstname.lastname@example.org. Follow her on Twitter @felicejfreyer.