As we get ready to reopen schools, here is what we can learn from other countries

(Leah Hogsten | The Salt Lake Tribune) Parents and students within the Salt Lake City School District rally for K-12 students to return in-person to school this fall, July 15, 2020.

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We are between a rock and a hard place.

If we open schools in Utah and throughout the nation, we are taking a huge risk with the health of our citizens. Because of limited data, we truly do not know how opening will affect the likelihood that students, teachers, and the community at large get the coronavirus. We do have some information on safety measures that have been tried — and discussing them will be the bulk of this article — but no school system in the world has opened in a community facing as many coronavirus cases as we are now.

On the other hand, if we don’t open schools, we are lowering the quality of life for many. Our kids will lose footing in a global market for talent, our parents won’t be able to fully return to work, and the strain it will put on both — from a mental and physical perspective — may well be too much to bear. That, too, will be discussed in this article.

It didn’t have to be this way, but our failure to control the virus has made it so. Given the set of facts we face, we have to make a decision. Our focus has to be harm minimization. Even the best possible decision will still bring pain to many.

With that in mind, let’s give it our best shot.

Sweden vs. Israel

As we looked at the data early on, one lesson was clear: children are less susceptible to the disease. As Science magazine concludes, kids are one-third to one-half less likely to contract the virus in the first place. Both younger kids and teens largely have mild illnesses when infected, but research points to kids younger than 10 being very poor transmitters of the disease, while teens are relatively contagious.

We don’t have great data on the long-term effects of contracting the disease in either group, but it’s clear that adults are more likely to have significant consequences than teens. And as much as we need to consider the health of students, the teachers are also a pretty key part of the equation.

Still, the promising news about COVID-19 in children gave some countries enough impetus to open schools. The “keep schools open without restrictions” approach is perhaps closest modeled by Sweden, the country that has made the fewest changes in all facets of life. Sweden implemented one big restriction: they closed high schools from 10th grade on up from March 18 to June 14. But schools from K-9 stayed open without rules on class sizes, social distancing protocols, or different lunch or recess policies. They just went for it with the younger kids.

The result hasn’t been catastrophic for students or teachers in Sweden. One study compared the number of detected cases among school-age children there to neighboring Finland, a similar country in many demographic and societal respects, and found no differences. School teachers at every level did not have significantly more risk of coronavirus cases or death than people in other professions. On the other hand, Sweden did see significantly more spread overall than its Scandinavian neighbors, and so it’s certainly possible that schools played a role. In serological surveys, 4.7% of Swedish kids had coronavirus antibodies, while 6.7% of adults 20-64 did.

Students run celebrating their high school graduation at Nacka Gymnasium in Stockholm, Sweden, on Wednesday June 3, 2020. After being subject to distance teaching since March due to the coronavirus, students got their grades at school, though only two relatives were allowed per student to receive them outside. (Jessica Gow / TT via AP)

Then there’s the experience of Israel. There, they had fewer than 300 deaths and a small number of cases in the country on May 3, so they decided to open schools. At first, they did so with limited class sizes, but then they decided to open it up to everyone two weeks later. Teachers and students older than seven had to wear masks, but no other protocols were in place.

Three weeks later, 139 schools had been indefinitely closed. One middle/high school saw 153 students and 25 staff members infected before shutting down, but even an elementary school had 33 cases in students and five staff members infected. Cases in the country spiked. Last week, Israel announced all schooling for those beyond 4th grade should be remote for now.

A classroom is empty at an elementary school in Tel Aviv, Israel, Thursday, April 30, 2020. Israel is considering reopening some elementary school classes starting Sunday. (AP Photo/Sebastian Scheiner)

Why was Sweden’s and Israel’s experience so different? That Sweden locked out their older kids, while Israel didn’t, is one possible explanation. One other factor may have been class sizes: Israel’s classes have an average of 27 kids, while Sweden averages 19.

Class size is a big issue in Utah. As of 2017, Utah’s class sizes ranked as the largest in the nation. There were an average of 26.6 kids per class overall, 24.2 in elementary schools and 29 in high schools.

Israel is planning on reopening schools again, but they’re limiting classes to 18 students and hiring huge numbers of new teachers to do so. For middle and high schools, students will learn at home for all but one day per week.

Other restrictions possible

Of course, that’s just two nations. Other countries have opened schools with various risk management protocols, and we can learn from their experiences as well. Researchers at the Washington State Department of Health in partnership with the Metacenter for Pandemic Preparedness at the University of Washington have summarized these approaches.

Israel’s new class size restriction is a common approach for the other countries that have opened schools successfully. Belgium, Denmark, France, Germany, Greece, South Korea, Norway and Switzerland have either limited classes to 10-15 students or 50% capacity.

Students, wearing face masks and paying attention to social distancing, study at Les Magnolias primary school during the partial lifting of coronavirus, COVID-19, lockdown regulations in Brussels, Monday, May 18, 2020. Belgium is taking the next step in its relaxation of the coronavirus lockdown on Monday, with more students going to school, markets and museums reopening and the snip of a barber's scissors filling the air again. (AP Photo/Francisco Seco)

In order to do so, they’ve had to take some drastic steps. Some have closed high schools and reallocated those teachers and classrooms to elementary education. In Germany and South Korea, students attend half days: some students take morning classes, the rest go to school in the afternoon. In Belgium and Switzerland, they alternate days of in-person education. Typically, when the students are out of school, they’re either given online instruction or workbooks.

Scotland hasn’t opened yet, but plans to Aug. 11. It has some good ideas about how to achieve class size limitations, including hiring former teachers, expanding classroom space by using libraries, community halls, and conference venues. Scotland’s schools are even renting vacant business spaces.

A writing on the ground remind students to keep distance as they arrive at a reopen primary school in Cologne, Germany, Monday, May 11, 2020. Germany eases the restrictions to contain the corona virus most of the federal states. (Henning Kaiser/dpa via AP)

Many of these countries also implemented the “cohort” method of separating students. The idea is to reduce intermingling so if a student or teacher does test positive, you only have to quarantine a dozen students rather than the whole school. This also means staggering break times, so each class gets its own turn on the playground or in the cafeteria. Obviously, this is easier with elementary school schedules, where students typically already spend most of their day with one teacher, than it is with high schools.

When it comes to face masks, schools in Belgium, France, Germany, Israel, Japan, South Korea, Taiwan, and Vietnam have some requirements, though as Israel showed, masks alone won’t lead to success.

That makes some sense based on what we know about how the virus is spread: while masks block big droplets that carry the disease, smaller ones that may linger longer in the air are still let through. Masks help, certainly, but given the amount of time students are spending in classrooms, aerosolized virus is still a threat.

And in Utah, students who will be in a classroom are expected to wear one.

Students wearing masks attend a class in Dinh Cong secondary school in Hanoi, Vietnam Monday, May 4, 2020. Students across Vietnam return to school after three months of studying online due to school closure to contain the spread of COVID-19. (AP Photo/Hau Dinh)

In Germany, some schools test students every four days. If they test negative, they don’t have to wear a mask.

Surface transmission of the disease has been found to be more rare, but many countries are still taking precautions. In Denmark, students are told to wash their hands hourly. In Norway, students are taught to wash their own desks daily.

In many Asian countries, dividers were used to separate students when distancing wasn’t possible in the classroom and in the cafeteria.

FILE - In this May 20, 2020, file photo, senior students wait for class to begin with plastic boards placed on their desks at Jeonmin High School in Daejeon, South Korea. Students have begun returning to school. As South Korea significantly relaxes its rigid social distancing rules as a result of waning coronavirus cases, the world is paying close attention to whether it can return to something that resembles normal or face a virus resurgence. (Kim Jun-beom/Yonhap via AP, File)

Taiwan, Japan, and South Korea also added daily temperature checks to the mix.

It’s worth noting that none of these reopenings happened when cases were as high as they are now in the United States or Utah specifically. Even in the countries that took massive precautions, the virus wasn’t as widespread as it is here.

That risk has been clear as some summer camps have opened in the United States.

Kanakuk, a Christian summer camp in Missouri, had a 31-point list of precautions. They asked campers to quarantine for 14 days before attending. They separated campers into groups of eight or 10, with cabins that had “NASA developed” air filtration units. Anytime campers were indoors with people not in their cabin group, they wore a camp-provided mask that were washed daily. They took temperature checks daily. The camp limited vendors, avoided shared objects, and forbade high-fives and handholding while saying grace.

On June 26, Kanakuk found two positive COVID-19 cases in their K-2 camp. By July 2, 82 cases among campers and staffers had been confirmed. The county health department is no longer releasing figures of how many people are part of the Kanakuk outbreak. Summer camps aren’t exactly like school — there is additional danger added by people sleeping in the same facilities, certainly — but it shows there is risk in getting kids together as cases spike, even with precautions taken.

The risks of no school

And yet, there’s a cost to our kids not attending school in person.

First, the research is clear: distance learning has not been as effective. A working paper from the NWEA estimated that students will return to the 2020-21 school year with “63-68% of the learning gains in reading relative to a typical school year, and with 37-50% of the learning gains in math.” One-third to two-thirds of our educational gains, wiped out just like that.

These losses are not universal. Kids in low-income homes are more likely to experience greater losses than those with more resources. The New York Times cited numbers from the Harvard Opportunity Insights team using data from Zearn, an online math learning suite. Through late April, they found “student progress in math decreased by about half in classrooms located in low-income ZIP codes, by a third in classrooms in middle-income ZIP codes and not at all in classrooms in high-income ZIP codes.”

That makes sense: it’s easier to stay engaged with a working laptop, high-speed internet and a full kitchen of snacks. Many kids don’t have those resources, and some countries and districts are scrambling to get their students access to the technology needed for distance learning.

But there are other negative impacts, too. Some parents will have to stay home to care for their children and some jobs aren’t as flexible. It means some will have to give up their jobs. For those parents who can work from home, keeping their children focused on assignments means they’re simply less productive. Again, resources are a major factor. If a family has only one computer, mom can’t attend a Zoom meeting at the same time her daughter virtually attends class.

There are obvious health detriments to getting COVID-19, but there are also health detriments to staying at home. Mental health is deteriorating among children, as detailed in this article in The Lancet. In a survey of 2,111 people under 25 with a mental health history, 83% said the pandemic had made their conditions worse. In Hong Kong, more than 20% of students surveyed said their stress levels were a 10 out of 10.

The Lancet article also cites higher rates of “child abuse, neglect, and exploitation” during the Ebola epidemic in West Africa, and worries that COVID-19 will lead to a similar finding. Social scientists worry about what the lack of socialization will do to kids as well.

The lack of school also impacts kids’ diets in a way that hurts their physical health, on both ends of the spectrum. On one hand, some low-income kids miss meals that their school would otherwise provide. One study estimated that just three days of missed school could mean 405,000 missed meals for kids in Philadelphia.

But for mid and high-income children, the problem is on the other end of the scale — most of them see weight gain during the summer months. A 2016 study found that for kids from kindergarten through second grade, obesity and overweight prevalence only grows during the summer, not during the school year when their diet is more controlled. A longer break likely means more growth, and not in a good way.

Deciding what to do

Again, there aren’t any good options here, only less bad ones. That’s kind of the deal with pandemics — they’re bad news bears. They’re even worse if you fail to control them on the scale that we have as a state and nation.

In my opinion, the evidence from other nations most clearly supports a return to school that includes some of both in-person and distance learning. That allows class sizes to be smaller, as kids spend half of their time at home, making it easier to provide the kind of social distancing that is significantly more likely to keep students and teachers safe. It also limits the amount of exposure kids have to the virus, in terms of both the number of students they’re exposed to and the amount of time they spend around those who are sick. Masks help, but aren’t sufficient on their own.

The situation is better for younger kids, who are less good at transmitting the disease to each other and to adults. It’s much easier to gather younger kids in classes that can be flexibly quarantined if need be. Also, older kids probably get more out of distance learning, and they’re a little bit better at adapting and understanding social distancing restrictions. We should treat these groups differently to highlight their relative strengths.

Quite frankly, we should allocate more money to schools in order to make this happen. We can access rainy-day funds. We can issue bonds.

Our policies will have to be flexible, based on the rate of spread in our local community. Some districts will have more harsh restrictions because the virus is more dangerous there. Outbreaks will occur, and some classes or schools may have to temporarily close to disinfect. If the situation gets worse, more distance learning will have to happen.

This is where the pandemic gets personal for many people, and I do not envy school administrators or district officials one bit — the number of calls they’re going to get from angry parents no matter what they do is going to be sky-high. They have until Aug. 1 to finalize their plans in Utah.

There will be sleepless nights for everyone involved: teachers, parents, politicians. It is the worst of times. And yet, all we can do is the best we can do. At this time and on this subject, we need to work together more than ever before. Doing so gives our kids — our future — a chance to stay afloat.