co authored by Nan Fulcher and Justin Parmenter

Governor Roy Cooper is expected to announce today whether North Carolina’s schools will fully reopen, reopen to reduced numbers of students, or remain closed and continue with remote learning when the 2020-21 school year begins on August 17.

On Saturday we wrote about the COVID-19 data that North Carolina school officials are mulling over. In analyzing the specific points presented by the North Carolina Department of Health and Human Services (NCDHHS) to the NC State Board of Education, we noted the scarcity of information on COVID-19 spread in schools, and the potential for misinterpreting the few studies that do exist.

In our article, we only addressed the studies cited by the NCDHHS that supported the statement “schools do not appear to have played a major role in COVID-19 transmission.”

We did not address the fact that the NCDHHS failed to include other data in their report — information about countries that had already reopened their schools prior to the end of the 2019-2020 school year.

To shed more light on reopened schools, we now highlight a recent New York Times (NYT) article, which was published the same day as our last blog article.

The NYT outlines critical considerations for reopening U.S. schools, citing much of the same research we analyzed — and identifying the same flaws.

In addition, the authors discuss what happened when countries reopened their schools following initial closure due to the first COVID-19 cases. Information about reopened schools was absent from the NCDHHS’s literature review. This data could have greatly helped to inform discussion about North Carolina’s plan for the upcoming school year.

The NYT article cites the report entitled “Summary of School Re-Opening Models and Implementation Approaches During the COVID 19 Pandemic, which was distributed by the University of Washington Department of Global Health (updated 7-6-2020). 

To set the stage for analyzing the UW report, we generated some values that reflect the COVID-19 burden in each country at the time they reopened their schools. Because the studies had different methods for determining transmission rates, direct comparison of each country’s infection data was not possible.

Therefore, to illustrate the prevalence of COVID-19 in each country, we determined the number of new daily cases expressed as a fraction of the country’s total population. (For example, Denmark had 198 new reported cases the day schools reopened; that value divided by the total population of 5.8 million equals 0.34 cases/10,000 people) [source of data for new daily cases and cumulative cases]

Table 1. COVID-19 infection data from six countries on the date that schools reopened.

In the UW report, the authors considered Denmark and Norway to be among the European countries with low community transmission, while Germany was considered to be “higher”. This conclusion doesn’t track with our calculations, but high variability among the number of new daily case reports at the time could account for the discrepancy.

As for the outcome of reopening schools, the UW report presented the following results: [*NOTE: each country employed different mitigation measures and different strategies for grouping students and determining which ages returned to school.] 

Denmark and Norway – These two countries reopened schools gradually, starting with preschool and then all students six weeks later. This approach did not result in an increased rate of growth of COVID-19 cases in either country.

Germany – The return of older students later in the reopening process was accompanied by increased transmission among students; staff infection rates were equivalent to that of the general population. Individual schools were closed for quarantine as outbreaks occurred. Recently, Germany closed a small number of schools preemptively in response to local community outbreaks.

Israel – Schools adopted fewer social distancing measures due to crowding. After reopening schools, over 300 children and staff were infected within a month, with over 130 cases at a single school. Around 200 schools out of 5,200 were closed for quarantine during June, others remaining open through the end of the month. 

South Korea – Soon after reopening, schools near a warehouse facility outbreak were closed and other schools postponed reopening. Other closings have occurred in response to other small community clusters. No reports of school-related infections have been reported to date.

France – There were no publications on the outcome, but news accounts indicate that, despite a small number of cases (70 per 1.2 million students) after gradual opening in mid-May, cases have subsided and schools have fully reopened with no additional outbreaks.

The overall conclusion from UW was that reopening schools in countries where community transmission was low did not increase overall spread, but opening schools in countries where community transmission was higher correlated with school outbreaks and subsequent school closures. 

To consider how reopening U.S. schools will compare to the other countries’ experiences, we looked at the current data for new daily cases for the entire country and for North Carolina (Table 2). 

Table 2. Current COVID-19 infection data (7-11-2020) for the United States and North Carolina.

It’s clear that none of the countries that reopened schools in late spring had anywhere near the extent of COVID-19 that’s present in the U.S. 

Further, the value for new daily cases from each country that reopened schools (with the exception of Israel) continued to decline after school was back in session. 

With transmission rates continuing to rise in the U.S. and in North Carolina, the number of daily new cases in both places could double by the time school starts on August 17^th.

If the experience of other countries holds true — that COVID-19 spread in reopened schools reflects the prevalence of the infection in the community — reopening schools where the number of active cases is high would present an enormous risk for students and staff in those areas. 

Even if children don’t pass along SARS-CoV-2 as easily as adults, there could still be a significant increase in spread among students and their families in communities hardest hit by COVID-19.

NC school officials urgently need to consider the lessons from other countries’ school reopening experiences, and look at the pace at which the virus is spreading right now … and where it’s predicted to be this fall and beyond.

Nan Fulcher earned her Ph.D. in Microbiology and Immunology from the University of North Carolina, specializing in infectious disease research. She’s involved in science and outdoor education programming for children and does freelance graphic design.