The Truth About Kids, School, and COVID-19

We’ve known for months that young children are less susceptible to serious infection and less likely to transmit the coronavirus. Let’s act like it.

(CHRISTOPHER LEE / THE NEW YORK TIMES / REDUX)

Federal health officials at the CDC this week called for children to return to American classrooms as soon as possible. In an essay in the Journal of the American Medical Association, they wrote that the “preponderance of available evidence” from the fall semester had reassured the agency that with adequate masking, distancing, and ventilation, the benefits of opening schools outweigh the risks of keeping kids at home for months.

The CDC’s judgment comes at a particularly fraught moment in the debate about kids, schools, and COVID-19. Parents are exhausted. Student suicides are surging. Teachers’ unions are facing national opprobrium for their reluctance to return to in-person instruction. And schools are already making noise about staying closed until 2022.

Into this maelstrom, the CDC seems to be shouting: Enough! To which, I would add: What took you so long?

Research from around the world has, since the beginning of the pandemic, indicated that people under 18, and especially younger kids, are less susceptible to infection, less likely to experience severe symptoms, and far less likely to be hospitalized or die. But the million-dollar question for school openings was always about transmission. The reasonable fear was that schools might open and let a bunch of bright-eyed, asymptomatic, virus-shedding kids roam the hallways and unleash a pathogenic terror that would infect teachers and their families.

“Back in August and September, we did not have a lot of data” to make a recommendation on schools, Margaret Honein, a member of the CDC’s COVID-19 team, told The New York Times. Okay, but September was 100 days, 15 weeks, and several dozen remote-learning school days ago! Meanwhile, anybody paying attention has long figured out that children are probably less likely to transmit the disease to teachers and peers. This is no longer a statistical secret lurking in the appendix of one esoteric paper. It has been the repeatedly replicated conclusion of a waterfall of research, from around the world, over the past six months.

In May 2020, a small Irish study of young students and education workers with COVID-19 interviewed more than 1,000 contacts and found “no case of onward transmission” to any children or adults. In June 2020, a Singapore study of three COVID-19 clusters found that “children are not the primary drivers” of outbreaks and that “the risk of SARS-CoV-2 transmission among children in schools, especially preschools, is likely to be low.”

By September, many U.S. scientists were going on record to say that transmission in schools seemed considerably rarer than in surrounding communities. “Everyone had a fear there would be explosive outbreaks of transmission in the schools,” Michael Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota, told The Washington Post. “We have to say that, to date, we have not seen those in the younger kids, and that is a really important observation.” Throughout the fall, the evidence accumulated. “Schools do not, in fact, appear to be major spreaders of COVID-19,” Emily Oster, an economist at Brown University, wrote last October in The Atlantic, summarizing the conclusions of her national dashboard of school cases.

In a January 2021 paper, a team of Norwegian researchers traced more than 200 primary-school children ages 5 to 13 with COVID-19. They found no cases of secondary spread. The findings “demonstrate the limited role of children in transmission of SARS-CoV-2 in school settings,” they wrote. Another study by researchers at Duke University of 35 North Carolina school districts with in-person teaching found no cases of child-to-adult spread in schools. They concluded that typical mitigation policies, such as masking and physical distancing, are sufficient to prevent school outbreaks. “Our data indicate that schools can reopen safely,” they concluded, as long as such policies remain in place.

If you have been intermittently following the news about COVID-19 transmission and children and remember only the scariest reports, you likely have two questions. What about that scary South Korean study? and What about that horrible summer-school outbreak in Israel?

Let’s start with South Korea. In July, a large Korean survey found that children ages 10 to 19 spread the coronavirus about as efficiently as, or even more aggressively than, older adults. (It found that kids under 10 did not transmit the virus as much.) This frightening conclusion was widely interpreted to rule out the possibility of in-person school for any children in fifth grade or above. But in August, the same Korean research team caveated those conclusions, saying it couldn’t prove whether the children in the study were infecting their parents, or whether those parents were infecting their kids, or whether entire households were being exposed by a third party.

More infamous was the reported outbreak at a Jerusalem high school over the summer, which made headlines around the world. The New York Times’ summary was representative: “When Covid Subsided, Israel Reopened Its Schools. It Didn’t Go Well.” Here’s how the Times described the outbreak:

The Israeli government invited the entire student body back in late May. Within days, infections were reported at a Jerusalem high school, which quickly mushroomed into the largest outbreak in a single school in Israel, possibly the world. The virus rippled out to the students’ homes and then to other schools and neighborhoods, ultimately infecting hundreds of students, teachers and relatives.

The Israeli lesson seemed simple: If you open your schools, cases will explode, the outbreak will reverberate throughout the country, and people will die.

Except it wasn’t that simple. Last week, a follow-up study of the Israel cluster found that what had been universally described as a school outbreak was really nothing of the sort. At the same time that Israel reopened schools, it eased restrictions on large group gatherings. “Easing restrictions on large scale gatherings was the major influence on this resurgence,” the authors concluded. “No increase was observed in COVID-19 … following school reopening.” The causal chain described by The New York Times was backwards. The real story went like this: Relax social-distancing measures in your community without vaccines, see cases explode, and then watch the outbreak ripple into schools.

As the evidence of children’s COVID-19 risk has diminished in the past six months, the evidence that families are struggling with school closures has mounted.

“If you ask me whether we are doing our duty as a society to look after children, my answer would be ‘No, I don’t think so,’” Matthew Snape, a pediatric researcher at the University of Oxford, told me. “There is clear evidence that shutting schools harms students directly, in terms of both their education and their mental and social health.”

Although the long-term scholastic and social effects of a year of remote learning on this generation of children are not yet clear, what we know already is damning enough: Remote learning has gutted public schools as high-income parents pull their kids into private schools and bespoke learning pods. Calls to mental-health hotlines have increased. In Las Vegas, home to the nation’s fifth-largest school district, a cluster of student suicides has pushed local officials to phase in elementary schools. More indirectly, school closures also result in the delay of immunization programs, interrupt free-lunch programs, and make impossible the edifying effects of play.

Nobody should claim that children cannot transmit this virus, or that schools are “safe” during the pandemic the same way that, say, talking on the telephone with a sibling who lives 2,000 miles away is safe.

But people under 18, and young children especially, are less susceptible to infection, less likely to experience severe symptoms, less likely to be hospitalized or die, and less likely to transmit the disease than older teenagers and young adults. Scientists aren’t entirely sure why, but one theory is that it has something to do with the way the virus docks with our cells. Coronaviruses are covered by a halo of spike-shaped proteins (that’s where the name comes from: corona, as in crown). These spikes are thought to attach to another protein on the surface of our cells called ACE2. Children have lower levels of ACE2 in their nasal tissue than adults do. That suggests that, under this theory, kids would provide fewer open ports for the virus to dock, invade, and ransack the rest of the body.

Overall, school cases are a reflection of their environment. If COVID-19 is running rampant through your town and you throw a bunch of kids and adults into a building without any safety protocols, the odds are pretty high that you’re going to exacerbate an outbreak. But as cases fall across the country we have to adjust the risk calculus. The choice before us is not between “Keep the schools closed until COVID-19 is eliminated, smallpox-style, from the face of the Earth” and “Open every school immediately.”

Instead, the United States needs a focused framework, guided by science and common sense, for how to open schools as safely and as soon as possible, considering the risk to students and parents from closed classrooms, while keeping teacher fears front of mind. That plan would look something like this.

• Reopen the lower schools. Start with day cares and elementary schools, given their reduced transmission risk.
• Enforce COVID-19 protocols both within schools and throughout the community. That means mandatory mask wearing in public and social distancing. It also means public officials should encourage “library rules” in public space—keeping quiet, or talking in whispers.
• Accelerate vaccination procurement and distribution. The U.S. could be well below 100,000 daily COVID-19 cases by the middle of February, at the current rate of decline. The faster we vaccinate, the faster we can get back to normal.
• Distribute high-quality scientific information. Most important, educate teachers about the lower transmission risk of young students—and the ongoing necessity of COVID-19 protocols—to get their enthusiastic buy-in, which will naturally be contingent on our success at reducing community spread and accelerating vaccination.

I don’t blame teachers for keeping schools closed yet. I blame the government and the media. Public communication about this disease has been horrendous, and the Trump White House was a fount of nonsense. Meanwhile, some journalists and professionals, in an attempt to fight back against Trump’s disinformation, leaned too heavily into COVID pessimism and clung to outdated fears about secondary spread among young kids. That’s made a lot of people unnecessarily concerned that kids are silent vectors for this disease, and made teachers feel like they were being thrown to the wolves in a country that has failed in just about every pandemic test. If I were a teacher relying on information from the mainstream press—especially a teacher in a pandemic pod that included immunocompromised relatives—I might be pretty scared of going back to school.

Under the banner of safety, too many people have passed along alarmist information that has contributed to a lot of misery. Americans have to learn, and accept, that the preponderance of evidence simply doesn’t support the fears that govern school policy today.