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Reopening Primary Schools during the Pandemic Muge Cevik, M.D., Marc Lipsitch, D.Phil, Meira Levinson, D.Phil. Paragraphs of note.
For the past 6 months, policymakers and the U.S. public have weighed economic against public health considerations in debating what limits to set on individual and collective behaviors in attempting to control the Covid-19 pandemic. As fall approaches, attention has turned to a third pillar of a pandemic-resilient society: schools.1 Under ordinary circumstances, about 40 million children would be entering prekindergarten through 8th-grade classrooms this year, including nearly 27 million students in grades pre-K through 5.2,3 Until these children physically return to school full time, many will lose out on essential educational, social, and developmental benefits; neither the economy nor the health care system will be able to return to full strength given parents’ caretaking responsibilities4; and profound racial and socioeconomic injustices will be further exacerbated.5 We believe that safely reopening schools full-time for all elementary school children should therefore be a top national priority.
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Children miss out on essential academic and social–emotional learning, formative relationships with peers and adults, opportunities for play, and other developmental necessities when they are kept at home. Children living in poverty, children of color, English language learners, children with diagnosed disabilities, and young children face especially severe losses.
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From a clinical standpoint, most children 1 to 18 years old experience mild or no illness from Covid-19 and are much less likely than adults to face severe consequences from the infection.18 Although a small number of children worldwide have been hospitalized with multisystem inflammatory syndrome in children (MIS-C) after SARS-CoV-2 infection, so far this appears to be a rare syndrome (affecting a reported 2 per 100,000 people under 21 years of age between March 1 and May 10, 202019), and with early recognition and treatment, clinical outcomes in the short term have been good.19-21 In contrast, adults, especially those who are over 60 or have underlying health conditions, are at higher risk for severe illness, hospitalization, and poor outcomes.18
But educators and other school personnel cannot necessarily dictate the place or terms of their employment, even (perhaps especially) when the social compact has broken down. It is tragic that the United States has chosen a path necessitating a trade-off between risks to educators and harms to students, given other countries’ success in reducing transmission and opening schools with routine control measures in place. This dilemma represents a social and policy failure, not a medical or scientific necessity.
Nonetheless, we would argue that primary schools are essential — more like grocery stores, doctors’ offices, and food manufacturers than like retail establishments, movie theaters, and bars. Like all essential workers, teachers and other school personnel deserve substantial protections, as well as hazard pay. Remote working accommodations should be made if possible for staff members who are over 60 or have underlying health conditions.5,18 Adults who work in school buildings (or drive school buses) should be provided with PPE, and both students and staff should participate in routine pooled testing.30