With coronavirus spreading in Connecticut, when is it appropriate to close schools?

Education Week

A map of school closures compiled by Education Week. This screen grab was done at 1:45 p.m. on Wednesday, March 11. (Click image to go to interactive map)

A mere five miles separate The Keio Academy in Purchase, New York and Glenville School in Greenwich, Conn.

As the number of people with coronavirus increases daily, Keio Academy, a private boarding school, has decided to end classes for its 330 students for the remainder of the school year. Nearby Glenville School, a public school with 404 students, remains open.

“Right now we just continue to monitor the situation,” said Sasha Houlihan, a spokeswoman for the Greenwich school system. “A decision on school closures has not been made yet.”

The different reactions from two schools in close proximity to New Rochelle – the epicenter of the outbreak in New York – highlight just how hard it is for school officials, state lawmakers and public health experts to decide when it is appropriate to close schools.

While a few districts in Connecticut closed their schools this week due to concerns that students were directly exposed to the coronavirus, an up-to-date map compiled by Education Week shows a hotspot of school closures right on Connecticut’s southwest border – and a paucity of closures here. Across the world, 16 countries have shut schools, impacting 363 million children, the United Nations reports.

On Tuesday, Connecticut Gov. Ned Lamont declared a public health emergency, which gives him broad powers, including the ability to shut down schools, if necessary.

But for now the administration says it is leaving the decision up to local health and school officials, while stressing that such a step be taken as a “very last resort” because of the disruption these closures will cause. Districts have also been advised they are still expected to provide 180 days of learning for students this academic year, or seek a waiver.

As of Wednesday afternoon, two schools districts in Connecticut had announced plans to close because of concerns about exposure to COVID-19. Region 14 public schools in Litchfield County will be closed through the end of the week. The Westport Public School system announced it would close its schools starting tomorrow “until further notice” because one of its 5,300 student was exposed to the virus.

Other districts, like Cheshire and Norwalk, are closing schools early one day this week so staff can prepare for students to learn remotely in the event that schools do need to be closed for an extended amount of time. An elementary school in Stratford has also closed following concern that a student was exposed to the virus.

The state’s chief epidemiologist, Dr. Matthew Cartter, told school and municipal leaders during a conference call Monday that it seems inevitable that there will soon be a hotspot of people infected with coronavirus in Connecticut.

But is closing schools a good way to help contain that future outbreak?

Closing schools sooner could spread out infection rates 

While children are typically more likely to spread and be susceptible to viruses such as the flu, they haven’t been as impacted by COVID-19, experts say, but it’s unclear if they are carriers and spreading the disease without showing symptoms.

This makes it “really hard to know if closing schools are going to be the thing that’s going to help blunt the outbreak in the community,” said James Meek, a lecturer of epidemiology at the Yale School of Public Health and the associate director of the Yale Emerging Infections Program.

“If we start seeing communities spread, it may be the prudent thing to do. … I know it’s really frustrating because we can’t have a straight answer,” Meek added. “But it’s so new that we don’t have the data yet to be able to say if kids spread the virus.”

So, for now, the only information on which officials have to base their decisions are studies that show how past school closures have impacted the spread of different viruses.

“It’s so new that we don’t have the data yet to be able to say if kids spread the virus.”

James Meek
Associate Director of Yale Emerging Infections Program

Nicholas Christakis, a physician and sociologist at Yale University, who studies social networks and is developing a statistical method to forecast an epidemic’s spread, believes closing schools early is appropriate.

“Let’s talk about school closures re COVID-19. It’s a tough topic, scientifically and pragmatically. It’s hard to estimate the benefits precisely. And closing schools can have costs, such as health care workers having to stay home, kids missing subsidized lunches, etc,” he tweeted last week. “Yet, studies show that school closures are one of the most beneficial ‘non-pharmaceutical interventions’ that can be employed, more effective even than reactive quarantines or banning of public gatherings. Partly, the reason is that *parents* also stay home as a result.”

Those studies include 2007 research on the timing of school closures in 43 major cities — including New Haven — as the Spanish Flu pandemic swept the country in 1918 and how many deaths occurred, depending if schools were closed proactively or reactively. The cities that closed schools earlier blunted a sudden influx of severe cases.

The lead author of that study – Dr. Howard Markel, who directs the Center for the History of Medicine at the University of Michigan – last week wrote in an opinion piece in The New York Times that warned policymakers “We can’t wait until it’s too late. Communities in the United States must shut down schools before, not after, the outbreak becomes widespread here.”

Last week, U.S. Sen. Chris Murphy, D-CT, was trying to get guidance on when the Centers for Disease Control and Prevention recommends closing schools.

“One of the biggest disruptions that can happen in a family’s life is the closure of a school,” Murphy said during a Senate Health, Education, Labor, and Pensions Committee with a top CDC official. “What’s the best protocol today?”

While school closing decisions are left to local officials, the CDC advises districts that they need to weigh the disruption it will cause against the potential benefits.

“You have this balance between the earlier you act the more impact it can have in slowing the spread, and the enormous disruption we see with school closures,” Dr. Anne Schuchat, the principal deputy director at the CDC, responded to Murphy.

It’s not necessarily the case that closing schools will reduce the overall number of people infected, but it will spread out and delay the spread. Think of it as flattening the peak of infections.

“If you have an explosive outbreak of influenza in a community and you close the schools quickly enough, you can blunt the peak of the epidemic, meaning the cases just get spread out further,” said Meek, the professor who studies emerging infections, including COVID-19. “So you don’t have everyone getting sick at the same time and presenting to the hospital and overwhelming the health care system … The real challenge is finding that golden spot of when to actually do the closures, because you may, by the time you start seeing the virus and seeing evidence of it in the community, it may be that you’ve missed that golden point that you could have slowed things down.”

Spreading out the cases over time is key so that hospitals have the capacity to handle the influx of patients.

The U.S. has lower hospital capacity – 2.9 beds for every 1,000 people – than China (4.2), Italy (3.4) and Japan (13.4), the World Health Organization reports.

A chance it might backfire

Health officials recommend that those who test positive stay home to avoid spreading the disease. Research into the first 425 confirmed cases of the virus in China by Edward H. Kaplan, a professor of public health at the Yale School of Medicine, showed that isolation will quell outbreaks.

“The good news is that, in principle, case isolation alone is sufficient to end community outbreaks of [COVID-19] transmission, provided that cases are detected efficiently,” Kaplan wrote.

But this week, Kaplan told The Mirror that closing schools in an effort to isolate the spread could have unintended consequences.

“Closing schools would reduce the chance an infected person could unknowingly transmit the coronavirus to a student, teacher or other staff member. It could also increase the risk of transmission to more vulnerable people, namely the elderly.”

Edward H. Kaplan, professor of public health 
Yale School of Medicine

“Closing schools would reduce the chance an infected person could unknowingly transmit the coronavirus to a student, teacher or other staff member. It could also increase the risk of transmission to more vulnerable people, namely the elderly,” he said.

That’s because when schools close, parents are often left scrambling for care and many will turn to the grandparents – the very people that the virus is impacting particularly hard.

A ‘domino effect’ on health care staff 

Chelsea Daniels doesn’t get an excused absence from her job as a nurse at Fresh River Healthcare nursing home in East Windsor if her daughter’s school closes.

Health care workers only get a certain amount of sick time and, when it runs out, they are expected to be at work. If schools close, many health care workers will have to scramble to find care for their children, or miss work and face discipline.

“It will definitely have a domino effect if schools close,” said Daniels. “It’s going to result in us working short staffed and people calling out.”

Photo provided by Chelsea Daniels

Chelsea Daniels

In Daniels’ case, her husband can scale back his work hours to be home with their 11-year-old daughter. But that means a loss of income for her family, which relies on his hourly income. He works at St. Francis Hospital in Hartford and helps with facilities maintenance. Nationwide, about 60% of  the workforce are hourly employees.

“It would be challenging,” she said of the loss of income.

Staffing shortages at hospitals, particularly, could also have disastrous consequences for the public during a national health crisis, officials said.

The Lamont Administration cited the impact school closures would have on health care workers being able to make it to work as the reason school closures should be a last resort.

“Closing schools becomes a very last resort, given how disruptive that is in so many dimensions and the other risks that can cause for the children, for the families, parents that have to stay home — some of those parents may be health care workers than then get pulled out of the hospitals,” Josh Geballe, the Democratic governor’s chief operating officer, told reporters Monday.

Closing schools can also have huge implications on children, with the most obvious being that public schools also feed thousands of students from low-income families for free. Free or reduced-priced meals are provided to 43% of Connecticut’s public school students each day.

Research also shows that when schools are closed without alternative activities planned, a higher number of children will get into trouble.

“Idle time is the devil’s playground,” State Rep. Robyn Porter told the state’s education commissioner recently of the governor’s proposed cuts to afterschool programs.

The United Nation’s also warns that when schools are closed, convincing students to return to school is a challenge and dropout rates rise.