School's Out (Sort of)

As of 3 days ago, CNN reported that 44 states as well as DC had chosen to close their schools for the remainder of the school year. Today, Governor Murphy announced that NJ will follow suit.

Of course, closure of the physical schools does not necessarily mean no instruction. Still, a lot of people are upset by the closures and I've seen a lot of refrains like "No children have died from COVID19" (not true) or "Kids can't even spread COVID19" (also not true). So let's look at some facts about children and COVID19.

According to the CDC, as of April 2nd, 22% of the US population are children under the age of 18. Among the positive COVID19 tests we had on that date, 1.7% were children under the age of 18. Data from Italy also suggested about 1% of their COVID19 positive patients were 18 or less. At face value, this seems to indicate the children catch COVID19 less frequently than expected. However, keep in mind that access to testing has been difficult in many places and that a lot of folks were not being tested even if they had obvious symptoms. 

A recent article out of Iceland that did random testing of almost 10k high risk people (with known travel to areas with outbreaks or potential contact with sick folks) found that children older than 10 had a 13.7% infection rate, which was comparable to all age groups classed together (13.3%). Children under the age of 10 were positive at a lower frequency (6.7%). Another new study from China showed that 7% of children with close exposure to others with COVID19 became infected, which was similar to the other age groups. Children with COVID19 were also more likely to have less severe symptoms or no fever.

Source: Lancet

So right now, at best we can say children MAY be infected at lower rates than older people, but the most likely scenario is that children who are infected are simply more likely to be asymptomatic or have less severe disease and therefore not be tested in the first place. Assuming your child doesn't have other underlying medical conditions, the data seems to suggest that most kids who get sick won't require hospitalization and the vast majority of them won't die. This is great news for parents worried about their kids. 

So why keep the schools closed? There's no evidence to suggest that infected children are less infectious than adults. In fact, a recent study out of Germany suggests that in spite of less clinically severe disease, children appear to have viral loads comparable to other age groups studied.

Source: Article Pre-print from Christian Drosten

So it's very possible that although children have less severe disease, they could be a major contributor to COVID19 spread to more vulnerable populations (read: everybody above 18). In a 2011 study from France, it was estimated that each elementary school age child has 323 contacts with approximately 47 individuals throughout the school day. 

Source: PLOS ONE

The school I work in has nearly 2000 students plus 200 staff members for a building that was designed for a population of 700 in the 1950s. It is simply impossible to use social distancing in this sort of environment. (And I'm certain our school building isn't the only one with a similar logistics problem.) Young children cannot wear masks and even asking older children, like the teens I teach, to wear masks for 6 to 7 hours a day is not really viable either. Combine that with the fact that a recent CDC analysis of Chinese outbreak data suggests that the R0 (reproductive rate of the virus) is probably closer to 5 to 6, than the initial 2 to 3 reported, one should come to the conclusion that asymptomatic children + open schools = massive disease spread.

Let's use my school as an example. Assume that shelter in place and social distancing rules are either relaxed or ignored and that 7-13% of the student population becomes infected. That's about 140-260 students. Each one of those students is then likely to infect 5 people. That's another 700-1300 people infected within 2 weeks or so. And another 3500-6500 people in the next two weeks... And so on and so forth. You get the picture.

So while it may be frustrating for families and educators alike and even heartbreaking for many students for physical schools to be closed for the rest of the 2019-2020 school year, Governor Murphy and other governors making this call are doing what they can to save as many people as possible. And I, for one, am thankful.

For more information on pediatric COVID19, check out this review.