NRPLUS MEMBER ARTICLE I t’s almost the middle of August, and many parents still have little idea if their kids will be able to go to school in a few weeks. If schools are unable to reopen, it will be one of the worst blows of the COVID-19 pandemic yet. A large part of the labor force with young children at home and no access to child care will be unable to return to work, just as the pandemic’s bonus unemployment benefits start running out. Millions of temporary business closures will become permanent. And children will be affected in all sorts of ways, from stunted educational growth to food insecurity, with disadvantaged and minority children particularly hard hit.
These consequences of schools remaining closed are detailed on the website of the Centers for Disease Control, which has several pages of guidance for parents, teachers, and school administrators. But we still don’t have a national policy on schools reopening, and we need one fast. The president is strongly encouraging schools to reopen on time. While the federal government has no power to regulate when local school districts open and close, a national standard is needed that takes account of what we know about how COVID-19 affects different age groups and where COVID-19 has spread.
Who is at risk from COVID-19
COVID-19 is most severe and most likely to result in death in the elderly and in people with other medical conditions. Unlike seasonal influenza, which primarily kills the very old and very young, or the catastrophic 1918–20 influenza pandemic that was especially lethal among young adults — half of deaths were in the 20–40 age group — CDC data show that 80 percent of COVID-19 deaths in the U.S. have been of people 65 and older and that 92 percent of all U.S. deaths have been of people 55 and older. The average number of comorbidities among people who have died is 2.5.
As of July 29, the CDC reports only 244 COVID-19 deaths nationwide among those age 24 and younger. That is less than 0.2 percent of all COVID-19 deaths, and nearly all the deaths have been in the 15–24 age group. Many had associated comorbidities such as obesity. Among elementary-school-age children (5–14 years old), there have been only 19 deaths in the whole country.
Likewise, the cumulative COVID-19-associated hospitalization rate per 100,000 population is 130.1 overall but heavily concentrated among the elderly — 360.2 per 100,000 in the 65-and-over group and 196.3 in the 50–64 age group. There have been only 6.4 COVID-19 hospitalizations per 100,000 among those 5 to 17 years old.
Children may also be less likely to be infected with or spread the virus that causes COVID-19. The American Academy of Pediatrics (AAP) reports that “the preponderance of evidence indicates that children and adolescents are less likely to be symptomatic and less likely to have severe disease resulting from SARS-CoV-2 infection. In addition, children may be less likely to become infected and to spread infection.”
The risks of reopening schools are not zero, but they are small and can be significantly mitigated. The risk of severe disease is vanishingly low for students and extremely low for teachers, who are mostly young and healthy — the median age for schoolteachers is 41.8, and less than a fifth are over 55. Teachers over 65 and those with medical problems should consider avoiding in-person contacts and can perhaps be tasked with providing online learning for students whose medical problems will exclude them from in-person attendance. Otherwise, the risks seem manageable.
The experiences of other countries suggest that, in communities with low transmission rates, schools can safely reopen with mitigation measures in place — temperature checks at the door, keeping students in smaller, defined units (cohorts) to minimize contacts, decreasing class sizes, staggering start times, maintaining physical distance between people as much as possible, and wearing masks when distancing is not reliable.
Many students and teachers may face lower risk in school, where proper mitigation measures can be enforced, than out of school, where they often can’t be.
When to reopen
The national policy should define objective thresholds so parents and school districts can know when it is safe to reopen and when schools should remain closed. Such thresholds should be simple and predictable and should make clear that schools should reopen except where COVID-19 breakouts have become uncontrolled.
The focus should be on counties, which are the ideal level of government for both assessment of infection risk and coordination among school districts. Since the beginning of the crisis, outbreaks have been highly concentrated in particular counties, which means that national- and state-level lockdown decisions would tend to throw babies out with the bathwater.
For example, Trousdale County in Tennessee leads the country with more than 13 cases for every 100 residents since the start of the pandemic, while nearby counties to east and west have seen well under one case for every 100 residents. Counties in the region of New York City have had a staggering number of cases — but may now be reaching herd immunity, in which the large number of people with antibodies starts to slow the rate of infection. Meanwhile, most counties in the state of New York are still under two cases for every 1,000 residents since the start of the pandemic. Los Angeles accounts for 10 percent of California’s population but 37 percent of its COVID-19 cases. Miami-Dade County is about 13 percent of Florida’s population but has 25 percent of its COVID-19 cases.
Focus on counties also makes sense from an administrative point of view. Most counties have at most a handful of school districts and a smattering of charter schools. This makes it easier for states to promulgate statewide orders that can then be managed at the county level.
The key factor is the rate of increase in new infections at the county level. Where uncontrolled transmission leads to a spike in new infections that threatens to overwhelm local health-care capacity, it may be advisable to promulgate pervasive lockdown measures. This follows from the CDC’s basic guidance to state and local governments:
The CDC has failed to establish numerical thresholds for what constitutes “uncontrolled transmission” or “minimal to moderate community transmission.” But a close look at the CDC’s county-level statistics gives a fairly clear picture of which counties have been spared and which have been particularly hard hit. But better national data are needed so we can see which counties have “uncontrolled transmission” and are contending with major outbreaks.
Most U.S. counties are at well under one confirmed case for every 100 residents since the start of the pandemic. Intuitively, these should be put in the “minimal to moderate” or “no to minimal transmission” categories. In these counties, school districts should probably be planning to reopen with basic mitigation measures. Nearly all the remaining counties in the U.S. have had between one and five cases for every 100 in the population (between 1,000 and 5,000 per 100,000). These, and the two dozen or so that are above 5,000 per 100,000, probably belong in a “substantial transmission” category.
Whether these counties should be considered in the category of “controlled” or “uncontrolled” transmission depends on whether they are currently experiencing a sustained decrease in new cases or not. Except where transmission is “uncontrolled,” school districts should also be planning on reopening, albeit with “significant mitigation” measures to ensure the highest practical social distancing among students and among cohorts of students. Ultimately, however, only the CDC or some other part of the administration can tell us what numerical thresholds correspond to the categories in its chart.
Schools should close only during the most severe outbreaks
Given that students are in a low-risk population, school districts should continue closures only where they are in counties that are in the highest category for spread of COVID-19: “substantial, uncontrolled transmission.” In such cases, the CDC guidelines call for “shelter in place” — in other words, comprehensive lockdowns of all but the most essential services.
States have up-to-date numbers, at the county level, for new infections and the percentage of COVID-19 tests that are positive. Even in localized hot spots (such as Miami and Los Angeles) that are showing “substantial” transmission, the counties should be put in the second category, “substantial, controlled spread,” when there is a sustained downturn in new cases. Substantial mitigation measures should then be put in place, but schools should be allowed to reopen.
Protecting vulnerable populations during school reopenings
Despite their own minimal risk of severe disease from COVID-19 infection, children could be the source of substantial spread throughout the population, as with many other infectious diseases. Computer simulations from Europe have suggested that schools reopening may further increase spread in communities where transmission is already high. This is of gravest concern with respect to secondary infections in households that include elderly family members.
The demographics of the COVID-19 pandemic suggest that public-health measures should focus on the well-identified, vulnerable populations at high risk of severe disease — namely, the elderly and those with serious preexisting conditions (who tend also to be elderly). Hence, the most crucial mitigation measures for those families with children back in school will be those taken at home. Many families have both school-age children and grandparents living with them or nearby. Parents and other children may also have medical conditions that make them vulnerable.
Ideally, regardless of whether they have children in school, these vulnerable people will be taking precautions by avoiding contact with others as much as possible (shelter in place) and by socially distancing and wearing masks when they do come into contact with others. Households with school-age children will have to adopt reasonable mitigation measures, including limiting contact and mask-wearing when around vulnerable household members. As was the case with SARS a decade ago, it may be possible to greatly reduce the incidence of household transmission of COVID-19.
The case for reopening schools is overwhelming
With the exceptions and mitigation measures outlined above, the case for reopening the vast majority of schools on time is overwhelming. Schools serve a crucial role in modern society. They provide education, socialization, and food security to children, as well as “child care” that allows working parents to go to work. A significant percentage of working parents may have to leave the labor force if their schools do not reopen.
The American Academy of Pediatrics has recommended opening schools on time with students physically present and mitigation measures such as social distancing and masks when distancing is not possible. The AAP goes on to affirm that “all policy considerations for the coming school year should start with a goal of having students physically present in school.”
Added to the immediate impact of closures on children is the potentially catastrophic impact on the economic well-being of families and, indeed, of the whole economy. In one instance that the CDC has looked at carefully, certain school districts in Kentucky were forced to shut down during a particularly severe influenza outbreak in February 2008. In a survey conducted by state public-health officials, an adult had to miss work to provide child care in 29.1 percent of households with children in school. In 15.7 percent of households, at least one adult lost pay because of missed work, and the closures lasted only three or four days!
Working families and businesses are certain to be hit much harder with the closures this year. According to the St. Louis Federal Reserve Bank, of the 20 percent of full-time workers with a young child (less than nine years old) at home, more than 60 percent have either no spouse or a spouse who works full-time. Millions of working families will suffer devastating consequences from long-term closures, with those living paycheck to paycheck hardest hit.
There will also be severe long-term consequences for the economy as a whole. According to the St. Louis Federal Reserve, these include reduced productivity even among those parents who can work at home; exacerbation of the gender income gap and other wage disparities; the significantly lower effectiveness of online instruction; and increased educational inequities as higher-income families and schools are better able to adapt to alternative arrangements.
Children also face serious long-term consequences. According to one model cited by the Brookings Institution, a year of lost learning could reduce the future earnings of students by as much as 10 percent per year, equating to $2.5 trillion — or 12.7 percent of annual GDP — for the nation as a whole. Michael Strain, of the American Enterprise Institute, has estimated that the lost earnings could be as high as $30,000 per decade for those who would graduate from high school but not college, a figure that would grow worse the longer that schools were closed.
Since the start of the pandemic, the U.S. economy has taken its worst hit since the Great Depression. But worse could be yet to come. The coming weeks are likely to be a turning point in the crisis. Whether it is a turn for the better or a turn for the worse may depend greatly on whether schools reopen on time. While the economy has shown some signs of revival, shutting down a significant fraction of the labor force through school closures could well push it over the edge.
President Trump is right to press for school reopenings. The administration should articulate clear and simple thresholds for when to reopen, in addition to its guidance on how to reopen safely. Let’s reopen our schools, as fully as possible, as soon as possible.
Joel M. Zinberg is a senior fellow with the Competitive Enterprise Institute and an associate clinical professor of surgery at the Mount Sinai Icahn School of Medicine. He was senior economist and general counsel at the Council of Economic Advisers from 2017 to 2019. Mario Loyola is a senior fellow at the Competitive Enterprise Institute. He is a former presidential speechwriter and from 2017 to 2019 was associate director for regulatory reform at the White House Council on Environmental Quality.