Aaron E. Carroll: We should close the schools last, not first

As the surge of coronavirus infections in the United States becomes undeniable, many leaders throughout the country are reacting by calling for closures. Bizarrely, they almost always seem to focus on schools first. That’s exactly the opposite of what they should be doing.

Don’t get me wrong. With cases climbing to levels we haven’t seen before, we need to restrict our physical interactions. But we should do so rationally and in an evidence-based manner. We should figure out what poses the greatest danger and act accordingly, instead of automatically asking schoolchildren to bear the brunt of the pain.

We should not be having large weddings. We should not be going to public events. We should not be eating indoors at restaurants. We should not be drinking indoors at bars. These are the activities responsible for a vast majority of transmissions, and these should be the focus of our initial interventions.

Schools are different. Cases have definitely been more common in school-age children this fall. But when schools do the right things, those infections are not transmitted in the classroom. They’re occurring, for the most part, when children go to parties, when they have sleepovers and when they’re playing sports inside and unmasked. Those cases will not be reduced by closing schools.

It’s not even clear how some areas derive their thresholds for closing schools. Some places, like New York City, have declared that schools might close if positivity rates reach 3 percent. Other areas have much higher thresholds, like 10 percent. Some have none at all.

None of this is based on statistical modeling or science. Positivity rates are affected by testing rates as much as by prevalence of infection, and no one should be under the illusion that we’re identifying the majority of cases through our testing of symptomatic people. To do that, we’d need to engage in random-sample asymptomatic testing as well. Until then, we need to use a variety of signals, including analyses of who is getting infected and where.

The playbook for keeping schools as safe as possible has been understood for many months. First, classrooms need to be less dense, so that students are sitting at least six feet apart at all times. Some classrooms may not be able to accommodate this, but there are often other school spaces that can be used for learning, like auditoriums and libraries. Vacant hotel ballrooms, office buildings, gyms and theaters could even be converted into temporary classrooms.

Second, class start and end times need to be staggered so students aren’t bunched together in the halls. Likewise, schools need to make sure students eat apart, and certainly are not confined to one lunchroom.

Third, students need to be universally masked. Before anyone says that kids will refuse this, as a pediatrician and a father I can assure you that at some point in their lives, children also refuse to wear pants. They’ll learn.

Finally, we need to recognize that some teachers are at higher risk than others, and be thoughtful in how we protect them. We need to invest in rapid, repeated testing schemes to provide an added layer of protection. Many colleges and universities have figured this out.

Following this playbook will require billions of dollars from the federal government, but the costs are well worth the investment. Education is hugely important. Unfortunately, our schools are not, for the most part, prepared to deliver high quality educational content online. Kids are also social animals and need safe in-person interactions for their mental health and development.

Schools are necessary for the economy as well. If they are not open, many parents cannot work, even if they’re doing so from home.

Closing schools also exacerbates social and economic disparities. In some cities, especially in poorer areas, as many as one in three children didn’t — or couldn’t — take part in online learning when schools across the country were closed in the spring. Students who fall behind will have an incredibly difficult time catching up. They will be less likely to graduate, with enormous, lifelong consequences.

There may come a time when the pandemic has become so unmanageable that we need to close everything, including schools. (This was the case when I argued that closures were necessary back in March.) But schools are essential, and should be treated as such. When we prioritize, they should be among the last things to close. Almost everything else should be put on pause first. This is what Europe is doing. No one can explain why, once again, the United States is choosing its own path.

Because schools are not the major cause of the problem, shutting them down won’t do enough on its own to slow the spread of the disease. When — not if — businesses are forced to shutter temporarily in the near future, we can tide them over with money, and we absolutely should. When schools are closed, however, handing students a check will not replace what they’ve lost.

American adults have failed in almost every way imaginable in this pandemic. None of it is kids' fault. When we try and fix this latest mess, let’s put their needs first.

Aaron E. Carroll

Aaron E. Carroll is a contributing opinion writer for The New York Times. He is a professor of pediatrics at Indiana University School of Medicine and the Regenstrief Institute who blogs on health research and policy at The Incidental Economist and makes videos at Healthcare Triage. He is the author of “The Bad Food Bible: How and Why to Eat Sinfully.”