Decisions about whether and how to safely re-open K through 12 schools have become polarized. A vast and growing number of scientific studies are related to COVID-19 and schools, yet few are landmark studies — those that definitively settle a scientific question.
The scientific process always builds on itself over time, with zigs and zags before ultimately reaching sound and convincing conclusions. A sensationalist approach to scientific reporting, with dramatic headlines that omit important limitations or lack context, benefits no one. With the physical and mental health of over a million students and educators in Massachusetts at stake, both researchers and media outlets have a critical responsibility to portray scientific findings in the most accurate and balanced way possible.
For example, much attention has focused on whether children transmit COVID-19 as often as adults. This is a difficult question to answer through the types of studies that can be done in most settings. A study from Korea suggested that older children transmitted COVID-19 to people living in their households at rates equal to or higher than adults, and was widely reported as jeopardizing safe school reopening. As in all contact tracing studies, differences in when symptoms appear and when tests are available made it difficult to tell who infected whom in a household. When the authors subsequently reported that the direction of transmission was unknown, raising concern about the conclusions of the original paper, this correction was not widely communicated.
A second recent study was tweeted out by the institution that conducted the research, overstating the findings as demonstrating that children are “silent spreaders” of COVID-19. It was corrected the next day. This study measured the quantity of virus in the nasal passages of symptomatic children early in their illness, and compared this to sick adults in a later stage of disease, when all patients have lower amounts of the virus. It did not measure transmission to other people at all. The study’s authors and other scientists recognized the limited type of conclusions that were appropriate to make, and headlines and stories from many outlets have since been revised. In these cases, the impact on parents, students, and educators considering a return to school cannot easily be undone.
Oversimplified conclusions are made in both directions. An attention-grabbing article asserted that, “Preschoolers are mask-licking germ bombs — yet few catch the coronavirus, data show.” Children are less frequently diagnosed with COVID-19 than adults — however, without widespread testing in children with and without symptoms, we cannot yet understand the full spectrum of disease (and transmission) risk in children.
Reports of apparent infections in schools also need context. A recent headline stated, “Florida confirms 9K new COVID-19 cases within 15 days as schools reopen.” In fact, only 714 of these cases were linked to educational settings, which also included colleges and universities, and there was little attempt to determine whether these infections were acquired within the schools themselves. Where community transmission rates are high, as in Florida, it is expected that people with COVID-19 will enter schools. For decisions in places like Massachusetts, where community rates are low, what matters more is how well we can prevent those rare infections from spreading inside schools.
While acknowledging the limits of each new scientific finding, responsible reporting by media and researchers alike should also include what we do know about how to prevent both the introduction and the spread of infection in schools. We know that the lower the incidence of COVID-19 in a community, the lower the risk that someone with COVID-19 will be present at school. Rates in most communities in Massachusetts are among the lowest in the United States, similar to rates in European communities where schools were opened successfully. If a child or adult with COVID-19 does enter a school, we know that strategies like masking, distancing, hand hygiene, and contact tracing are highly effective, as shown in child care programs in Rhode Island, summer camps in Maine, and schools in England. Alternatively, when schools are opened without proper social distancing or mask usage (e.g. in Israel), outbreaks can occur.
Decisions about school reopening need to balance the harms of remote learning (with respect to social and emotional development, academic progress, food security and obesity, physical safety, and mental health, and even potential exposures in learning pods and childcare settings) against the risks and consequences of in-school COVID-19 transmissions, particularly for vulnerable children. These decisions must be made in the face of uncertainty.
We owe it to our community to share new scientific information about the coronavirus as it is learned, but also to avoid sensationalist and misrepresentative reporting. Researchers must carefully explain, and media outlets must carefully report, how each new finding fits into the growing understanding of COVID-19. Political leaders, educators, and parents deserve to understand both the science and the limitations in our understanding as we face these difficult decisions.
Dr. Andrea Ciaranello is an infectious disease specialist at Massachusetts General Hospital and Harvard Medical School. Dr. Lloyd Fisher is division chief of community pediatrics at the University of Massachusetts Medical School and president of the Massachusetts chapter of the American Academy of Pediatrics. Dr. Christina Hermos is a member of the Division of Pediatric Immunology and Infectious Diseases at the University of Massachusetts Medical School. Dr. Safdar Medina is a pediatrician at the University of Massachusetts Medical School. Dr. Sandra B. Nelson is an infectious disease specialist at Massachusetts General Hospital and Harvard Medical School. Editor’s note: Dr. Nelson is a medical adviser to the Massachusetts Department of Elementary and Secondary Education.