If you went to high school in the US, you may recall early morning extracurriculars, sleeping through first period algebra, or bleary-eyed late-night study sessions (as opposed to other wide-awake “study sessions” we told our parents we were having). As an adult, you might wonder if there’s a better time to explore Shakespeare than at 8 am, or expand a Taylor series right after you collapsed into your chair, half-asleep from your sunrise bus ride.

As it turns out, early school start times for US high schools are built on a shaky scientific foundation, as journalist and parent Lisa Lewis lays out in her new book, The Sleep-Deprived Teen. She details why high schools in the US tend to start early, the science behind why that’s bad for kids, and how later school start times can benefit not only teenagers, but, well… everyone. Perhaps most importantly, she provides a primer on advocating for change in your community.

The wheels on the bus go round and round

Our early start times are a bit of a historical accident. In the first half of the 20th century, schools tended to be small and local—most students could walk. Lewis points out that in 1950, there were still 60,000 one-room schoolhouses around the country. By 1960, that number had dwindled to around 20,000.

According to Lewis, that trend accelerated as authorities in the US feared that education—especially in science and math—lagged behind that of its arch nemesis, the Soviet Union. She describes how a 1959 report written by James Bryant Conant, a chemist and retired Harvard University president, recommended that high schools have graduating class sizes of at least 100—a far cry from small local schoolhouses. School consolidation, which had already begun, hastened. Neighborhood schools continued to close. And the yellow school bus was locked into a trajectory toward its current iconic status.

To minimize costs associated with busing, Lewis describes how many districts staggered school start times so they could use the same buses for transporting elementary, middle, and high school students. At the time, there was a societal consensus that teenagers needed less sleep than youngsters, so high schools got the earliest slots.

And the science says…

In the 1950s and 1960s, scientists had yet to delve into teen sleep. But that began to change in the 1970s, beginning with the Stanford Summer Sleep Camp experiment led by then-doctoral student Mary Carskadon, now a professor of psychiatry and human behavior at Brown University. Lewis takes readers through highlights of the multi-year study, in which scientists tracked sleeping patterns and metrics ranging from brain wave monitoring to cognitive tests in the same children over 10 years, from 1976 to 1985.

Surprising results came from this first look at teen sleep. For example, adolescents needed the same or even more sleep than younger children. On average, all children in the study, regardless of age, slept 9.25 hours per night. Subsequent studies have shown that the ideal amount of sleep for teens lies between 8 and 10 hours per night. Yet Lewis reports that by 2019, a mere 22 percent of high school students reported regularly getting at least eight hours of shut-eye, according to the CDC.

Another key finding from the Stanford Summer Sleep Camp experiment was that older kids had bursts of energy later in the day. Subsequent studies showed that as kids hit puberty, their brains delay the release of melatonin—the hormone that makes us sleepy. For teens, melatonin rises later at night and falls later in the morning, shifting their circadian rhythms. High schoolers’ propensity to stay up late and sleep the morning away isn’t necessarily laziness or defiance—it’s biological.

Yet here we are, decades later, with average school start times in 2017 beginning at 8 am and 40 percent of schools starting even earlier. This is a dramatic change from a century ago when high schools in the eestern US began at 9 am, notes Lewis.

Why haven’t schools adjusted to this influx of new information? Well, some schools have. Lewis threads several examples throughout the book, showcasing schools that reaped positive effects aplenty, even in the age of smartphones and social media.

Lewis describes one study, published in 2018, in which students slept an additional 34 minutes each school night when their Seattle district shifted start time to 8:45 am That might not seem like much, but many students and families provided positive feedback, as did the teachers, with one describing the morning ambiance as “upbeat”—an adjective many of us might find unfathomable for first period.

https://arstechnica.com/?p=1884031

The state of Florida this week withheld nearly $700,000 in funding from two school districts as part of an escalating feud led by Florida Gov. Ron DeSantis over school mask requirements.

The state had previously financially penalized the Alachua and Broward school boards by docking their salaries for issuing school mask requirements, which DeSantis has worked to ban. In response to the financial penalties, the Biden administration last month awarded the counties federal funding to compensate for losses. Alachua County was awarded $147,719 and Broward County Public Schools received $420,957 in federal grants under the US Department of Education (USDOE) Project Safe grant.

But this week, the Florida Department of Education took things a step further. For this month’s budgets, the Sunshine State docked the school boards’ salaries and overall school funding in amounts equal to the federal grants, effectively canceling out the counties’ federal aid.

The Florida Department of Education deducted $164,505 from Alachua’s October budget allocation and a total of $526,197 from Broward’s, according to Politico.

Alachua County Public Schools Superintendent Carlee Simon told the outlet that the district was hit hard financially because it had not yet accessed the federal grant money.

“I am appalled that the state would penalize the district by pulling funding we have not even received,” Simon said. She added that the deduction would impact support for students.

The funding cut is also in direct defiance of the federal government. Just Monday, the USDOE sent a letter to the Florida DOE stating that if the department went through with the funding cut, it would be “failing to comply with federal requirements,” particularly of the Elementary and Secondary Education Act of 1965. A section of the act says that states are not to take federal funding into account when setting their own aid to schools. Florida DOE spokesperson Jared Ochs responded Wednesday by calling the USDOE’s letter “harassing and legally hollow.”

Meanwhile, DeSantis’ executive order barring school districts from setting mask requirements remains in legal limbo. In August, a Leon County Circuit judge struck down the order, saying it violates the state constitution. DeSantis appealed, and the 1st District Court of Appeal allowed the governor’s order to remain in effect until the case is considered.

Both the Centers for Disease Control and Prevention and the American Academy of Pediatrics endorse universal masking in schools to prevent transmission of the pandemic coronavirus and to protect children, teachers, and staff. Studies published last month by the CDC concluded that schools with universal masking were 3.5 times less likely to have a COVID-19 outbreak. Additionally, masked school districts saw 50 percent lower rates of child COVID-19 in their counties than schools without mask requirements.

https://arstechnica.com/?p=1808637

Schools with universal masking were 3.5 times less likely to have a COVID-19 outbreak and saw rates of child COVID-19 cases 50 percent lower in their counties compared with schools without mask requirements. That’s according to two new studies published Friday by the Centers for Disease Control and Prevention.

The new data lands as masks continue to be a political and social flash point in the US. And children—many of whom are still ineligible for vaccination—have headed back into classrooms.

In one of the newly published studies, health researchers in Arizona looked at schools with and without mask policies in Maricopa and Pima Counties. Together, the counties account for more than 75 percent of the state’s population. The researchers identified 210 schools that had universal masking requirements from the start of their school years. They compared those to 480 schools that had no mask requirements throughout the study period, which ran from July 15 to August 30.

The researchers tallied 129 school-associated COVID-19 outbreaks in all of those schools during the study period. About 87.5 percent of the outbreaks were in schools without mask requirements. The researchers then ran an analysis, adjusting for school sizes, COVID-19 case rates in each school’s zip code, socioeconomics measures, and other factors. The researchers found that the odds of a school-associated COVID-19 outbreak were 3.5 times higher in the schools without mask requirements compared to those with universal masking.

In a separate study, CDC researchers tried to assess if schools’ mask policies have broader impacts for their communities—and they do. The researchers looked at county-level data on the rates of pediatric COVID-19 cases in 520 counties around the US. They compared rates of child COVID-19 cases in the week before and week after schools started their terms.

Though all counties generally saw increases in pediatric COVID-19 cases after schools started up, the counties with universally masked schools saw smaller bumps. For counties with school mask requirements, the average increase in case rates after schools started was 16.32 cases per 100,000 children per day. Counties without school mask requirements saw an average rate increase about twice as high—34.85 cases per 100,000 children per day.

Mask safety

The US continues to see a patchwork of mask use and other protective measures in schools as the 2021-2022 school year gets underway. Many schools in many states do not have universal masking requirements even though the CDC and the American Academy of Pediatrics both recommend universal masking in schools. In some states state leaders have prohibited schools from issuing mask requirements—and even penalized them for requiring masks.

Florida Governor Ron DeSantis is among the leaders who have banned mask mandates in schools. And, although the ban is being challenged in court, DeSantis is withholding money from school boards that have issued mask mandates anyway.

On Thursday, the US Department of Education announced that it had granted the school board of Florida’s Alachua County $147,719. The money is intended to “restore funding withheld by state leaders—such as salaries for school board members or superintendents who have had their pay cut—when a school district implemented strategies to help prevent the spread of COVID-19 in schools.”

In a statement, Alachua County Public School Superintendent Dr. Carlee Simon: “I’m very grateful to [US Secretary of Education Miguel] Cardona, President Biden and the federal government for the funding. But I’m even more grateful for their continued support and encouragement of our efforts to protect students and staff and to keep our schools open for in-person learning.”

Alachua is the first county in the nation to receive such funding, provided through the new Project to Support America’s Families and Educators (Project SAFE) grant program.

In a separate statement, education secretary Cardona said: “We should be thanking districts for using proven strategies that will keep schools open and safe, not punishing them. We stand with the dedicated educators in Alachua and across the country doing the right thing to protect their school communities.”

Public health experts say that masks are a critical tool to help protect children, teachers, and staff from the spread of the pandemic coronavirus, SARS-CoV-2. Masks are intended to be one key layer of a multi-layered approach that also includes vaccination for those eligible, physical distancing when possible, improved ventilation, testing, quarantining, improved hygiene, and disinfection and cleaning.

https://arstechnica.com/?p=1798388

President Joe Biden on Thursday unveiled a sweeping six-pronged plan to try to regain control over the COVID-19 pandemic, which is wildly raging once again in the US.

Biden will discuss the plan in remarks from the White House at 5 pm EDT.

The main focus of the president’s “Path out of the Pandemic” plan is on reducing the number of unvaccinated people in the country. As such, the plan’s most prominent elements are hefty vaccination requirements for millions of federal employees, health care workers, school employees, and even employees of private businesses.

Biden signed an executive order Thursday requiring COVID-19 vaccines for millions of federal workers plus millions more federal contractors. The new vaccine mandate eliminates a previous option that allowed federal workers to undergo regular testing in lieu of vaccination.

In addition to mandating vaccines for federal workers, Biden will also require vaccination for over 17 million health care workers who work at facilities that receive federal funding. The administration had previously required vaccination for all staff of federally funded nursing homes. The new requirements will extend vaccine mandates to hospitals, dialysis facilities, ambulatory surgical settings, and home health agencies—most facilities that receive Medicaid and Medicare reimbursements.

“Bold and ambitious”

The administration is also working on a rule—to be implemented through the Department of Labor’s Occupational Safety and Health Administration—that will require employers with 100 or more workers to ensure that their workforce is fully vaccinated or submits to regular COVID-19 testing. The rule is expected to apply to over 80 million employees nationwide. OSHA is also working on a separate rule that will require those employers to provide paid time off to get vaccinated.

For schools, Biden will require vaccination for the nearly 300,000 staff in federal Head Start and Early Head start programs. He will also put pressure on governors to get all teachers and school staff vaccinated. Last, the administration will push more schools to implement regular testing, which will be funded by $10 billion the administration already allocated to schools earlier this year.

Pressure to vaccinate the unvaccinated comes amid rampant spread of the hypertransmissible delta coronavirus variant, which has propelled a massive, nationwide surge in transmission among the unvaccinated this summer. Average daily cases jumped from as low as around 11,000 at the start of July to the current average of around 150,000 new cases per day. Hospitalizations are also peaking nationwide, with the current daily average around 100,000 people in the hospital with COVID-19. Cases, hospitalizations, and rising deaths are largely among the unvaccinated.

“The reason we’re here is because people have not gotten vaccinated—80 million of them,” White House press secretary Jen Psaki said Thursday. Currently, only 177 million people are fully vaccinated in the US. That’s 62.5 percent of people eligible for vaccination (people ages 12 and up) and only 53 percent of the population overall. “What our objective is, from the federal government, is to continue to take bold and ambitious steps to get more people vaccinated and protect more people.”

Other elements of the plan look to boost testing availability, reinforce masking guidance, provide loans and other support for small businesses, provide aid for overburdened hospitals, and support the Food and Drug Administration in swiftly reviewing vaccines for kids. Biden is also expected to touch on plans for the rollout of booster doses in his remarks.

https://arstechnica.com/?p=1793332

While battles over mask mandates in schools rage on in several states, the delta-fueled COVID-19 surge continues to sicken more and more children, sending some to the hospital.

“There’s no doubt that there are more children getting infected,” top infectious disease expert Anthony Fauci said in a White House COVID-19 press briefing Thursday. “The delta variant is much more highly transmissible than was [the] alpha [variant],” he said, noting that delta is more than twice as contagious and those infected can carry viral loads up to 1,000 times greater.

“So, given that, you’ll see more children likely get infected and since you have a certain percentage of children—even though the percentage is small—a certain percentage of children will require hospitalization, so quantitatively, you will see more children in the hospital.”

Though some studies have suggested that the delta coronavirus variant may cause more severe disease than alpha, the data so far is not definitive. “The only thing we know for sure is that more infections mean more children will be in the hospital,” Dr. Fauci said.

Rochelle Walensky, director of the Centers for Disease Control and Prevention, noted in the briefing that the areas seeing the largest surges in cases in children and adults are largely places with low vaccination rates.

In Mississippi, for instance, nearly 1,000 children and 300 teachers and school staff tested positive for COVID-19 between August 2 and 6, the second week of the new school year. Nearly 5,000 more children, teachers, and staff are now in quarantine. Mississippi has one of the highest rates of new COVID-19 cases in the country currently and one of the lowest vaccination rates, with just 35 percent of residents fully vaccinated. Some school districts have mask-optional policies for in-person learning.

In Indiana’s Scott County—which has one of the highest case rates in the state and only 36 percent of residents vaccinated—officials for one school district moved children to virtual learning just days after welcoming them back to classrooms. The district said the move was “due to the high rate of positive cases and extremely high rate of student in quarantine.”

In Florida, where vaccination is below average and Gov. Ron DeSantis banned school districts from issuing mask mandates, cases are skyrocketing as children are preparing to go back to classrooms. In the past week, Florida had more new cases of COVID-19 than all 30 states with the lowest rates of new cases combined, White House COVID-19 Response Coordinator Jeff Zients noted Thursday. Florida also has the country’s highest daily average of children (under age 17) admitted to the hospital with COVID-19: 54 children per day. An analysis by the Miami Herald found that, while cases are rising in every age group, the rise is sharpest in children under the age of 12.

Needless suffering

Many school districts throughout the Sunshine State are in open defiance of DeSantis’ order and mandating universal masking in schools anyway—which aligns with guidance from the CDC and the American Academy of Pediatrics. In response, DeSantis has threatened to withhold salaries of school administrators if they enact mask mandates.

On Thursday, more than 800 doctors signed a letter to DeSantis, blasting him for his “reckless” mask-mandate ban and not doing more to get people vaccinated. “What’s heartbreaking and infuriating for us as doctors is watching children needlessly suffer while Gov. DeSantis rejects simple protections such as masks and vaccinations,” they wrote. “Asking local schools and jurisdictions to look the other way while COVID-19 tears through our communities, or lose funding if they implement safeguards, won’t protect kids.”

A similar battle is playing out in Texas, where school districts continue to defy Gov. Greg Abbott’s ban on mask mandates. Texas has the country’s second-highest rate of children being hospitalized for COVID-19 each day—after Florida’s. Like DeSantis, Abbott is a Republican.

In the White House press briefing, Dr. Walensky was clear about how to keep children safe from COVID-19 and schools open for critical in-person learning: vaccinate all eligible adults and adolescents around children and use mitigation strategies—like masks—in schools.

“We do know how to keep our children safe,” Walensky said. When COVID-19 is getting into schools, it’s because there are high rates of COVID-19 in the community, she said. “So, the best way to keep our schools safe—and we know how to do it—is to vaccinate everyone who can be vaccinated… and then to follow the mitigation strategies

So far, that’s bearing out in real life. Kim Anderson, executive director of the National Education Association, the country’s largest teachers’ union, told CNN that the NEA had been closely watching school reopenings. “In places where [schools are] not communicating well and in places where politicians are trying to strip the ability of communities to try to protect themselves, things are not going well,” she said. In places where there is good communication about safety plans and reopening, “things are going better,” she said.

https://arstechnica.com/?p=1786940

Fully vaccinated Americans should go back to masking up in schools and areas of high or substantial COVID-19 transmission, the Centers for Disease Control and Prevention announced Tuesday.

The CDC says its stark reversal in mask guidance is prompted by the current surge in COVID-19 cases and the spread of the hyper-transmissible delta variant, which is now dominant in the US and thought to be more than twice as contagious as previous versions of the virus.

Specifically, the CDC says new data from outbreak investigations in the US and elsewhere suggests that fully vaccinated people who have breakthrough infections with the delta variant carry similar levels of viral loads in their respiratory tracts as unvaccinated people infected with the delta variant. This raises concern that fully vaccinated people can spread the delta variant to others.

“The vast majority of transmission occurring [in the US] is occurring through unvaccinated individuals,” CDC Director Rochelle Walensky emphasized in a press briefing Tuesday. She also highlighted that “the vaccines continue to do an exceptional job at protecting the individual who is vaccinated from severe illness, hospitalization, and death, and even against mild illness.”

“But unlike the alpha variant that we had back in May, where we didn’t believe that if you were vaccinated you could transmit further, this is different now with the delta variant,” she said. And this new concern “unfortunately warrants an update to our recommendation.”

New recommendations

The CDC now recommends that all fully vaccinated people wear a mask in indoor public spaces when local COVID-19 transmission levels are “high” or “substantial.” The agency defines “high” transmission as more than 100 new cases of COVID-19 among 100,000 people in the course of seven days, while “substantial” is defined as 50 to 99 cases among 100,000 over seven days.

Those definitions currently apply to a large swath of the country. As of Tuesday, 46 percent of counties nationwide have high transmission levels, and an additional 17 percent of counties have substantial transmission, the CDC reports. All or nearly all counties in Arkansas, Louisiana, Florida, Missouri, and Mississippi are included. The southeastern US has generally become a hotbed of transmission in recent weeks, along with many areas in the Midwest. Many counties in several states have case rates well over 500 per 100,000 in the past seven days.

Additionally, the CDC is now recommending universal masking in all K-12 schools. That is, all teachers, staff, and students, regardless of vaccination status, should wear masks in schools.

As before, people who are unvaccinated or partially vaccinated—even those who have recovered from COVID-19—should continue to wear masks, practice social distancing, and get vaccinated as soon as possible. Anyone who has questions about the vaccines should consult their medical doctor.

The new recommendations for the fully vaccinated are a turnaround from the agency’s earlier guidance from May 13, which said that fully vaccinated people are extremely well protected from the pandemic coronavirus and no longer need to mask in most settings. That guidance, however, was seen as abrupt and premature and has been dogged by controversy since its announcement. Among the leading criticisms are that it is currently impossible to determine vaccination status in most settings, it put vulnerable people at risk, and it didn’t account for local conditions that could warrant more precautions, such as high transmission and low vaccination rates.

About face

In May, transmission levels were on the decline, and the delta variant had not taken hold of the US. Now, with delta dominating the country, cases are spiking nationwide. In the press briefing, Walensky said that the mask guidance will help drag down the transmission rate, which is critical for everyone—not just the unvaccinated.

As the pandemic virus has more opportunities to spread and infect people, it has more opportunities to mutate and evolve into yet more dastardly variants. Future variants, Walensky cautioned, could further thwart protection from vaccination.

In addition, the new mask guidance will not just protect those who are unwilling to get vaccinated but also those who are unable to be protected. That includes children who are still ineligible to get vaccinated and immunocompromised people who may not be well-protected.

In closing remarks, Walensky addressed the frustration she expects in response to the new guidance, given the length of the pandemic so far, mental health struggles, vaccine hesitancy that is causing preventable surges, and fully vaccinated people now being asked to again take mitigation efforts.

“It is not a welcomed piece of news that masking is going to be a part of people’s lives who have already been vaccinated,” she acknowledged. But she said experts that the CDC consulted “universally” supported the masking change. “This was not something that we took lightly, and it’s something that I know weighs heavily with me and with all of America.”

https://arstechnica.com/?p=1783521

Is it safe to open schools? From the moment it became clear that the COVID-19 pandemic had set up shop in the US, answers to that question have been scrutinized, analyzed, and even politicized. Lost in all of this is the realization that it’s a terrible question—because there’s no single answer to it.

Instead, any answer to that question only applies to individual communities and, in many cases, individual schools. It’s also subject to change with the evolving dynamics of the pandemic, including the appearance of new variants. Fortunately, a detailed understanding of why the question is bad can help people understand which questions they should be asking instead.

Schools are part of a community

A couple things that are relevant to school safety have become clear over the course of the pandemic. One is that school-aged children are the least likely to be hospitalized or die of any age group tracked by the Centers for Disease Control and Prevention. Out of the over half-million COVID-19 deaths in the US, only a few hundred have been kids under the age of 17. In addition, in a few cases where new infections were tracked in detail, schools that adopted adequate safety measures saw lower infection rates than the surrounding community.

All of this would seem to indicate that opening schools can be relatively low-risk. But that risk is to the students themselves. Other studies have found that closing schools is associated with lower transmission in the community at large. That’s because schools are one part of a larger community. Parents who take their children to school may spend time talking to their fellow parents or be more likely to stop off for a coffee or some shopping on the way to or from the school. That’s also true for the teachers and staff of the schools. Each of these interactions provides a possible opportunity for the virus to spread.

The community’s attitudes and capabilities also matter. An area in which many of the parents are angrily confrontational about being asked to wear masks is going to have a much harder time getting students to comply with safety rules, for example. Many of the other means of keeping students safe—adding teachers, keeping students in pods, allowing distancing, etc.—will depend on the community’s wealth and facilities.

Finally, the spread of the virus within the community is central to determining safety. If there’s a high degree of spread within the community at large, there’s a far greater chance that this will lead to outbreaks in the schools. That’s in part because of the tendency of school-aged children to have asymptomatic cases, meaning they’re more likely to go to school without realizing that they’re infected.

(Testing capacity is essential for understanding both the rate of infections in the community and identifying when outbreaks are happening in schools. For communities without adequate testing capacity, opening schools will be riskier.)

School isn’t just one thing

Beyond the community, each individual school matters. The CDC may break out school-aged children as their own age group, but there are some indications that younger children in this range are less susceptible than older ones. That’s one of the reasons the CDC has different recommendations for separation among older and younger students. Since many school systems have separate buildings for different age groups, there can be a lot of complicated issues regarding whether an appropriate level of separation and ventilation can be maintained in the different facilities.

Finally, there are large expectations, both among students and parents, that school is more than just the classes. For many parents, it also acts as daycare they could not otherwise afford. For many students, it’s a place where they can be certain they’ll get a nutritious meal. Both groups associate school with a large range of additional activities, like sports, music, and theater.

Which of these activities are safe? Is anyone willing to sacrifice all of the ones that are not?

All of these complexities point to why, rather than issuing a yes-or-no decision on safety, the CDC has an extensive school safety checklist. It helps focus parents on making sure they consider all the factors that go into school safety rather than viewing it as a simple yes-or-no question.

Everything is changing

There’s one final reason that it doesn’t make sense to look for simple answers here: the answers are constantly changing. The risk of having schools open, for both students and the community, will go up if the community’s infection rate rises. When the CDC relaunched its school guidance webpages earlier this year, CDC Director Rochelle Walensky emphasized that most of the US simply had community infection levels that were too high to allow schools to open safely. However, she offered hope that the situation would change in the future.

(Obviously, detecting an actual outbreak in a school would require a new risk assessment, as well.)

Finally, the recent detection of a number of new, more infective strains can also change the risk evaluation, as a number have made their way into the US. We’re not certain at this point whether the increased infectivity of these viral variants applies to school-aged children. And there’s at least one strain (B.1.1.7) that seems to also cause increased mortality. Again, if that increased risk applies to school-aged children, then communities where the variants have been detected will want to re-evaluate school safety.

None of this is to say that schools can’t be opened in a way that minimizes the risk to students. But figuring out when that’s the case, and ensuring that things stay safe, has to be done on a community level. And each community may have different definitions of what level of risk constitutes safe.

That’s why we should be paying more attention to people who are talking about how to evaluate risk—and far less to anyone who believes the question has a simple, binary answer.

https://arstechnica.com/?p=1752567

The most sensitive and heated topic of the entire pandemic is—without a doubt—the welfare of our children. How can we best protect them from this devastating virus? What role do they play in spreading it? How can we even come close to meeting all their health, developmental, educational, and social needs as we try to navigate our topsy-turvy reality?

The path to daycare and school might as well be rerouted through a minefield. And the hazards don’t end when you reach the front doors. This nightmare has only been exacerbated by media reports of single studies that yanked parents, educators, and caretakers from one extreme to the other: Don’t worry, children are completely unaffected by the virus and don’t spread it! No, wait, they’re actually superspreaders, who can develop a deadly multisystem inflammatory syndrome!

More than a year into the pandemic, it’s very clear that the inflammatory syndrome (MIS-C) is rare. And although children can certainly catch and spread the virus, mounting studies continue to find that children generally have less severe disease than adults. Also, a consensus has emerged that schools do not tend to be hotbeds of virus transmission. While having schools open has been linked to higher community spread, studies have found basic precautions can be effective at limiting spread within schools.

But this last point has only opened up new controversies about which precautions schools should take when they have in-person learning. One of the thorniest particulars in this discussion is whether children should be spaced 3 feet apart or 6 feet apart in schools. At 6 feet, children may be safer. But school classrooms were not designed to give each child such a wide berth. Instituting 6-feet policies means schools can accommodate fewer students, and in-classroom learning will remain dramatically altered. On the other hand, 3-feet of distance is a lot easier to adjust for. But it may increase the risk of kids catching and spreading the virus to their teachers, school staff, and families back home.

Distant debate

Many health agencies, experts, and the US Centers for Disease Control and Prevention have so far recommended 6-foot spacing—for schools and for nearly all other settings. In making the recommendation, agencies cite decades of research and understanding of how respiratory pathogens, like the pandemic coronavirus, spread. Although 6 feet is not a magic distance at which risk from respiratory viruses falls off a cliff, it has become a routine threshold at which the risk is considered reduced enough.

But not everyone toes the 6-feet line. The World Health Organization and other experts say that only about three feet of distancing reduces risk enough. The WHO’s guidance to schools recommends “physical distancing of at least 1 meter (3.3 feet) between individuals, including spacing of desks.” In explaining its recommendation, the WHO often cites a literature review published in The Lancet in June 2020, which the United Nations health agency itself funded.

The review scraped together data from 172 studies looking at transmission of coronaviruses, such as SARS-CoV-2, SARS, and others, as well as the effectiveness of different mitigation strategies, such as distancing and masking. Without a doubt, the data suggested that physical distancing is effective at reducing transmission. However, the different studies in the review evaluated different distances, making it difficult to directly compare the risk levels of one meter versus two. For the most part, the review authors merely found that distancing was effective, and it seemed that more distance was better.

“We found evidence of moderate certainty that current policies of at least 1 m [meter] physical distancing are probably associated with a large reduction in infection, and that distances of 2 m might be more effective,” the authors concluded.

While the review was enough to convince the WHO that it could safely recommend at least one meter of distancing in its guidance, it has done little to end the 3-vs-6-feet school debate.

Fresh data

Since that June review, there seemed to be little scientific movement on the issue. But that changed last week with a study published in the journal Clinical Infectious Diseases, which concluded:

Increasing physical distancing requirements from 3 to 6 feet in school settings is not associated with a reduction in SARS-CoV-2 cases among students or staff, provided other mitigation measures, such as universal masking, are implemented.

The study was observational in nature, comparing rates of coronavirus cases in students and staff that attended in-person learning at Massachusetts Public Schools between September 24, 2020 and January 27, 2021. Of the 242 schools included in the primary analysis, 194 had policies for 6-feet distancing, while the remaining 48 had 3-feet distancing policies. Nearly 100 percent of the schools had universal mask policies. In the end, the rates of cases between the schools appeared statistically indistinguishable.

The study immediately made waves. In an interview this past Sunday, CNN anchor Jake Tapper asked top infectious disease expert Anthony Fauci, “Does this study suggest to you that 3 feet is good enough?”

Fauci responded, “It does indeed.”

But a closer look at the actual data in the study provides a much murkier answer. The study had many noteworthy limitations, and the data is simply too noisy to draw any clear conclusions—despite the very clear conclusion the authors wrote. The authors found no significant difference between 3-feet and 6-feet distancing, but the uncertainty in the numbers was simply too wide to assess differences.

For instance, one of the authors’ analyses—which accounted for levels of community spread and school district demographics—found that the rate of coronavirus cases in students attending schools with 6-feet policies was 21 percent lower than that of schools with 3-feet policies. But that estimate was considered not significant and had a notably large confidence interval (which provides the range of plausible estimates based on the raw data). The confidence interval for that 21 percent estimate ranged from -47 percent to 18 percent. That means that the 6 feet of distancing could have decreased case rates as much as 47 percent compared with 3 feet—which most parents and school staff would probably consider significant. But confusingly, 6 feet of distance could have also increased case rates by as much as 18 percent.

The other calculations weren’t much better. Looking at case rates in school staff, the authors found rates were about 9 percent lower in schools with 6-feet policies, again adjusting for levels of community spread and demographics. But the confidence interval also spanned a wide range, from -33 percent to 25 percent, meaning that the 6 feet of distancing could have plausibly reduced case rates in staff by 33 percent or increased them by 25 percent.

More limits

And these large ranges are added to many other complicating limitations. The study wasn’t able to include contact-tracing data, so although the counted cases were among staff and students who recently attended in-person school, there’s no way to know how many of their infections happened while they were at school. Also, children tend to have asymptomatic or mild infections, and it’s not clear how many infections in students may have been missed. Notably, case rates in school staff closely tracked with case rates in the community, while student case rates tended to be much lower than both.

There’s more. The simple classifications of 6-feet vs 3-feet school policies are a little fuzzy. For instance, the study noted that “Districts that allowed ≥3 feet of physical distancing in their full re-opening plan but opened in a hybrid learning model with requirements of ≥6 feet in the hybrid model, were classified as requiring ≥6 feet of physical distancing.” The study also didn’t assess implementation of distancing, only official policies as written. Some schools opened with very low attendance—only 5 percent attendance was required to be included in the study. With so few students, written distancing policies may have been moot. For schools with higher attendance, 6-feet policies may have had lower compliance.

Lastly, the study also didn’t include detailed data on school closures and quarantine policies, which also may skew in-school transmission. “It is possible that districts with lower distancing requirements closed more frequently, or required more quarantines, due to how SARS-CoV-2 exposures are defined,” the authors note.

Overall, it’s difficult to make any firm conclusions from this study, and the debate over 3 feet vs 6 feet is likely to continue. In a press briefing Monday, CDC Director Rochelle Walensky was more equivocal about the study than Fauci.

“We are looking at these data carefully,” she said, noting that the agency is acutely aware of the distancing debate and is constantly reviewing the data. “The question actually prompted more studies to be done, so we know more are forthcoming. We’re taking all of those data carefully and revisiting our guidances in that context.”

https://arstechnica.com/?p=1750371

As the US approached the start of the school year in 2020, the guidance it received from the federal government was a mess. The Centers for Disease Control (CDC) issued a series of documents in late July that was a mix of evidence-based risk analysis and full-throated endorsement of having children back in school, with no consideration of risk at all.

Now, with a new administration in charge and promoting evidence-based policymaking, the CDC has revisited its advice on pandemic safety in schools. The result is a set of documents that are far more coherent in their approach to managing risk. Several documents all promote a single approach to keeping schools open, focused on mask use and distancing, and back that up with an analysis of the latest research on the pandemic’s spread in children. And, in introducing them, CDC Director Rochelle Walensky announced, “I can assure you this is free from political meddling.”

Science-focused

In a press conference announcing the release of the new documents, the count of Walensky’s use of the term “science based” probably reached double digits. Backing that up is one of the three documents released by the CDC on Friday, which focuses entirely on the evidence that was used to formulate the new guidelines. The document makes clear that a lot of the information we now have has come from analyses of what happened after schools were reopened in the autumn, both in the US and overseas. This makes it clear that, even if it weren’t for the change in administration, we were due to revisit our thinking about school safety.

One thing that has remained consistent is that school-age children seem to be less severely affected by COVID-19 than adults. As the US approaches half a million people killed by the pandemic, only 203 of the victims have been under the age of 18. Symptoms in general appear to be less severe in younger individuals, and there are some indications that children are more likely to have asymptomatic cases.

That has ensured that children are less likely to be tested, which has made it harder to determine the spread of the virus between children and from children to adults. The CDC notes that there are some indications that spread via children may be less frequent, but the evidence here is much less certain.

The lower incidence of spread among children would tend to indicate that the risk to children in schools is lower. But the CDC also notes that, in cases where safety guidelines aren’t followed, there have been instances where schools have allowed significant spread of SARS-CoV-2. But safety guidelines can make a big difference. “When mitigation strategies—especially mask use and physical distancing—are consistently and correctly used,” the CDC document states, “the risk of transmission in the school environment is decreased.”

The other key piece of data that informs the new guidelines is on the relationship between spread in the community and that in schools. The CDC says that, for every five additional cases per 100,000 in the community, the risk of an outbreak in schools goes up by over 70 percent.

Science into policy

So, how do you convert that information into policy? In the CDC’s case, there are two key features. One is what Walensky called “layered mitigation.” She said that individual policies each provide a degree of protection, and layering each protection on top of the others can do far more than any individual one can on its own. The five layers the CDC is calling for are:

• Mask use. Mandatory under all circumstances, with guidance on how to wear them effectively.
• Distancing. Beyond spacing students in schools, use small class groups that stay together all day, stagger schedules, etc.
• Handwashing and respiratory etiquette. Make sure students know how to keep themselves and others safe.
• Healthy facilities. Improved ventilation, regular disinfection.
• Contact tracing and isolation. Handled in coordination with local health authorities.

The first two of these—mask use and distancing—are considered the most essential components of the strategy and the ones with the clearest evidence of their effectiveness. But all five are considered central to any strategy to reopen schools safely.

As the Biden administration is expected to boost national testing and vaccination plans, the CDC recognizes that both can also play a role in school safety. While vaccine safety in children is only starting to be tested, vaccination of teachers and staff can help improve safety. And regular screening, if available, can identify and isolate people at risk of spreading the virus in schools and, so, limit the pandemic’s spread. But the guidelines appear to be written with the sense that testing and vaccines are a welcome addition, rather than something that can be relied upon in the immediate future.

Community matters

In addition to describing these policies, the CDC also provides some advice on when they’re most needed. As mentioned above, the spread of the virus in the community has a profound effect on the risks posed within schools. These are defined in terms of both the number of positive tests per capita, as well as the frequency of tests that return positive results (called positivity, this acts as a measure of testing capacity).

A low rate of SARS-CoV-2 transmission is defined as fewer than 10 cases per 100,000 people within the last week, with less than 5 percent of tests returning a positive result. Those numbers shift gradually to high transmission, which is defined as over 100 cases per 100,000 people, and a positive test rate of over 10 percent.

At low and moderate transmission, the CDC advises that schools can be open for full in-person education, with some tolerance for lapses in our ability to keep everyone distanced at all times of the day. This includes allowing sports and other extracurricular activities, although these should be curtailed as the risk of transmission shifts to moderate.

When transmission reaches levels termed substantial, extracurricular activities are eliminated unless they can be held outdoors and with distancing. Physical distancing inside schools becomes mandatory at all times, and teaching shifts to hybrid modes with reduced in-person attendance. At high transmission, students over the age of about 12 shift to remote education, since their risks are thought to be more similar to those of adults. The only exceptions are schools where all of the elements of layered mitigation can be adopted with total compliance. Extracurricular activities are virtual only.

The documents make it clear that evaluating spread in the community is an ongoing activity, and school authorities need to be ready to shut their schools down entirely should conditions indicate this is needed.

In conjunction with these documents, the Department of Education has also issued a document that reiterates much of the CDC’s guidance. In addition, it goes into some of the practicalities on how to create pods of students that are kept together all day and how to bus kids to and from schools while maintaining the distancing advised by the CDC.

A “long needed roadmap”

In introducing these documents, CDC Director Walensky emphasized that “the safest way to open schools is to ensure there is as little circulating disease in the community as possible,” and she went on to call keeping schools open a “shared responsibility.” But right now, we’re nowhere close to handling that responsibility. She said that only 5 percent of counties in the US would currently fall into the low community spread category, while about 90 percent of them would fall into the highest.

Walensky also emphasized that the CDC wasn’t mandating anything via these documents; they were meant to act as “a long needed roadmap” to help guide schools through the process of opening (or keeping open) their schools in a way that’s safe.

Overall, the new documents make a welcome change. While some elements of these documents had been developed during the Trump administration, they were consistently undercut by contradictory messages from different agencies, and political signaling that promoted full school opening regardless of risk.

And that last element may end up undercutting even the best-designed school guidelines. In the US, educational policy decisions happen at the state and local level, and many of these governments are run by people who have gone in for the “open regardless of risk” approach, and the disdain for distancing and mask use that have accompanied it. It will be a difficult fight to get them to adopt the CDC’s guidance.

https://arstechnica.com/?p=1742201

Florida’s state government cannot force schools to reopen this month, a judge ruled yesterday. The state’s order to reopen K-12 schools disregarded safety risks posed by COVID-19 and gave schools no meaningful alternative, according to the ruling issued by Judge Charles Dodson of the Second Judicial Circuit in Leon County.

On July 6, Florida Department of Education Commissioner Richard Corcoran issued an emergency order stating, “Upon reopening in August, all school boards and charter school governing boards must open brick and mortar schools at least five days per week for all students.” Schools that don’t meet this requirement could lose state funding. Corcoran, Governor Ron DeSantis, and other state officials were then sued by the Florida Education Association, a statewide teachers’ union; the NAACP; and several individual teachers and parents.

After summarizing the health risks of reopening schools during the pandemic, the judge wrote that the state’s order to reopen schools “takes none of that into consideration. It fails to mention consideration of community transmission rates, varying ages of students, or proper precautions. What has been clearly established is there is no easy decision and opening schools will most likely increase COVID‐19 cases in Florida. Thus, Plaintiffs have demonstrated a substantial likelihood of success in procuring a judgment declaring the Order is being applied arbitrarily across Florida.”

Dodson concluded that the state’s order violates the Florida state constitution “to the extent it arbitrarily disregards safety, denies local school boards decision making with respect to reopening brick and mortar schools, and conditions funding on an approved reopening plan with a start date in August.” Having found that the plaintiffs are likely to win at trial, the judge issued a temporary injunction that strikes down the controversial portions of the state’s school-reopening order.

“The districts have no meaningful alternative,” the ruling said. “If an individual school district chooses safety, that is, delaying the start of schools until it individually determines it is safe to do so for its county, it risks losing state funding, even though every student is being taught.”

Florida has so far recorded 600,000 COVID-19 cases and more than 10,000 deaths, the ruling said.

Governor appeals, claims suit is “frivolous”

The state may still be able to force schools to reopen this month unless another court order is issued. DeSantis, Corcoran, and the state Department of Education immediately appealed the ruling to Florida’s First District Court of Appeal and said in a court filing that the appeal “triggers an automatic stay pending review.”

Despite Judge Dodson finding that the state is likely to lose the case on the merits, Corcoran issued a statement saying, “We are 100 percent confident we will win this lawsuit.”

“If you are one of the 1.6 million students who have chosen to return to the classroom, a parent, or a classroom teacher that wanted to educate their student in person, we strongly encourage you to call the Florida Education Association and tell them to drop this frivolous lawsuit,” Corcoran said.

Florida Education Association President Fedrick Ingram said in a press conference held via Zoom, “shame on our governor and our commissioner of education who recklessly told us we had to have a brick and mortar option no matter what,” according to the Orlando Sentinel.

“Teachers want to be back in school,” Ingram also said. “We don’t want to risk our own lives.”

Local experts’ opinions disregarded

“Schools should reopen when the local decision-makers determine upon advice of medical experts, that it is safe to do so,” Dodson wrote in yesterday’s ruling, adding that the Florida constitution “requires safe schools.” The state “cannot constitutionally directly force schools statewide to reopen without regard to safety during a global pandemic,” which means the state also cannot achieve the same goal “indirectly by threatening loss of funding through the Order,” Dodson wrote.

The July 6 order said that schools must open in August “subject to advice and orders of the Florida Department of Health [and] local departments of health.” But the language about “local departments of health” didn’t actually provide leeway to remain closed.

As Judge Dodson wrote, the “Hillsborough County School Board called a special board meeting on August 6, 2020 with a panel of seven doctors to assess whether it was safe to reopen schools based on the current levels of COVID-19 in the community.” Five of the seven doctors said it wasn’t safe to reopen, while “[o]ne of the doctors stated it was not safe that day but maybe it would be in a few weeks,” and the other doctor declined to give an opinion.

“Based on the medical information at that meeting, the Hillsborough County School Board voted to delay the start of in‐person learning by three weeks, from August 24, 2020 to September 14, 2020. Virtual learning would still begin on August 24, 2020,” Dodson wrote.

The state wouldn’t allow it, Dodson explained:

The next day, August 7, 2020, the Superintendent and Chair of the Hillsborough County School Board received a letter from Commissioner Corcoran stating their proposal was not consistent with the Order. If they chose not to revise their plan, they would not receive the financial flexibility otherwise available under the Order. After another proposal, to delay reopening until September 7, was also rejected, Hillsborough County voted to reopen brick and mortar schools August 31, 2020. They had no real choice. Defendants arbitrarily prioritized reopening schools statewide in August over safety and the advice at health experts; and all school districts complied in order to avoid a drastic loss of State funding.

“Extremely unsafe conditions”

Evidence presented in a court hearing “demonstrated that some teachers are being told they must go back into classrooms under extremely unsafe conditions,” without enough room between desks for social distancing and without “adequate personal protection equipment,” Dodson wrote.

Plaintiffs showed evidence that “teachers throughout the State are deciding whether to retire, resign, or put themselves and their families in harms’ way,” the ruling said. “One witness testified that because of his preexisting condition, his doctor advised he will likely die if he contracts COVID-19. If he is forced to return to school, he will be risking his life on a daily basis.”

The state’s expert witness, Stanford University medical professor and doctor Jay Bhattacharya, testified that it is safe enough to reopen Florida schools, Dodson wrote. But the same expert “admitted Stanford University will not be holding in-person classes in the fall. Classes there will be taught remotely because of the pandemic.”

Even the court hearing on the state’s school-reopening order was conducted remotely, via Zoom. “That is because it has been decided it is unsafe to hold in-person trials in the Leon County courthouse during this highly dangerous pandemic,” Dodson wrote. “That was a local decision based on local conditions. Because of COVID-19, jurors and witnesses are not allowed to come into our courtrooms, almost all of which are larger than classrooms in our schools.”

https://arstechnica.com/?p=1701162