turns out that children who attend schools with mask requirements are likely equally safe from COVID-19 sitting just 3 feet from each other and not the 6 feet previously recommended by the Centers for Prevention and Disease. CDC will update its guidance on schools in mid-March, derived from a study conducted during the fall and winter that examined transmission rates in K-12 schools in Massachusetts, where masks are required for the majority of students from public schools and all staff.
Bringing students closer together in classrooms did not lead to an increase in COVID-19 cases, a group of medical researchers and policy experts concluded in the accepted manuscript published March 10 in the medical journal Clinical Infectious Diseases. One of the researchers is Dr. Elissa Schechter-Perkins, a Boston Medical Center emergency room physician who performed infection control in the emergency room during the COVID-19 pandemic. “In the spring of 2020, we didn’t know much about COVID-19,” he said in a March 23 interview with MarketWatch. “And based on what we’ve seen in influenza pandemics, it was thought that closing schools would be essential and effective in preventing the spread of COVID-19.” But now, as the pandemic has spread into its second year and the science is still evolving, it appears that the 6-foot rule, which was particularly burdensome for classrooms, might not be necessary. – MarketWatch: Has much of the research on distancing in schools so far been anecdotal? Dr. Elissa Schechter-Perkins: I would say it went beyond anecdotal evidence. There have been multiple studies that are primarily epidemiological in nature, from around the world and around the US, in which students returned to closer distances. [Editor’s note: The World Health Organization recommends 1 meter — about 3 feet — in schools.] There have not been large amounts of transmission at school and there has been no increase in cases in school settings compared to surrounding communities. Therefore, a body of literature has emerged that says our schools are safe, even with less than 6 feet of distance between students. MarketWatch: How do you think mitigating factors like masking, Plexiglass dividers, or open windows affect transmission in schools? Schechter-Perkins: It’s a really important point. Our study couldn’t really determine which of the mitigation measures, other than distancing, was not important. I think it’s important to understand that all of the Massachusetts district schools that were part of our study had a 100% masking mandate for all staff and all students in second grade and up, and most districts had a 100% masking mandate. masking requirement or a masking. Younger students were also strongly encouraged. [Editor’s note: The Massachusetts Department of Elementary and Secondary Education requires noses and mouths to be covered at all times, except during designated breaks, for staff and students in second grade or older. Kindergartners and first graders were encouraged to wear masks or shields, but it’s not required.] Many of the schools, but not all, had many other mitigation measures, including daily symptom screening. Many of them had other mitigation measures in place, such as ventilation controls and requirements for contact tracing and quarantine for exposed people. Although we cannot say which of the mitigation measures was the most important, our thinking is [that if] the set of mitigation measures taken together is enough to decrease the spread of COVID-19, so it is safe to decrease the distance between students. We should not extrapolate our findings to other less controlled settings where those other factors are not present. MarketWatch: Now that we have the new CDC guide for schools, are you planning any follow-up studies? Schechter-Perkins: It’s going to be very important to keep tracking the data, and it’s something the country has struggled with a lot over the last year. As new studies emerge and new evidence emerges, the guidelines should change, and that has been a real struggle for the general US population to accept. We are not used to things changing so quickly, but I would say that as schools open for more in-person learning, it is really essential that we continue to see what happens, especially since we know that new variants are circulating, but so is vaccination. . is increasing. MarketWatch: Do you think we might one day see the spacing requirement get further reduced? Schechter-Perkins: I would absolutely be open to that. I am very optimistic about where we are now. We are doing an excellent job vaccinating an increasing number of the population, and I am very hopeful that we can decrease the transmission of COVID-19 in our country to the point that, instead of becoming widespread, it becomes episodic in our countries. communities. . [Editor’s note: About 16% of the U.S. population has been fully vaccinated, as of March 31, according to the CDC.] At that point, we can use other public health measures, such as rapid diagnostic tests, rapid contact tracing, rapid surveillance tests, and quarantines, and really reduce the transmission of COVID-19. When we start to get to that point, I think we can open up a lot of things with fewer distancing requirements, and life will look a lot more normal. We haven’t got there yet, but I think that’s in the future. The other opportunity to consider is what was mentioned in the CDC guidelines, where they talk about cohort. This has worked very well in other countries, especially in Europe, where there are groups of students that do not require any distance between them. So if there is an outbreak, that particular cohort or bubble is at a higher risk, but [the virus] it is not expected to spread outside of that cohort. That’s another model that can be considered, as a way to get more students back into the classroom and try to get life back to normal. Our study did not evaluate that at all. That’s more of an international phenomenon. MarketWatch: Strictly from a vaccination point, how long do you think distancing is necessary in schools? Schechter-Perkins: It is a difficult question to answer. Our study was conducted during a time when virtually no one was vaccinated. [Editor’s note: It was conducted between Sept. 24 and Jan. 27.] What our study and others have shown is that vaccination is not essential to return to school safely, provided mitigation measures are in place. To really start relaxing some of the other mitigation measures, you really have to vaccinate a large chunk of not just the teachers, but the entire community. We will get there, but I think there is a long way to go. MarketWatch: One of my co-workers has talked about how there is an exposure cycle, kids get tested or stay home, then go back to school in person. Would the cohort be a way to compensate for this type of cycle? Schechter-Perkins: I would. The cycle we have really depends on where you are in the country. Certain places are being quarantined very aggressively. I don’t know if this has changed in New York, but I know that at one point it only took two cases in a school building, and the entire school would be quarantined. [Editor’s note: New York Mayor Bill de Blasio is reportedly re-evaluating that policy, as of March 14, according to Gothamist.] That is incredibly conservative and a really harmful policy that is not necessary. More schools across the country are going to go into a more modified quarantine, in which, as long as students are only exposed at school with masks on, they will not be quarantined. There are many places that have recently turned to that type of model, and reportedly there hasn’t been much transmission at school, even with that modified limited quarantine. So I am eagerly awaiting the release of that data. At this time, if people are within 6 feet of each other for 15 cumulative minutes, according to CDC guidelines, they should still be in quarantine. But hopefully it’s not about entire classrooms at once. There is a lot of variation in the way people interpret exposure in the school setting. I’m worried about constant exposure, shutting down, quarantining the whole class for 10 days, and then resuming [cycle] it may very well be too conservative and disruptive, and it may not prevent more cases either. If you don’t prevent cases, I don’t think we want to follow that strategy. But I think we still need more data. MarketWatch: Do you think this is a leftover reaction from last spring? Schechter-Perkins: It has been very difficult to change. A long time ago when we established these guidelines, they were based on the best evidence at the time. It is really important that the guidelines change as the evidence evolves. We need to keep doing the studies, providing the science, so the guidelines can catch up with what the evidence really shows. MarketWatch: At what age are children in a K-12 school most at risk of contracting the virus? Schechter-Perkins: It seems around age 12, maybe around puberty, this is when things start to change, when younger children who seem more protected and less likely to transmit start to behave more and more like adults. , regarding your infection. risk and its risk of transmission. That said, in our study, and many others, even high schools remain safe for students and staff with those mitigation measures in place. So even though you have older students who may behave more like adults when it comes to the virus, they can still be safe in the school setting. In addition, they are at particular risk of some of the harms of not being in school. We see damage to their mental health, with anxiety, depression, isolation, suicide, as well as a tremendous loss of learning. So that risk-benefit analysis really needs to be done when it comes to keeping schools closed. We have seen that, in a regulated school environment, they can still be safe in school, and their teachers and educators can also be safe in schools with them. So even though they may be at a higher risk of getting sick or transmitting the virus, I still think they may belong to the school. This question and answer session has been edited for clarity and length. Read more Interviews A few words from the experts: • It’s a ‘matter of time’ before another virus passes from animal to human, says co-inventor of the flu treatment Tamiflu. Preventive therapies are needed. • The new B.1.1.7 is a ‘superpreader’ variety. Here’s how the United States can control it, says Dr. Eric Topol. • Dr. James Hildreth: Here’s how to instill confidence in vaccines among people of color.