About That JAMA Article on COVID Transmission and Reopening Schools

On January 26, 2021, the Journal of the American Medical Association (JAMA) published this “viewpoint” regarding COVID-19 and in-poerson school attendance, entitled, “Data and Policy to Guide Opening Schools Safely to Limit the Spread of SARS-CoV-2 Infection.”

It seems that in the press, the conclusion of this study has been reduced to the convenient byte, “there has been little evidence that schools have contributed meaningfully to increased community transmission.” Thus, it seems that many are quick to say, “There you have it. Science says COVID-19 is not a problem at schools, so reopen school, period.”

Not so fast.

The JAMA article, which includes links to a number of studies of COVID-19 spread in school compared to community, both in the US and in other countries, also includes the following information about COVID-19 spread:

While these data are encouraging overall, large outbreaks have occurred with apparent transmission in schools. In Israel, within 2 weeks of schools reopening in mid-May 2020, a large high school outbreak occurred when 2 students with epidemiologically unrelated infections attended classes while mildly symptomatic.Testing of more than 99% of at-risk students (n = 1164 eligible; 1161 tested) and staff (152 eligible; 151 tested) identified 153 and 25 cases of SARS-CoV-2 infection, respectively (attack rates of 13.2% and 16.6%). Contributing factors to this outbreak included crowded classrooms with insufficient physical distancing (eg, student density in classrooms exceeded recommended values), exemption from face mask use, and continuous air conditioning that recycled interior air in closed rooms during a heat wave.

And:

Preventing transmission in school settings will require addressing and reducing levels of transmission in the surrounding communities through policies to interrupt transmission (eg, restrictions on indoor dining at restaurants).

And:

In addition, all recommended mitigation measures in schools must continue: requiring universal face mask use, increasing physical distance by dedensifying classrooms and common areas, using hybrid attendance models when needed to limit the total number of contacts and prevent crowding, increasing room air ventilation, and expanding screening testing to rapidly identify and isolate asymptomatic infected individuals.

And:

Staff and students should continue to have options for online education, particularly those at increased risk of severe illness or death if infected with SARS-CoV-2.

And:

…Some school-related activities have increased the risk of SARS-CoV-2 transmission among students and staff. Numerous media reports of COVID-19 outbreaks among US high school athletic teams suggest that contact during both practices and competition, and at social gatherings associated with team sports, increase risk. On January 26, 2021, CDC released a brief report describing the initial investigation of a COVID-19 outbreak associated with a high school wrestling tournament that occurred in December 2020 and included 10 schools and 130 student-athletes, coaches, and referees. … Paradoxically, some schools have used a fully online model for educational delivery while continuing in-person athletic programs. Even though high school athletics are highly valued by many students and parents, indoor practice or competition and school-related social gatherings with limited adherence to physical distancing and other mitigation strategies could jeopardize the safe operation of in-person education. 

So. This JAMA article is not advising a devil-may-care attitude towards the presence of and problems associated with COVID-19 transmission in schools. Protocols need to be in place, including those for social distancing (which is quite a challenge in may school settings) and mask wearing (also a challenge or simply not a requirement in some schools). Notice also that the comparisons tend to be of school transmission to community spread, meaning that what occurs in the community does affect the schools (no surprise here), and that higher community transmission is still reflected in schools even if it is lower than community transmission by comparison.

And, athletics.

In my own classroom, what I have noticed post-holiday season is that an increasing number of my students (who are mostly ages 17 and 18) are contracting COVID and manifesting symptoms as opposed to just being quarantined for close contact and manifesting no symptoms pre-holiday season. 

I wonder the degree to which the increasing manifestation of symptoms among my ill students is related to the presence of COVID-19 variants circulating in the US and that were not present in the fall.

The JAMA article does not address the impact of COVID-19 variants on in-person learning because, it seems, the studies cited are from the fall of 2020, a time when COVID-19 variants were not the focus of concern that they have become by early 2021.

Potential impact of variants aside, the JAMA article does not offer unconditional, blanket support for opening every K12 school nationwide for in-person learning. I can tell you that I would not feel nearly as comfortable in my own classroom if I were not able to arrange my room to keep myself over six feet away from my 17- and 18-year-old students for most of my instruction; if masks were not mandatory in my classroom, and if I did not have two air purifiers in my room.

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