Another surge of coronavirus cases is upon us, and it is horrifying. The last seven days saw more than a million new cases in the United States. Last week, there were two days in which the national tally of reported COVID-19 deaths rose above 2,000—for the first time since May. Based on current projections, 60,000 to 90,000 additional deaths are expected by late January. Any easing of masking or social distancing restrictions is likely to add to that total. Despite ubiquitous warnings from news media and public health authorities about the risks of holiday travel and visits, thousands of people who were infected over the Thanksgiving weekend will likely be in hospital beds around Christmas.
At the same time, the public-private partnership called Operation Warp Speed and a massive global research effort are on track to produce billions of doses of effective, safe vaccines that should help crush the pandemic over the next year. We are about to cross a bridge that will take us out of the pandemic. What matters now is getting as many people as we can across that bridge with as few infections, disabilities, and deaths as possible.
In this landscape of daunting challenges and surprising hope, we have, in the short term, a limited set of tools available to mitigate the pandemic. These tools center on various expressions of social distancing. Within this category, closing K-12 schools has probably been the most consequential decision—and the most contentious: Many places across the country have seen strident debate on the tradeoffs between the needs of children to be educated and socialized and the extent to which open schools contribute to the spread of infections. This is doubly unfortunate because, from a scientific and public health perspective, the evidence strongly indicates school closures are among the most effective strategies we have for reducing the spread of viral infections.
In a new book, Apollo’s Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live, Yale physician and sociologist Nicholas Christakis reviews the historical and epidemiological data on this issue. While not discounting the ambiguities and tradeoffs associated with school closings, he argues that “the impact of banning occasional large gatherings like sporting events or religious services does not even come close to that of school closure” and that “school closures are the most consequential [public health measure] that can be employed, short of requiring everyone to stay home.” Moreover, Christakis says, the data show that these policies are most effective in reducing disease when they are imposed early, even before cases show up in a community, and are maintained for prolonged periods.
Christakis relies on data drawn from past pandemics within the United States and other countries. A review of studies from 1957 to 2015 in 12 different countries showed that closing schools delayed and reduced epidemic peaks. The longer schools were kept closed, the later the peak arrives. Whether the peak arrives early or late, these closures have the benefit of reducing the final case count, thereby avoiding disease and death.
Within the United States, the evidence is even stronger. A paper examining “nonpharmaceutical interventions” implemented during the 1918 pandemic examined more than forty U.S. cities and found that closing schools and restricting public gatherings helped significantly reduce excess deaths. The same paper found that cities adopting these policies early and sustaining them over long periods, like St. Louis, Missouri, experienced outbreaks that were less brutal than other cities that did not adopt them early or sustain them as long. One interesting factor here was that in some places, whether or not schools closed officially, absenteeism rose sharply at the peak of the epidemic—effectively a closure of the schools by the community rather than government edict. Something similar happened this year: Especially during the early months, parents in some places starting keeping their children home even before schools had officially closed.
These closings are effective whether they are applied early in an epidemic or late. Proactive closures (i.e., before cases of a disease actually appear) yield the best results but even reactive closures (i.e., those executed after cases appear) are also effective. A reactive closure can reduce peak attack rates by up to 40 percent. Early closures are hard and politically controversial but yield the best public health results.
COVID-19 is overwhelmingly a disease of adults, and the older the adult is the harder the disease hits. Then why are school closures effective at reducing cases and deaths? The answer is that a school is a hub for community interactions and potential transmissions among parents and other adults. School closings are effective because they reduce contact between and mobility of the adult population. Parents aren’t interacting with teachers, other school staff, or one another as much. Extracurricular activity halts or is moved online. Parents stay home more to care for children thereby reducing their exposure to the disease in their workplaces. As we’ve noted in the past nine months, when schools close, life slows down and so does the transmission of the virus.
In short, school closures are not about protecting children per se as much as protecting the adult population on which those children depend. School closures are an act of social and intergenerational solidarity, with children postponing the benefits of education and peer relationships while adults sacrifice the freedom to carry on with their normal personal, business, and professional lives.
The payoffs of these policies are manifest: less disease and death and, therefore, more parents and grandparents around to teach and nurture children in the future. As other studies of the 1918 pandemic have suggested, policies that preserve human life, knowledge, skill, and wisdom provide the basis for restoring socioeconomic functioning after the pandemic. The communities that imposed and sustained harsh social distancing measures and economic shutdowns had the earliest and strongest economic recoveries once the influenza passed.
Finally, the intergenerational compact needs to work in both directions. It is unfair to close schools while allowing adult recreational spaces, namely bars and restaurants, to remain open. These can also be major sites of transmission, and the principle of solidarity demands they close as well with government support to ensure their ability to reopen later.
If school shutdowns are effective and necessary, it’s important that they be done carefully, predictably, and in the most logical and least burdensome way possible, with maximum coordination among government officials and between schools and parents. The farcical behaviors, unpredictability, and miscommunication among New York City Mayor Bill de Blasio, Governor Andrew Cuomo, and parents and teachers in New York City is a model of bad policy made in the worst possible way.
The important thing to bear in mind at this point is that—as bad as things now look, with the case counts and death counts rising again—we are far closer to the end of the pandemic than the beginning. Commitments made to limit social activity now, including school closures, are not meant to last indefinitely but have a specific time horizon as the pandemic crests and hard-won vaccines and drugs become available in the first half of 2021. While school closings in many ways involve painful tradeoffs, by imposing them for the next few months we can significantly reduce illness, disability, and death and look forward to a stronger recovery next summer.