Coronavirus in Context: Insights on Reopening Schools

[SUSPENSEFUL MUSIC PLAYING] You're watching "Coronavirus in Context." I'm Dr. John Whyte, Chief Medical Officer at WebMD. Today, we're going to talk about the importance of reopening schools. My guest is Dr. Joshua Sharfstein. He's a pediatrician and professor at the Bloomberg School of Public Health at Johns Hopkins. Dr. Sharfstein, thanks for joining me.

Thanks for having me.

Let's start off with why is it so important to reopen the schools.

Well, this has been a very difficult time for children, and not just because they aren't in class learning. Uh, schools have a really important role in child health and development. 20 million kids get school lunches or school breakfasts. Um, and many are going hungry without being in school.

Um, teachers protect children. They see signs of abuse. They do about one in five reports of child abuse. And so all those, um, cases are now going undetected.

Um, there are other really essential services and experiences kids have in school. So it's really been a-- a very costly, um, situation for them.

Does it matter if your, uh, kids are young-- say, grades one through three-- versus, you know, you're dealing with high schoolers? Ca-- can you have different approaches and attitudes for-- for different grades?

I would say, generally speaking, yes, although there are going to be exceptions in different areas. There may be some high school kids who really benefit a tremendous amount from in-person school and some kids who, you know, have a lot of support at home in their early grades and could do OK at home, kind of, you know, partially being taught by their parents, um, along with online learning. But generally speaking, I think the younger kids, um, need the in-school more. They're less likely to be successful with online learning.

And many parents have criticized the online learning that their kids experienced in the spring. Teachers were not, you know, well qualified to use that modality. It wasn't always working in-- in different districts. Is there confidence that, if schools use virtual learning, it's going to be more successful in the fall than it was in the spring?

Uh, well, I think it's hard to be in a worse situation than the spring, where everything just, you know, abruptly changed. A whole bunch of kids in many school districts didn't even have any access to online learning. So that-- that was pretty much the worst-case scenario. So I'd imagine it would at least be somewhat better.

I think the question is whether, you know, it's going to be, uh, partially online, meaning the kids will be in school most of the time, in which case, you know, maybe they get some, essentially, extended homework to do on the days that they're not in school versus really online and they have to be interacting over the-- over the computer.

Well, what do you think about this kind of hybrid, where-- is two days of in-class instruction enough and then three days, basically, self-directed in many districts?

Well, it-- it depends some on that. I mean, I think-- um, I wrote this article with the dean of the School of Education at Johns Hopkins. And the point that he made was that there are curricula that can be flexible for online and in-person. Um, you do want kids to have, um, access to a device and then be able to, um, do different tasks when they're not in school.

Um, but again, it will, you know, vary by child. So some children will be OK in that situation. Others, um, if they really need to be in school, are going to suffer. And that's why, you know, um, we recommended that there be some-- uh, it shouldn't be one size fits all-- that the kids who really need to be in school should be brought back. That should be a priority.

And you have this thought-provoking editorial in The New York Times that says we have to focus on opening schools, not bars. But are priorities wrong in-- in some counties that are focusing on-- on businesses, on-- and perhaps they should focus more on the schools?

I think that there was, unfortunately, some wishful thinking, um, in a lot of places that the virus, uh, challenges have passed, that they could just go back to life as it was before the pandemic, and we should just be in the business of reopening everything as quickly as possible. And we're learning that that really isn't, um, the way the world is right now. That's now how the virus behaves. It is wishful thinking-- and that, uh, we need to really prioritize.

And as we're thinking about, well, what are we going to, uh, do as a society, we should be, first, I think, trying to save lives, drive the number of infections down. Um, and then, as we're thinking about reopening, rather than going to bars or gyms or other areas where we know you can have big outbreaks, we should be looking at, uh, schools, where there's enormous value, um, to, uh, opening to children.

Does the public understand what the risk truly is to children? You've talked in your editorial about risk and the risk of children, uh, versus the risk to staff and-- and elderly, you know, grandparents. There are school districts around the country that's-- you know, some of the teachers have said they're not going to return to work because they're concerned about risk and safety. And some of them are connecting it to a vaccine, which we don't know, you know, is realistic. So how do we help parents and teachers and community leaders understand risk, particularly as it relates to children?

JOSHUA M. SHARFSTEIN: So at this point, I think it's important to share the information that we have. And it's important to study to get better information. So we know that children are much, much less likely to get very sick than, uh, adults. We also, um, know that they're probably less likely even to get infected and less likely to pass on the infection, uh, definitely less likely that-- compared to influenza, um, and probably less likely compared to adults as well.

Now, that doesn't mean no risk. Less risk doesn't mean no risk. We know that kids can get sick. In some very rare cases, they can get very sick. And then we have this, uh, post-inflammatory condition for kids who have gotten sick that, um, they can then get really sick-- also very rare.

So, um, there is definitely a small amount of risk. Um, it is, uh, you know, not, um, uh, the kind of thing that you would just want to ignore. It's the type of thing you'd want to minimize. And that's the reason for all these different precautions to be put in place.

Um, ultimately, I think the parents who have very low risk tolerance-- they're terrified that their kid could bring something home. Maybe they themselves are very high risk for a serious illness or death. Think about grandparents raising their kids. You know, I think there should be an online option. I think that we should respect their risk tolerance.

I think many other parents will look at the information and say, it's extraordinarily rare. And we can see in these other countries that the schools have reopened without any real problem. You know, we should be able to do that here, too, and be confident, you know, uh, to give it a try if their school system has a strong approach in place.

Now, teachers, you know, I view similarly. There's some teachers who, um, are at high risk for a serious illness event. They may have chronic illness. They may be older. And I think that, uh, those teachers should definitely have the option to do this totally online, teaching those kids who want to be totally online, um, and that, um, we should also, uh, take all these different precautions to minimize whatever residual risk there is for the teachers who are in school.

But we will need a critical mass of teachers in each group, meaning we can't say all teachers, if they choose to be online, can be online, just as we can't say all kids, um, can choose to be in school if there's not enough teachers, right? So we-- we do have to, you know, as physicians, you know, and health professionals-- we have to manage that risk. D-- do we need to have more of those discussions of trying to help people, you know, figure out where is the real risk? It can't just be perception of risk.

Well, I think we need, you know, the best possible data in the first instance. You know, are we misunderstanding, um, the-- the risk? I think, uh, basically, recognizing that this is, uh, a low risk that can be mitigated is basically, um, the situation for kids and for teachers who are not themselves at high risk.

You know, I think that, uh, what we're seeing, at least, as-- uh, is that there are a lot of teachers who want to go back in the classroom, um, who are comfortable doing that. But they also want to know that there-- there-- you know, there's going to be protection. There are also some teachers, and I've heard from some, who do not want to go back in the classroom who are very worried because of their own personal, uh, circumstances about getting too sick.

And hopefully, we can find a path during this period where we can, you know, respect both, you know, perspectives and have, uh, a lot of kids come back with a lot of teachers and the ones who want to stay online could stay online. And hopefully, they'll be supported at home in a way that won't make it, um, uh, such a difficult situation.

You are deputy commissioner of the FDA. Many folks are-- are tying these mitigation strategies to the availability of a vaccine. Is-- is that a realistic approach, in-- in your mind, in terms of saying, well, do these things until we get a vaccine, or-- or do we say, you know, we need to figure out a way-- how do we live with the virus, and then determine what are the matrices that we're going to look at-- is it number of cases, the number of deaths-- to try to return to some sort of pre-COVID, um, you know, in-school instruction?

Well, I think until we have a vaccine, we're going to have to be careful about the spread of the virus. And that's in many different settings. And so I would think that this sort of new normal for schools is going to have to be in place for a while. I'm-- I'm worried that if we just say, well, we got to go back to our life the way it was, we're going to have so many cases, so many people sick, um, and we won't be able to protect people at very high risk. And as a result, we'll have a lot of deaths.

But if we don't have a vaccine, this could continue for many years. I mean, you've talked about, in your article, that perhaps school districts should be, you know, leasing additional buildings, you know, having additional instructors, more of a focus on, you know, returning to school for a greater period of time--

Yeah.

[INAUDIBLE] the other aspects of learning that occur other than just direct instruction.

Correct. I mean, I think we should be investing in those things that would allow us to survive in a new normal and give kids the, uh, education in person.

So, um, I just think that we can't necessarily say, well, who knows how long it's going to be, let's just let everyone go back to school like it was before, because I think that that poses too high a risk of transmission. And some countries, uh, like Israel, that have tried that for a little bit have regretted it. And so, you know, I think that it's-- um, we're going to have to figure out a path through this. And that path probably does involve putting resources and-- and supporting safety in the activities that we really, um, prioritize.

What can we learn from other countries? You mentioned, uh, early on about some countries that have adopted some policies, um, and largely have reopened. Is-- are there any good examples that we can use here in the United States?

Well, there are a number of countries-- Denmark, um, Germany, Norway, for example-- um, that have opened schools, even with some community transmission. They generally have, um, increased distance between kids, uh, have masks. Um, they have, um, taken other, you know, basic infection control precautions and have not seen the schools become a site for outbreaks. And so I think that it is possible to do this in a way that really reduces the risk. And because of the benefits, it's worth it.

One of the aspects that people have been talking about is the COVID bubble. And you talk about that in your editorial in terms of grades. Can you explain how that would work for school-age children and how that might be a strategy?

The idea is that kids would spend the day with a small group of children and, um, you know, a teacher or teachers. And they would pretty much be with them all day. They would eat lunch together. They would go to recess together-- and so that if someone were to get sick, the exposure would be limited to that group.

And, uh, depending on the age, you might have to quarantine all the kids in that group. But you wouldn't have to quarantine the whole school, wouldn't have to shut down the whole school. If you could maintain these different pods on their own, um, that would be the idea. It's a similar idea to, um, the fact that people are with their families and, you know, people are spending, uh, a lot of time close to other family members, um, and recognizing that if one were to get sick, everyone's going to have to quarantine themselves. It's sort of like your school family.

Well, Dr. Sharfstein, I want to thank you for taking the time today to share your insights about the need to reopen the schools and do that in a way, uh, that makes sense for each community.

Thanks so much for having me.

And thank you for watching "Coronavirus in Context." [SUSPENSEFUL MUSIC PLAYING]