Few issues in the policy response to the coronavirus pandemic have inspired as impassioned debate as reopening our schools, write Jeremy Goldhaber-Fiebert, David Studdert and Michelle Mello in this JAMA Health Forum Insight article.
"There is broad agreement that school closures involve heavy burdens on students, parents, and the economy, with profound equity implications, but also that the risk of outbreaks cannot be eliminated even in a partial reopening scenario with in-school precautions. Consensus largely ends there, however: the approaches states and localities have taken to integrating these concerns into school reopening plans are highly variable.
"This variability is driven partly by differences in values and priorities. More concerning is that it may reflect inattention to or underweighting of key epidemiological considerations. In particular, the intense focus of school reopening discussions on in-school mitigation measures has tended to underplay relevant features of the surrounding community and the relationship between school and community transmission of COVID-19. To succeed, school reopening efforts must account for salient characteristics of the communities within which schools are embedded and engage with fundamental questions regarding intergenerational risk and benefit tradeoffs.
"Three community considerations are especially important. First, school reopening increases the risk of transmission within schools but also within households, workplaces, and the community at large. Second, community disease prevalence affects in-school transmission risk, and third, other community characteristics drive the potential impact of increased spread. We elaborate on each of these considerations."