Covid-19 in schoolchildren – A comparison between Finland and Sweden [pdf]
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Right now, the options are either send them to school, where there are (in the US) government employees making sure they are safe. The workers are well represented by a strong union, have good healthcare and reasonable wages. The other option is to send them to private day care, where private citizens with no oversight, very low pay and no worker protections are being asked to shoulder the risk. It seems like we have no problem hoisting even more responsibility upon the poor and least represented in society.
Teaches are essential workers, much like firefighters, DMV workers or court clerks. We expect a girl making minimum wage at Kroger to accept that she is an essential worker. Why do we not expect the same from school staff?
Disclosure: I have siblings and other close relatives that work for and in school in the US. I am not externalizing the risk.
I'm not saying they don't have legitimate questions about how schools will reopen safely, but to be frank, it's really easy to argue that it's "just not safe enough", when you're still pulling a paycheck sitting at home and the closing of schools is felt by working parents who are SOL -- not by yourself.
I heard of teachers outright disappearing, claiming "technical issues" during this time.
The issue comes with trying to force kids to wear masks when so many parents are against them in many places, maintain social distancing, and keeping things clean and sanitized.
Keeping kids focused and learning has become difficult enough, but add on all those measures plus the possibility of contracting covid, just means you will lose a lot of experienced teaching staff.
Sure, if someone wanted to pay me to do whatever I wanted I'd take it no qualms whatsoever. But yes, I may not admit to it.
While we're doing that, maybe a compromise with A/B school days to limit student numbers, with online participation for whichever group is at home. Schools also need to create strict rules as far as cafeterias, masks, etc... With clear consequences for violations.
The school I am at has dividers in the cafeteria and staggered lunches with no talking while eating. Masks at all times. Temperature checks at the doors and such. This is countrywide (not US) and there has been no spread in schools.
Should this be an ongoing conversation to prepare for the _next_ pandemic? Certainty. But we lost the benefit of time on this one.
In some cases, it is better to continue course with known variables.
Also, I wouldn't say it is non-existent. As I said in another response, I currently see a lot of evidence for the cross-reactive t-cell immune response causing the virus to burn out after around 25% infection rate.
There’s likewise no firm understanding of the duration or quality of immunity, nor will there be for probably years, making every appeal to herd immunity little more than dangerous speculation.
Having public schools function as de facto daycares when there’s not a pandemic makes a certain amount of sense, but in the circumstances of the US, where we have uncontrolled spread and a dysfunctional healthcare system on many levels, it makes little.
The sane thing to do would be to implement some form of short term UBI that allows one parent or a designated caregiver to stay home and attend to children’s needs and do everything we can to get the situation under control (universal mask orders, regional lockdowns, replenish PPE, etc.)
1. What makes you think we _can_ get this under control without herd immunity or a vaccine? I am of the belief that there is a certain level of latent immunity via t-cells in a large portion of the population and thus effective herd immunity is around 25-30% infected. But for arguments sake, lets say it is around 70 based solely on Rt.
2. Who would pay for the UBI? My state is already running low on money. We are already having to cut programs. Raising taxes doesn't count, that would take a year to pass, a year to implement and collect and probably a few years in court litigating. So how do we pay for it?
3. How do you equitably select a parent to stay home? And how to do reimburse their employer for lost productivity? Do you guarantee their job upon the end of the pandemic?
New Zealand, Taiwan, Vietnam, South Korea, and Germany have done it without herd immunity or a vaccine with a variety of strategies. We should follow their examples and stop using various forms of “American Exceptionalism” as an excuse to not learn from them.
>2. Who would pay for the UBI? My state is already running low on money. We are already having to cut programs. Raising taxes doesn't count, that would take a year to pass, a year to implement and collect and probably a few years in court litigating. So how do we pay for it?
Print the money. It’s short term and there’s already massive demand and supply shocks that will only get worse if the pandemic isn’t curbed.
>3. How do you equitably select a parent to stay home? And how to do reimburse their employer for lost productivity? Do you guarantee their job upon the end of the pandemic?
I believe Canada and some countries in Europe are doing this through an employer-based grants, where the government subsidizes wages to keep them on the payroll. Whether this is ultimately desirable is up for debate, but the companies are going to be screwed in terms of productivity (and everything else) if this ravages the US labor force. How to do it equitably? Just let the parents/caregivers decide for themselves.
Two of those are islands, one might as well be and the other two are Vietnam and Germany. Vietnam is very interesting. There is a strong chance of Vietnam being a prime area to study the cross-reactive T-cells due to the previous experience with SARS. Furthermore, besides dickhead in chief, I don't believe most people made any sort of exceptionalism claim. The USA is a massive nation experiencing several outbreaks at once. The EU just happened to all have their outbreaks around the same time. We can't compare _just_ the results of each nation and rank the response. We need to look at demographics, density, cultural aspects, interconnectedness etc.
>Print the money. It’s short term and there’s already massive demand and supply shocks that will only get worse if the pandemic isn’t curved.
No. This has never been, and never will be, a sound economic strategy in anything but the most extreme of examples. Also, the pandemic _is_ flattened. Remember we were supposed to have millions dead by now had we done nothing. We did flatten it (too much, probably) and now it is curving up, but still not at the rate that was first feared. But this gets in to a different debate. I have made this point elsewhere in my comment history if you are interested in my opinion.
> believe Canada and some countries in Europe are doing this through an employer-based grants, where the government subsidizes wages to keep them on the payroll. Whether this is ultimately desirable is up for debate, but the companies are going to be screwed with in terms of productivity (and everything else) if this ravages the US labor force. How to do it equitably? Just let the parents/caregivers decide for themselves.
Most relationships are not like that. This would almost universally fall upon women to put their careers on hold. This has been researched and reported widely. We did a similar thing with PPP and it saved many jobs. It was a terrible implementation and corrupt as fuck. But it did save many jobs. But again, someone has to pay the piper and don't keep swooning over the nonsense that is Modern Monetary Theory.
UBI has not ever been tested at a large scale, and we have no reason to believe it will work. The last thing we need in this fragile economy is inflation. And UBI without increasing revenue will cause inflation, no way around that.
Ideological opposition to MMT is fine, I guess, but that’s not really a rebuttal or explanation of how allowing the disease to ravage the labor force won’t be worse, let alone in anyway moral, given its disproportionate impact on the poor and minorities.
There are always tough choices with caring for kids, but even paying a caregiver to stay home would be more equitable than the status quo (where this already happens as largely uncompensated labor).
You are making an assumption that this would ravage the labor force. Not to be glib, but unless your country has a labor force primarily comprised of 75+ year old workers, no labor force is getting ravaged by this disease. Yes, people will get sick. Some will die. Some will die from loneliness. In the time it took me to write this, hundreds of children died of preventable disease the world over. Some died of starvation. Some of lack of access to clean water. A woman was just murdered and another killed her lover, probably, somewhere. We can't ever have zero risk and to advertise otherwise is irresponsible at best.
Also please note, the poor and minority people that you are claiming to protect through blunt force lockdowns are actually the ones still working. Still butchering your meat, picking your fruits, delivering your Amazon order and washing your apartment complex. And the poor who aren't lucky enough to still be in work and in debt, falling further behind and face the least amount of economic security in 100 years. Let people decide what is best for them, you have no moral authority to claim righteousness in your cause and disparage mine.
Please, don't accuse me being counter-factual unless you want to counter my facts. Yes, I left Germany out. Germany is interesting. There are some theories around about that, but I am not well versed enough on them to comment, so I didn't include it. Well caught. I apologize for not blindly speculating and instead passing it over.
Finally, we were already told that mitigation saved two million lives: https://www.cato.org/blog/did-mitigation-save-two-million-li... so the corollary is that had we not mitigated, two million would be dead. And the Imperial College model really did estimate that much. Though they didn't give such a precise timeline: https://www.cato.org/blog/how-one-model-simulated-22-million...
And lets not forget the folks at the UW: A different, data-driven model from researchers at the University of Washington predicts “about 1 million cases in the U.S. by the end of the epidemic, around the first week in June, with new cases peaking in mid-April,” said UW applied mathematician Ka-Kit Tung, who led the work. “By the first week of June, we project that the number of new cases will be close to zero if current social distancing policies are maintained.” That model predicted two weeks ago that the number of new daily cases would peak around now, as seems to be the case. (https://www.statnews.com/2020/04/17/influential-covid-19-mod...). Again in that model, nobody ever talked about what comes next. I will tell you. More cases. Or immunity. One of those two.
My spouse and sister are both schoolteachers. Sister's situation: laid off from a private school where enrollment will drop significantly this year. Spouse's situation: works for a well-funded school in one of the most populous states in the U.S., where there is no strong union, the pay is below the poverty line after mandatory deductions, and the healthcare is so bad (no out-of-network benefits and in-network only applies within the county, basically) that most people have to expand their view of what "health insurance coverage" is in order to understand it. A number of the teachers in their network are considering teach 5 kids in a private daycare group (working 30 hours a week) instead of teaching 30+ kids working 50 hours a week under very constrained public school conditions. These are anecdotes, of course, but what we're seeing from over here is that teachers don't feel safe reopening schools, and aren't overly committed to their benefits since they're not particularly well taken care of by the standards of the average American worker. Just a different two cents.
Thank you!
It is also somewhat common in immigrant groups in western Europe and the US (though somewhat out of economic necessity rather than cultural norms) and those groups are also the hardest hit in the US (apart for retirement homes).
Causality is hard to prove, but it is something worth looking at.
Most if not all of my colleagues and I have worked incredibly hard teaching remotely when that was the only option. We've been expected to use self purchased electronic equipment for that. When limited on-site teaching became possible again, we took the opportunity. Yes, older, overweight teachers most at risk also did.
We saw our bosses cared. We saw a fairly competent chain of command up to the prime minister, very much guided by the scientific approach. My guess is that made a large difference. At least with me it did.
Would we have done the same in the US? I don't think so. The scientific approach has been disregarded so badly, not to say ridiculed, at so many levels. Individual students, parents, school district leads, governors, the president. Don't expect me to voluntarily take the risk they've created.
Here are some of the important questions that need to be answered before I'd consider going back to teach on site:
- Will sufficient personal protective equipment be provided?
- Will elementary technical precautions like distancing, natural ventilation etcetera be taken?
- Will parents and students over 12 years old be required to use a facial mask in any physical proximity situation?
- Will my obese colleague with a heart condition be shielded from teaching in direct physical contact with students?
Also, it would be nice if government showed some appreciation for our hard remote work, by way of a budget for electronic equipment for remote teaching for example.
What country do you live in? Most teachers are employees of the local school district, not directly of the government. (When I was a Title I teacher, I was a federal employee, but that's not very common). I was never in a union, because there weren't any in the Detroit charter schools I worked at. And I only made $27,000 a year. Does that sound well-paid to you? Even though we had decent health care, with student loans I couldn't afford the copay, so I forwent any health care unless it was an emergency.
I wish that as a society we could decide that anyone we're going to call an "essential worker" and draft to the biohazardous front lines should bloody well be paid at least as much as the rest of us who can be gone for a week with little ill effect to society at large.
Not just during an emergency either - they're essential the rest of the time too.
INFECTIONS, however, matter a LOT. If you're infected you can pass a virus on without ever being counted as a "case." And we have zero reason to think children can't be infected. Hell, tigers and mink can be infected. Of course children can be infected. This thing is crazy infectious.
Children will spread the infection to their teachers, school staff, and families. There is no question about that, regardless of whether children's infections count as "cases."
And we know that, while presymptomatic spread is an issue, asymptomatic spread is between rare and nonexistent.
The fact that children tend not to be diagnosed because they tend much more strongly than adults to be asymptomatic when infected is not irrelevant to their propensity to spread the disease.
Our knowledge is not that precise yet.
What we do know, based on models, is that "silent" transmission accounts for about 50% of covid-19 infections.
https://abcnews.go.com/Health/asymptomatic-presymptomatic-pe...
But the ol' maxim applies here: absence of evidence is not evidence of absence
That applies to infection/transmission via schools in general. Precisely because we don't have decent testing and tracing, we have a large number of cases whose origin is unknown. Schools have to be considered as one possibility, especially considering the several cases where reopening schools has been strongly correlated with spikes in infections. The precise mechanism doesn't matter. It's a red herring. Whether it's kid to kid, parent to teacher, cafeteria workers, whatever, it seems to happen some of the time. Until we've clearly ruled out a cause for those unknowns, we have to consider it still operative.
"Our results indicate that silent disease transmission during the presymptomatic and asymptomatic stages are responsible for more than 50% of the overall attack rate in COVID-19 outbreaks."
Actually this is exactly the big question right now -- ignoring "cases", are children as infectious as adults?
We don't know, signs point to "not as infectious, but probably nonzero".
Of course, and so has every parent -- what, exactly, are you implying, that the people studying this haven't had this experience? And are therefore not considering that kids can have mild symptoms but still be contagious?
If so, that's an awful lot of ignorance that you are ascribing to everyone studying this with an opinion that doesn't match your lived experience with other viruses.
If not, please enlighten me.
> It's highly likely this is the same, and the burden of proof is on those who want to say this coronavirus is the exception.
Yes. You are literally commenting in a thread about a paper that is trying to provide evidence ("burden of proof") by looking at differential rates of illness, and not simply drawing inferences from general facts about viruses -- which is what you are doing here.
In that report (see reference 6) for example taxi drivers had 4 times the increased risk of exposure compared to teachers of primary school.
| Children are not a major risk group of the covid-19 disease and seem to play a less important role from the transmission point of view, although more active surveillance and special studies such as school and household transmission studies are warranted.
I feel like that is probably the next most important question to answer.
[1] https://www.npr.org/sections/coronavirus-live-updates/2020/0...
"Since the first phase of the schools reopening last month, 968 schools have had to close due to outbreaks and 2,400 teachers and 1,260 learners have tested positive for COVID-19."
Source: https://medicalxpress.com/news/2020-07-south-africa-phase-re...
Or the Georgia summer camp that had an outbreak involving 85 campers and staff:
https://www.wftv.com/news/trending/85-campers-staff-test-pos...
Or the Missouri summer camp that had an outbreak involving 82 kids and staff:
https://www.foxnews.com/us/missouri-summer-camp-closes-after...
A lot of this is anecdotal, sure, but I find it hard to believe that kids don't spread the virus if we're seeing large outbreaks like these already.
It's pretty interesting that almost twice as many teachers as students tested positive. Presumably there are ~20x more students than teachers?
It may very well be the case that children are far less likely to either catch or spread the virus, but far less likely is not the same as not spreading it at all.
It might be impossible to know whether the adults infected the kids or vice versa (or both), but Coronavirus cases are growing fastest among kids younger than 10 in Oregon right now [2], so ... to me, it makes sense to assume that kids can spread it until it's proven otherwise.
Lastly, for those who don't know, the CDC internally lists reopening schools as the "highest risk" for Coronavirus spread. [3]
[1] https://www.wweek.com/news/state/2020/06/30/oregon-child-car...
[2] https://www.oregonlive.com/coronavirus/2020/07/coronavirus-i...
[3] https://www.cnn.com/2020/07/11/politics/cdc-documents-warn-h...
Is there another example in the U.S where U.S citizens reacted reasonably and averted disaster?
We had fewer people in 1918 so this would still mean millions of deaths if we let this run it's course without mitigation.
My other concern is whether this virus will have adverse effects later in life when one's immune system weakens.
This virus may very well drastically drop our overall life expectancy.
1. https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scena...
> Based on a systematic review and meta-analysis of published evidence on COVID-19 until May, 2020, the IFR of the disease across populations is 0.68% (0.53-0.82%). However, due to very high heterogeneity in the meta-analysis, it is difficult to know if this represents the ‘true’ point estimate..._
There have been several reports that the IFR has lowered since late May, so it will be interesting to see if they rerun their metanalysis with June/July data. Their paper also makes the point that this could be an underestimate due to reporting issues (under-reported deaths). But likewise it could be an overestimate due to under-reporting infections (with so many asymptomatic cases). I am a little concerned over the lack of mention of that fact in the paper, which to me is as important as the under-reported deaths.
I understand your concern regarding long-term impacts. While we can't dismiss those concerns, it would be the only coronavirus in the history of known coronaviruses to do anything like that. So with our knowledge of this virus and the family of viruses, we can say that is "unlikely".
Tissue damage from a lung infection is _not_ rare. The flu does this (https://www.sciencedaily.com/releases/2009/07/090717150302.h.... Any pneumonia can cause scarring of the lung tissue, viral or otherwise.
If you are referring to the clotting and inflammation, again this is not altogether rare for a serious infection. Inflammation is common and not normally dangerous. The clotting is interesting, but also not unheard of. Also some interesting evidence that this may be a secondary infection (perhaps caused by venting? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6836438/) https://principia-scientific.org/cv-19-autopsies-show-blood-...
There are going to be a lot of deaths. I can't argue out of that reality. It is really unfortunate. We will all known somebody who dies from this, or at least are within a free degrees. The debate, in my opinion, isn't on preventing all deaths, it won't happen. It is how do we minimize death while preventing long term societal and economic damage. And how do we protect the most vulnerable without causing those damages elsewhere.
I know it sounds weird, but the age stratification of the IFR is a HUGE gift of this virus. It is more age stratified than the flu or other common pandemic sources. We are very lucky. Next time we may not be, so I hope we can learn from this on how to prepare for what we feared this was.
This seems to be a common thought, but it is an error to assume that incidence of death = acceptance of death.
The truth is, the socially and politically acceptable incidence of death from seasonal communicable diseases is 0. Yes, deaths still occur, but that is in spite of absolutely tremendous investment of resources to try our very best to get it down to 0.
To pick on the flu, for example, there is no tactic or resource that we have available that we have not deployed. We have invested many $billions to create an annual national vaccination program that aims for 100% uptake and is even backed by a special liability regime to manage lawsuit risk. It is the largest vaccine program we have for any disease.
We have also invested (and continue to invest) additional $billions in studying every aspect of the disease, how it invades the body, how it spreads, how it harms people, etc. We have spent even more to create public awareness of flu symptoms, treatments, and appropriate behaviors.
The fundamental difference between the flu and COVID-19 is the possibility of significant asymptomatic or presymptomatic contagion. With the flu, you're not really contagious until you are symptomatic, so getting people (including kids) to stay home when they feel sick does as much good as a lockdown would. We don't really know for sure with COVID-19. So far it seems like a big possibility, hence the emphasis on masks, separation, stay at home, etc.
Also unlike the flu, we don't know what COVID-19 does to the human body. We don't know how long post-infection immunity lasts, and we don't know what chronic ailments might linger with survivors.
The reality is that we can't compare it with "other threats of similar risk" because we don't know what the risk is yet. That's why it is appropriate for the current response to COVID-19 to differ from the way we fight the flu and other more well-understood communicable diseases.
Yeah, sounds a bit crazy, but could probably be made to work.
I have much less faith in 8 years olds.
I like the young proctor suggestion a lot!
What bothers me the most is that just like retail / grocery store workers we put people with the lowest earning potential and generally worst benefits directly in the path of this. I don’t want to get COVID but unless I convince my wife to quit her job my odds of getting it greatly increase due to situations out of my control.
The most obvious answer is that quite a lot of the population are already not susceptible to this virus for whatever reason.
And we also know that the excess death rate on the under 40s is negligible - which is the majority of the population. The median age of deaths is over 80 in Europe.
Since it affects the older population more than the younger, you want to catch it as early as possible. Catching it next year is more likely to kill you than catching it this year.
There is no longer any justification for holding back the majority of the population when we can just retire the old and ask them to keep out of the way until the virus fully burns out.
https://www.theguardian.com/world/2020/jul/12/immunity-to-co...
(Of course, since I'm sure I'll be called on this, the fact that herd immunity is possible does not by itself prove it's a wise course of action.)
The first paragraph of the article amiga_500 linked says: "People who have recovered from Covid-19 may lose their immunity to the disease within months, according to research suggesting the virus could reinfect people year after year, like common colds."
I don't think there is significant doubt that immunity exists; the question is how long it remains in effect. The drop in deaths that you mention would be compatible with a several month long effective immunity period, but a herd immunity approach would probably not work well if reinfection is possible every year.
Hard for who? This is Epidemiology 101 stuff. You don't have to totally eliminate a virus to go back to normal. If the few infected individuals are quickly identified and isolated, along with contacts, outbreaks can be contained quite well. Test, trace, and isolate. We've been managing many other diseases this way for years. There's little mystery to it.
That might be true if you assume that there will not be a vaccine AND that medicine will not advance in the near future. But we have already seen medicine get better at treating Covid. (For example, doctors have learned not to use ventilators so much and proning is used more often, from what I understand.) I would rather get Covid now than a few months ago both because the medicine has gotten better and because the hospitals in my area are less overwhelmed—despite the fact that I am a few months older now. Furthermore, if I do have to die from Covid, I'd rather live a little longer first!
> retire the old and ask them to keep out of the way
Plenty of high-risk folks are not of retirement age. And many who are older live with younger family members for various reasons. It is not feasible for all of the high-risk people to "keep out of the way." Who will take care of high-risk elderly and disabled people who need help with bathing and toileting? What should grandparents do who are the guardians of their grandchildren? It's obvious that you have not thought this through.
"Outbreak investigations in Finland has not shown children to be contributing much in terms of transmission and in Sweden a report comparing risk of covid-19 in different professions, showed no increased risk for teachers."
"In conclusion, closure or not of schools had no measurable direct impact on the number of laboratory confirmed cases in school-aged children in Finland or Sweden"
"In the contact tracings in primary schools in Finland, there has been hardly any evidence of children infecting other persons. The Swedish comparison of number of reported cases among staff in day care and primary school to number of cases in other professions does not show any increased risk for teachers. This also indicates that the role of children in propagating this infection is likely to be small. Various papers on contact tracing have also found that children rarely are the first case in family clusters (4, 12, 13)."
"Closing of schools had no measurable effect on the number of cases of covid- 19 among children."
"Children are not a major risk group of the covid-19 disease and seem to play a less important role from the transmission point of view, although more active surveillance and special studies such as school and household transmission studies are warranted."
Intriguing.
This Mercury News article from a couple days ago tells the same general story, and offers some theories on how things might work biologically:
Coronavirus: Why kids aren’t the germbags, and grownups are.
As school districts sweat over reopening plans, a growing body of research suggests young children are unlikely to transmit COVID-19 virus. They get it from us.
https://www.mercurynews.com/2020/07/10/coronavirus-why-kids-...
No details around:
* distancing measures * space utilization * travel arrangements * coplay arrangements
More directly- as a parent in NYC, I am unhappily looking forward to people citing this unhelpful paper and "the Swedish model" claiming return to school will be safe. No and no is what I say to them.
Cheers.
https://www.folkhalsomyndigheten.se/smittskydd-beredskap/utb...
If this thing is an aerosol and kids are going to school, seems to me we could do class outdoor until further notice.