Every parent knows a child with a cold can be a leaky, disgusting mess. Snot everywhere. Coughs spread far and wide.
Diseases can travel fast when those kids show up at a day care center or school and begin spreading their germs — or novel coronavirus — onto desks, doorknobs and cafeteria tables. And the first instinct of state officials might be to slow the spread of a disease by closing these germ spreading factories — quickly.
Experts say, however, that closing schools for long periods may not always be in the best interest of either students or the public health. The novel coronavirus that’s sickened thousands with COVID-19 in China, South Korea, Iran and Italy reached Maryland with three confirmed cases in Montgomery County. School districts in Washington, Oregon and New York have closed schools, including at least a dozen in the Seattle area this week, providing a preview of what may face other areas of the country.
So far, those closures have been brief, but UNESCO said Wednesday that school closures in 13 countries are disrupting education for 290 million students around the world. Japan, for example, closed schools for a month.
“We may think as soon as we hear about cases we should close school, but we should take a thoughtful and nuanced approach,” said Jennifer Nuzzo, senior scholar at the Johns Hopkins Center for Health Security and an associate professor in the Hopkins’ Department of Environmental Health and Engineering and the Department of Epidemiology.
If parents can’t find child care when schools are closed, they are stuck home with their children.
“We should make sure health care workers can get to work, people who stock groceries for us and others can keep society functioning," she said.
Closing schools for an extended period of time, such as a month or two, could have significant financial consequences for families and economic consequences for businesses and the state. For many parents, staying at home during a closure might not be an option. Many wage earners lack sick leave, vacation time or the means to absorb not being paid for an extended period.
“You might have to go to work because that is the only way you can feed your family,” said Tara Kirk Sell, a senior scholar at the Johns Hopkins Center for Health Security in the Bloomberg School of Public Health.
The central questions, health experts say, are whether students are driving the spread of the disease, and, if they are, how long would schools need to stay closed in order to stop it.
“It is unclear right now. It seems like kids don’t get severe disease. Is it possible the less sick you are the less viral load you have?” said Sell, using the medical term for how much virus an individual carries and can spread. “Those are questions we have not answered and those answers would help us decide what the best course is.”
Bruce Y. Lee, a professor of health care policy and management at the City University New York Graduate School of Public Health & Health Policy, has argued that the virus could be viewed as a fire. If you keep schools open, it might burn out more quickly because you are putting lots of logs on the fire at the same time.
If you close schools you are just adding logs more slowly so the disease continues for a longer period of time. If schools are closed and reopened before the epidemic runs its course, he said, then the closure doesn’t help because you are just adding fuel, he said.
“If you are trying to prevent the schools from being fuel to the epidemic you have to close them for the duration, so it could be a long time,” he said.
But others say that deciding whether to close schools depends on the circumstances.
“I think it might be worth closing schools if it was clear that it lowered the epidemiological curve, so that fewer people are seriously ill at the same time," Sell said. "In that case, it could make it more likely that ICU beds and ventilators were available for the very ill and reduce chances that hospitals would be overwhelmed.”
While COVID-19 can be mild for most people infected, perhaps a sore throat for a few days, its more serious symptoms include fever, coughing and difficulty breathing. About 16% suffer more severe symptoms and need hospitalization, according to the CDC. Scientists estimate the infection kills fewer than 1% of those infected.
“It seems like kids don’t get severe disease. Is it possible the less sick you are the less viral load you have? Those are questions we have not answered and those answers would help us decide what the best course is.”
Tara Kirk Sell, a scholar at the Johns Hopkins University Bloomberg School of Public Health
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Another issue with closing schools is leaving students who depend on school breakfasts and lunches without a source of food. In Baltimore, schools provide a free breakfast and lunch to every child, while almost half of Baltimore County students qualify for free meals. Districts even feed children in the summer when schools are closed, but students have to travel to centralized cafeterias.
If students are still going to crowd together eating every day, “are we changing the situation that much?” Sell said.
In addition, experts say, older, out-of-school children and teenagers still would find places to congregate.
“It’s kind of a mixed bag," said Trudy Henson, public health program director at the University of Maryland Carey School of Law’s Center for Health and Homeland Security. "Closing schools can be effective if they are disinfecting the schools and preventing spread at school. But it’s unlikely students are going home and staying home and not congregating somewhere else. They’re at the malls or movie theaters, so you’re just changing the place of transmission.”
Students also might fall behind academically if they are out of school for long periods of time. Educators say even a long snow break can be detrimental.
Maryland State Department of Education officials did not respond to questions about what protocols would be used for closing schools. Then-Maryland Gov. Martin O’Malley briefly closed a handful of schools for several days during the 2009 H1N1 swine flu outbreak at the advice of the federal Centers for Disease Control and Prevention.
In 2012, researchers at the University of Pittsburgh looked at data from the 2009 H1N1 outbreak and its transmission. Using statistical models they tried to calculate how long schools should be closed in the case of a pandemic.
“What we found was the optimal timing is eight weeks from a disease transmission” standpoint, said Tina Batra Hershey, an assistant professor in Pitt’s graduate school of public health. Opening schools too soon might leave students vulnerable to infection. The same model might not follow for this outbreak, she said, and it should be left to local school systems to decide.
There also are legal questions. Many U.S. governors cannot simply order all the schools to close in their states. Across the country, state laws vary, said James G. Hodge, Jr., director of Arizona State University’s Center for Public Health and Law.
“This is not about turning the light switch on and off," he said.
If Gov. Larry Hogan were to decide he wanted to close schools, he has said he would make the decision collaboratively with the Maryland State Superintendent of Schools and Secretary of the Department of Health and Human Services. If Hogan declared a state of emergency, he could order schools shut.
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Even President Donald Trump does not have the authority to unilaterally close all schools in a state or across the country, Hodge said. The federal government doesn’t own or run the schools, he said, although it does provide a small percentage of funding.
“They could say either close your schools or we are pulling your funds. That would not be well received by states,” Hodge said. "The economic impacts of this are so profound. Some states might really be saying to the feds, we are not closing schools.”
The decision about whether to close universities and colleges likely would be far easier because students can more easily use online learning tools.
Joann Boughman, the University System of Maryland’s senior vice chancellor for academic and student affairs., said the challenges are different, but the system has many options to provide alternative forms of study.
“Those of us who have levers to push will do so with as much sobriety as we can, but it is a quickly evolving situation,” Boughman said.