Are We Going Back To School?

Online school was tough for us. I’m not going to lie. When the schools closed in March, I lost any semblance of work/life balance, and our household was not a happy place.

We spent the first few weeks ignoring the online school effort and doing our own thing. Kids miss school for many reasons: Illness, hospitalizations, travel, stuff happens. And kids are usually OK. We figured, Hey, we have books, art supplies, and LEGOS. Let them read, let them create, let them build! They’ll be fine, it’s only going to be a few weeks.

But March led to April. The Massachusetts COVID-19 numbers were appalling, I got pulled to inpatient duty, and we realized school was not going to re-open. So one evening I ran to Target and plunked down the cash for the last two Chromebooks in the store.

I hated that we had to have these things, because we’ve been so good about limiting screens and machines for our kids. They’ve never even played video games. (They’re eight and ten years old BTW.) But if we were going to do the online school thing, the kids needed their own devices, and I had high anxiety about the high probability of our kids breaking any school-provided equipment, and we could afford them, so I lugged those big boxes home.

Online school did NOT go well at first, at all. But our son has autism and is on an IEP, so his teachers created a daily hourlong one-on-one session just for him. Once he was able to connect directly with his own teachers and didn’t have to deal with the rest of the class, he did fine. Then my mom offered to join our quarantine bubble so she could help with the kids’ schoolwork, and he truly blossomed. He dutifully completed his assignments and then happily turned to his “fun” stuff: Hours and hours of LEGO mechanical engineering, stop motion filmmaking, and world history, sometimes all combined. His confidence has soared. We may never send him to real school again.

Our daughter, on the other hand, completely crumbled, and we never got a handle on online school for her. Despite the fact that her teachers were willing to ‘meet’ with her one-on-one, she would not, not, not participate in any ZOOMs, nor log onto the school website. We all gave up and literally printed out her assignments and scanned them back to her teachers at the end of the day. She was so emotional throughout the whole ordeal, we considered therapy, but ended up getting a puppy instead. (Which was a good call!)

Now, here we are almost in August. I have no doubt our daughter would be happier going back to in-person school, but I have my doubts school will stay open for long even if they try. Yes, Massachusetts managed to escape the worst-case-scenario surge. But our numbers are simmering. And we know that when numbers are simmering, they can easily spike.

According to the evidence-based academic-affiliated website CovidActNow, here is today’s Massachusetts infection snapshot below. Note that we’re in the “yellow” zone, which indicates that the virus is still spreading in the community:

This website is really cool because you can see what the same metrics were at any point going back to early March. So we can see that at the end of April, there were 35.9 daily new cases per 100k population (which was totally in the red zone), and we were using 79% of our ICU beds. We do NOT want to head in that direction, people.

And we are. Let’s talk about the infection rate, which is the number of other people that a person with COVID-19 could infect, if they walked into a room crowded with unsuspecting non-immune humans and started coughing. The fancy epidemiological term for this is “reproduction number” and is abbreviated R0 (pronounced R-naught) and apparently is used in alot of movies, like Contagion, which I never saw. If the R0 is anything over 1, and no one is immune, then whatever the disease is could spread exponentially. The WHO estimates the R0 for SARS-CoV-2 to be between 1.4 and 2.5.

But the R0 doesn’t tell us what is happening in real time, when people are wearing masks and washing their hands and maybe some people have already had it so they’re immune. For that, we need a different number. Explained by some really smart Dengue fever experts who published in Nature:

“...the basic reproductive number (R0) is a fundamental measure used to quantify the transmission potential of an epidemic in public health practice. However, R0 cannot reflect the time-varying nature of an epidemic. A time-varying effective reproductive number Rt can provide more information because it tracks the subsequent evolution of transmission.” 

So the Rt is the real-time R0, and we can refer to it as our infection rate. (I’ve also seen the same number abbreviated Re, but I like Rt better. It sounds like Real time.) Some experts have suggested that if the infection rate is above 1, we should be shutting down again. Why? Because science. Seriously. We know from studying other viruses that if each infected person can infect more than 1 other person, then a virus can spread exponentially.

Let’s go back to that graph on the CovidActNow website and see how our Rt, or infection rate, has evolved. We had an Rt of 2.3 back in March, which then dropped to 0.74 in early June (way to go, Massachusetts!)… and now is back up to 1.07 today (What are you thinking, Massachusetts?). Another site has our Rt at 1.05, which is not substantially different. So… We’re over 1, and that curve is curving upwards.

Ugh. This is not good, people. Some experts would argue that we should be shutting down again. What are we doing, letting people gather indoors to eat and drink, and talking about reopening schools?

Welp, maybe we know enough about the virus to do this safely. I mean, we know that certain basic measures can help prevent the spread of virus. I think back to my time on the surge wards: There were hundreds of healthcare workers pouring into our hospital every morning, pulling twelve-hour shifts in very close proximity to one another, surrounded by patients actively sick with COVID-19. On our ward, we had three, four, five, six, sometimes even more physicians and NPs and PA’s and RN’s in the workroom or the nurses’ station for good long stretches of time, talking and discussing, all indoors, and NO ONE I KNEW OF GOT SICK.

You could argue that’s anecdotal evidence, and it is, but the official numbers reflect the truth of my experience. At the height of the surge back at the end of April, our staff infection rate (14%) was far below the community infection rate (22%), suggesting that people weren’t getting infected at work. (Those numbers were emailed to us weekly by our hospital officials.) How can this be? PPE, baby. Those masks work. And our obsessive hand washing. And that none of us ate or drank while on the floor. (Well, maybe sometimes but VERY CAREFULLY.) This is why healthcare workers need masks, gloves, and gowns. Because when used correctly and combined with hand washing and being careful, they work.

So, if we extrapolate my experience and those data to the school situation, we should be good, right? I mean, our surge ward was literally full of patients coughing coronavirus, it was clouds of virus all around, crowded with personnel, and we didn’t get sick. In-person school should be a cinch, right?

Nope. I don’t think for one second that it’s an applicable analogy, and here’s why. Many people are not taking the virus as seriously as we did. They’re getting together, indoors and outdoors, without face masks. They’re shaking hands, sharing meals, flying places. And now they’re going to restaurants and stores, too. As the reopening phases march forward, people are getting complacent, and our rising infection rate reflects that.

I also worry it will be hard to make kids to wear face masks all day, or for the staff to enforce strict distancing and monitor hand washing. I worry that schools will struggle to obtain necessary cleaning supplies and equipment. If the community is getting sloppy, the supplies run short, the protective measures are iffy, and the infection rate is already over 1, then it’s a pretty sure thing that we’ll see a spike in cases come fall.

One of the best evidence-based articles I’ve seen on this was in Science last week. They looked at the data from school reopening around the world and saw these patterns:

“…a combination of keeping student groups small and requiring masks and some social distancing helps keep schools and communities safe, and that younger children rarely spread the virus to one another or bring it home. But opening safely, experts agree, isn’t just about the adjustments a school makes. It’s also about how much virus is circulating in the community, which affects the likelihood that students and staff will bring COVID-19 into their classrooms.”

The article details the successes and failures of many countries and cultures. Experts from the Harvard School of Public Health created guidelines for school openings based on similar evidence. The authors wrote an OpEd for the Boston Globe in which they also raise concern about Massachusetts being in the “yellow” zone with an infection rate over 1, and suggest that we’ll have a much greater chance of success if we get that level down, now.

And maybe we can. If politicians and policymakers apply the brakes to reopening indoor spaces, and if people wear masks and distance consistently, maybe we can get our infection rates trending downwards again before the fall.

And then if we’re creative and resourceful about planning, and schools get the money to buy the supplies they will need, maybe we have a chance of keeping schools open past September. Maybe classes can be outdoors as much as possible, groups can be kept small, kids will wear masks, and their families will be really careful. It’s a lot of maybes.

Us, personally, we don’t know yet if we’re going back to school. We’re watching the numbers and keeping our minds open. We may have one kid home and one kid at school, who knows. I’ll keep you posted…