The United States has exceeded 31 million Covid-19 infections (a messy data point) and is approaching 570,000 Covid-19 deaths (a more robust data point). Yet despite the abundance of data about the pandemic, the best available information is not usually what guides policymakers.
Some policies are senselessly cruel, such as keeping family members from visiting loved ones dying of Covid-19. Others heighten disparities in income, health, and education.
After nine months of observing school closures and reopenings, we identified two factors that appear to be influencing decision-makers toward making less rational, less effective school-reopening policies: overreliance on alarming “predictive” models that are not actually predictive, and media reports based on data that are poorly analyzed and then manipulated to fit preconceived negative narratives.
We propose three simple solutions to address these factors.
Don’t use doomsday scenarios based on flawed models for planning purposes
Models that later turn out to be inaccurate have distorted Covid-19 policies since the pandemic started. Such models have been cited repeatedly by school administrators, legislators, and governors as reasons schools should close, or remain closed.
In January 2021, for example, a biostatistician modeler serving as a consultant to a large school district in Oregon gave a presentation to a widely attended public school board meeting. His model predicted a large local spike in Covid-19 hospitalizations in February and March, based on assumptions about variants and mitigation fatigue. This model showed hospital cases in Oregon nearly doubling between January and March.
In a video of the meeting, school board members can be seen asking fearful questions about this grim scenario. One board member comments, “My fear is we are going to get both the fatigue and the variant.”
Yet between January and March, hospitalizations in the region actually fell by 66%.
This school district maintained fully remote learning into April, despite some of the lowest Covid-19 rates in the country. Middle school and high school students in the district are now back for a few hours of in-person instruction per week, and elementary schoolers are back only 2.5 hours four days per week.
It will take years, even decades, to fully measure and understand the harms of prolonged school closures on children. But preliminary data from California’s Bay Area, where public schools were not and are still not fully open, show increased visits to emergency rooms for children in mental health crises, and increased suicidality and eating disorders. Nationally, data on massive learning losses, weight gain, unreported child abuse, and children missing from their school districts are extremely worrisome.
While influences on school closures are multifactorial, it is reasonable to conclude, based on the number of times this model was cited by district officials and school board members, that incorrect predictions create unfounded hesitancy in policymakers. Numerous examples of wildly inaccurate Covid-19 models exist, some summarized in a March 2021 report in The Lancet Microbe.
Conduct simple analyses of publicly available data to inform policy
Inaccurate models converging with media narratives create the second factor skewing Covid-19 school reopening policies: the related ideas that variants of SARS-CoV-2 are causing children to be sicker than previous strains, that cases and hospitalizations are increasing in children more than in older people, and that these phenomena are driving new surges across ages.
Much of the misinformation around variants is gleaned from popular media reports, although much of it originates with Covid-19 experts. Local news and smaller media outlets usually lack in-house data departments, but bigger news outlets have no excuse for their failure to dig into publicly available data from the Centers for Disease Control and Prevention and state databases to unpack these narratives to see if they are accurate. If not, those narratives should be corrected.
Spoiler alert: They often are not accurate or corrected.
We did what we propose large media outlets should do: investigate narratives put forward by Covid-19 voices with large platforms to see if they were supported by data.
We used publicly available data collected by the CDC from Michigan and Minnesota, two states in the news throughout March and April due to their case surges, to examine claims that children were getting sicker due to variants and that cases and hospitalizations were rising in children more than in other ages.
Michigan and Minnesota, which both have a high prevalence of the B.1.1.7 variant, had large surges in cases between March and early April, but showed no increase in severe illness (represented by hospitalizations) among children in these states (Figure 1). This finding is consistent with two recent papers in Lancet Infectious Diseases and Lancet Public Health showing no evidence of increased virulence of the B.1.1.7 variant in the United Kingdom.
Our analyses indicate that Covid-19 cases are not increasing more rapidly in school-aged children nationwide than in any other age group. Although K-12 aged children are the least-vaccinated age group, they had the lowest rise in cases except 18- to 24-year-olds.
Most importantly, the data invalidate the claim that hospitalizations were being led by younger patients. When we examined the CDC data for cases per 100,000 people, hospitalizations among those aged 5 years to 17 years barely budged and were still quite low, and hospitalizations among 18-49 rose very slightly (Figure 2). The biggest change was exactly what should have been expected given that older individuals were vaccinated first: The rise in hospitalizations was low and mostly among those over 50 who were not yet widely vaccinated.
Graphs of Michigan and Minnesota’s cases (Figure 3) show a similar story, with Michigan experiencing more of a surge. Starting with the trough in mid-February and ending April 8, school-aged children in Michigan had the smallest increases in cases of any age group except older vaccinated groups.
Despite more cases in Michigan, hospitalizations in the age 5 to 17 group were not up at all, except for a small blip in the week of March 20. Michigan began requiring asymptomatic testing in early March for sports participation, which may explain the higher number of cases identified. It is unlikely that a smaller proportion of children with Covid-19 in Michigan were suddenly requiring hospitalization, supporting the idea that Michigan’s surge was unlikely to be driven by children.
The hypothesis that young people are spreading Covid-19 to adults as asymptomatic carriers, but not themselves falling sick, is invalidated by studies showing that asymptomatic young people do not readily spread infection to family members.
Three simple solutions
We suggest three changes to create more rational Covid-19 school policies moving forward.
First, school decision-makers should stop relying on “predictive” models that are too often wrong and create unnecessary and harmful amounts of caution toward school reopening. Instead, modelers and media outlets should draw upon publicly available real-world data from the CDC and vetted state databases. Using inputs based on assumptions related to unquantifiable human behaviors, such as fear and fatigue, rather than quantifiable data based on local hospitalization rates, in-school transmission events, and vaccination rates has led to school policies based on emotions rather than data.
Second, much misinformation comes from experts fitting data to preconceived narratives rather than the other way around. Although this is difficult to stop, large media outlets with data bureaus could and should investigate these narratives before repeating and amplifying them. They should also ensure they are using best data practices such as comparing case and hospitalization numbers corrected for population distribution. Cherry-picking date ranges to make data fit a narrative should be avoided.
As we demonstrated by following these simple recommendations, there was no surge in hospitalizations among school children, and cases in young people in Michigan and Minnesota were occurring at the same proportion, or slightly less often, than in other age groups.
Third, school policymakers should stop using case rates as a barometer of Covid-19 fluctuations and focus exclusively on hospitalizations and deaths. Guidance from the Oregon Department of Education, for example, currently suggests that schools in small counties return to all remote learning when cases exceed 90 per 100,000 people, regardless of the demographics of cases. Case numbers, however, are a highly variable statistic since they depend on factors such as testing rates or the presence of symptoms. Sickness and death are more important and reliable outcomes than case rates. As the least healthy and oldest people get vaccinated, case rates and hospitalizations will become further uncoupled. This is already happening. Although about half of U.S. states are seeing increases in cases, deaths are not rising steeply in nearly all states, but are rising slightly, holding steady, or declining.
A trio of researchers recently suggested a population-based metric of 5 hospitalizations per 100,000 people as a cutoff to remove all school-based restrictions such as wearing face coverings and physical distancing. The CDC and state health departments should develop a series of reliable metrics to guide lifting restrictions on schools and youth sports.
These changes will help policymakers create better, more effective policies to guide school reopening. We owe this much to children, whose lives have been severely upended during this yearlong pandemic.
Leslie Bienen is a veterinarian, scientific editor, and professor of public health at the OHSU-Portland State School of Public Health. Eric Happel is director of global strategy, capabilities, and excellence for Nike stores. Monica Gandhi is an infectious disease physician, professor of medicine, and associate division chief of the division of HIV, infectious diseases, and global medicine at UCSF/San Francisco General Hospital. Bienen and Happel are affiliated with ED300, an organization that advocates for opening Oregon schools and sports.
One important thing RWE does not account for is the emergence and growth of new more infectious variants. For caution, look to India. Troubling that the authors did not disclose all their affiliations. Thanks to the editor for the note.
I agree with you about the variants, we have to do some kind of modeling, taking into account variant’s morbidity and mortality, especially for young people, as the reports out of Brazil now are of much sicker minors and young adults, infectivity, and vaccine induced and natural immunity escape.
According to the books written about CDC they go to remote places to find new viruses and stop outbreaks – but it appears no one sent our 3 vaccines to Brazil or South Africa to find out precisely how well they work (we have some data but there seems to be no consensus). This is a not a helicopter ride to a jungle – this is flying in a US military cargo plane full of vaccines to an international jetport – or more than one – – why do we still not know ??????
Is this article implying that in the US that School committees, made up of parents and school staff representatives, make decisions on whether schools remain open or closed during a global pandemic?
That is totally absurd! I live in Australia and the State and Federal Chief Health Officers (CHO) as well as the State Premiers make that call – for all schools in their state. I would not want teachers and parents at my sons school making such important decisions… this needs to be left to the experts and then when a decision is made it impacts all kids and families in the region to similar degrees.
I am sure you can find millions of Americans who agree with you. It is due to a political schism – we have a Federal system – it is called – kind of a misnomer – where states make their own choices. Teacher’s unions are far too powerful. Biden mocked the idea of going back to school in the debates with Trump – as something like “Choosing who is going to die” – in order to get votes, he essentially promised to let the teacher’s unions decide if they wanted to go back or not – but then to his credit (????) AFTER getting elected he said he wanted schools to reopen – and got legislation to encourage that – but in some areas, the teacher’s unions STILL – even today – get to say no.
Trump was 100% right at the time of the debate, but since then variants have come in – and Dr. Fauci admitted, though it was like pulling teeth to get it our ot him – that he is pushing TWO masks now because of fear of the variants.
Back to the need for data we ought to already have, if only WHO and CDC had done their jobs.
Written by a veterinarian (Bienen), and a Nike stores affiliate (Happel). And how did Monica Ghandi (the 3rd author) get roped into this garbage? Not a word about logistics for an air-borne virus, like improved air filtration systems in the schools, masks, distancing, smaller class sizes, vaccinating the teachers, etc. The authors state fear-mongering is augmented with data modelling – but their inferrings of suicides, mental disorders, eating disorders, weight gain, learning losses and child abuse are not? This “article” only leads to creepy thoughts of an awkwardly hidden sports ad. Enough said.
Not once were teachers and parents mentioned in this far-out school-promo article. WHY did STAT publish this one-sided rubbish? The narrow-minded thinking of people like these writers is clearly contradicted by the urge and rightful need that teachers and parents need to get vaccinated. Their kids may have “mild” symptoms or cases, but for the adults in their environment the exposure and outcome are a vastly different story. The authors fail to link school society members as a group. They are also cold-wrong in not alluding to the rather important fact that serious Covid illness is seen in every younger people, even babies now. SHAME on this whole Spiel !!!
Stuart, your description doesn’t reflect reality. For one, every study shows that school spread is minimal. For another, American Academy of Pediatrics releases data on child cases, hospitalization and death; the latter are incredibly low. Finally, middle and high schools are closed in areas like mine (San Francisco) where 80% or more of teachers HAVE ALREADY BEEN COMPLETELY VACCINATED (and 60% of our entire population). Nevertheless, some of these teachers (a full 20%) requested a “distance learning accommodation” to teach in classrooms with PK-5 kids spaced out 4 feet apart, even after being fully vaccinated, because of preexisting conditions like obesity. I know for a fact that some of these teachers have moved to a different location 2 hours away and don’t want to commute; others are planning vacations to other states but still taking advantage of this distance learning accommodation.
The author’s main point is completely correct. The other posters who seem to think they have a “gotcha” with the author’s affiliations with groups which advocate in line with the article do not understand the concept.
My kid’s NoCal school district has been closed since March 2020.
The evidence that almost all kids were at extremely low risk, and young teachers with no health problems were are extremely low risk, and the rest could be isolated – yes, “Isolated” – and it does sound a bit sad – was very strong by around June 2020.
But, the schools have been closed, distance learning only, for a bit over 13 months now.
Again – we live in California – there could have been outside classes, or at least activies, in tents, for all but around 5 months of that time, or we could have done in person for low risk students and staff – I can think of many possibly solutions – none was even discussed.
Our district has a very high number of people who are not in the country legally, and it is my belief the fact the parents can not safely complain – and do not speak English very well, = leaves a power vacuum which is filled by the teacher’s union – they are firmly in charge – and they did not want to teach in person – they put the welfare of the kids at the bottom of their priorities – there I said it – they were not heroes at all.
I very much agree with the sentiments of the article. The issue of variants has now complicated the problem – but they closed for about 8 months when they need not have.
I’m glad STAT made it clear up front where this article comes from. After reading it, I’m thinking it should probably have been withdrawn. It is so rife with spin, twisted facts, and deception that it really serves nothing but the Covid deniers propaganda machine.
Funny how quick you jump to deny this article a place in the information stream based on the authors’ un-clarity in stating their personal biases.
This, in contrast with all the wildly made assertions we have been seeing and hearing for the past year by those who absolutely do not reveal not only their biases, but their blatant conflicts of interest.
You may call them “Covid deniers” all you wish but that does not negate either their message or their veracity.
Thanks for clarifying the potential sources of bias in this opinion piece. If anything, schools in my area need support for following public health advice, rather than yielding to local political pressures to ignore them.
It should be noted that the authors are involved with the ED300 PAC calling for schools to reopen and are not coming from an unbiased starting position. You can tell by the correlational hyperbole attempting to connect school closures with a spike in mental health concerns in children. These could very easily also be attributed to the trauma of a pandemic, the trauma of the George Floyd case and resultant protests and highlight on police brutality, the trauma from the economic impacts of COVID, or some combination of all these factors. Implying that the blame for the negative impacts mentioned in this article is solely resident in the decision to close schools is disingenuous at best and is equally unscientific as the misinterpretation of data being decried by the authors of this article. You don’t get to play the “emotional decisions are bad” card when you begin your article with an emotional correlation implying causation fallacy.
Thank you for letting us know about this. The connection between two of the authors and ED300 are now clarified in the article.
Patrick Skerrett
STAT
And yet, they didn’t imply causation, only correlation. Yes, the other factors mentioned could have an impact, but so too could school closures. Let’s not ignore the other factors presented; like learning loss.
We are not part of the ed300 PAC to clarify, a pac by the same name but a different group. We are members of a Facebook grassroots group that is associated with ed300 and post and respond to comments in that group. We did not think that being in a Facebook group was something to note. Really didn’t cross our mind. Ed300 is mostly parents who want schools open but also includes parents who do not. Once schools are open the Facebook group and associated website will likely end. I do personally believe schools should be open in every state per the data. The article/opinion piece here is data driven and includes data points. You are free to conclude what you want after you read it. But we did not fail to disclose. We didn’t realize it was something to disclose.