The message dinged our phones on Oct. 27: “Not great news, but a friend just shared there are six confirmed COVID cases in the fourth-grade class.”
The group chat of parents and caregivers of third-graders at the Manning Elementary School in Jamaica Plain is usually about misplaced homework and after-school activities. This was something else, and it eventually became clear that the Manning School was facing the largest COVID-19 outbreak of the year in Boston Public Schools — now surpassed by the Curley K-8 School in Jamaica Plain and Orchard Gardens in Roxbury in total cases.
Each of us has children at the Manning School. We work in pediatrics, internal medicine, infectious diseases, and public health. The back-to-back outbreaks at three BPS schools is a cautionary yet insufficiently understood tale for all schools grappling with how to keep children healthy and in classrooms. To learn from these outbreaks — including gaps in prevention and response — an epidemiological investigation by the Centers for Disease Control and Prevention is urgently needed.
BPS appeared caught off guard as cases climbed. The school district had seven contact tracers for 51,000 students and over 10,000 staff. That might explain why several caregivers whose children tested positive for COVID-19 or whose children met the CDC definition of “close contact” were never contacted by a contact tracer.
During the first week of the outbreak, days passed with limited in-school testing. That was partially due to state-level directives that forbid “opt-out” consent policies for testing. Opt-in testing requires parents to enroll their children with an online form, creating a hurdle that decreases testing rates, while opt-out testing automatically enrolls all students with an option to decline. There appeared to be no plan to pivot from a testing strategy designed for sporadic cases to one suitable for outbreaks, with entire classrooms likely exposed.
Our principal began calling families that had not yet consented to testing, quickly achieving a 93 percent consent rate. She then began administering rapid tests daily, swabbing noses of every consented child herself. This approach was possible at the Manning (with only 160 students) and probably curbed transmission. When the much larger Curley School attempted a similar approach, the system became overwhelmed. The Curley is now temporarily closed.
Insufficient communication left families dependent on intel from other caregivers. About one-third of families kept their children home during the outbreak, fearing in-school transmission. Fewer students in classrooms may have limited spread — however, it also meant fewer kids were getting tested at school. Updates to the BPS COVID-19 dashboard were so delayed they were not useful for real-time decision-making.
At the Manning, school leadership established mitigation measures beyond what BPS requires — including outdoor lunches. We’ve heard that staff vaccination rates are high. (But we’ve also learned “possible” teacher-to-student transmission occurred and that unvaccinated individuals may have contributed to transmission.) Despite the precautions, our school outbreak exploded to 18 cases — not including cases among family and community members.
The Boston Public Health Commission and the Massachusetts Department of Public Health should invite the CDC to conduct an epidemiological investigation — which would include support by Epidemic Intelligence Service officers. CDC assistance, which must be requested by local health authorities, is the way forward to facilitate learning and action — for school communities in Boston and throughout the country — and to ensure independence from local politics. Implementing policies based on what is learned from the investigation would allow for changes that are informed by evidence and address the gaps that led to the outbreaks.
We are encouraged that children ages 5-11 are now COVID-19 vaccine-eligible — and hopeful that many BPS students will be immunized. But pediatric vaccinations will take time, may not be equitable, and our youngest learners are not yet eligible — leaving school communities vulnerable. Discouraging rates of participation in pooled testing across the district also continue to limit surveillance.
We are relieved that the Manning outbreak is contained, but containment happened after more than 10 percent of students tested positive. We remain concerned by the other two school outbreaks — and the increasing cases across BPS and the state. We are also aware that more transmissible vaccine-resistant variants may emerge.
State-level directives, resource constraints, and staffing shortages have probably contributed to the outbreaks. Those hurdles provide further justification for an extensive investigation so that schools can prioritize funding and advocacy toward the most critical gaps.
When half of a first-grade classroom tested positive for COVID-19 in Marin County, Calif., in May, the CDC investigated and revealed the risks associated with unvaccinated staff and poor adherence to prevention strategies.
Roughly half of the fourth-grade at the Manning School have tested positive. Our confidence in BPS strategies has eroded. Yet we continue to drop our children off at school, not knowing what we or BPS could have done — and can do — to better protect our children, their peers, and their teachers.
Kate Mitchell Balla is a doctoral candidate at the Boston University School of Public Health. Mei A. Elansary is a pediatrician at Boston Medical Center. Bevin E. Kenney is a primary care internist at Brookside Community Health Center. Philip A. Lederer is an infectious diseases physician at Uphams Corner Health Center.