The outcomes of pandemics are best understood in retrospect. Years from now, historians, epidemiologists, psychologists, and economists will provide extensive explanations of the damage done, mistakes made, and lessons learned. While in the thick of it, decisions must be made without the benefits that hindsight will provide, and those decisions can have considerable and lasting implications. It is also clear that certain vulnerable subpopulations have been asked to make greater sacrifices, as noted by Dooley et al1 in this issue of JAMA Pediatrics. Elderly people in institutions have given up all in-person visits; many adults in the workforce have been asked to forego their livelihood, together with all of the attendant hardships that brings; and millions of children have been kept home from school and transitioned rather abruptly to distance learning that no child, school district, or teacher was adequately prepared for. The decision to close schools was among the first action that many states took to stave the impending pandemic and was based on a strong theoretical foundation. Children are typically at greatest risk of infectious diseases, and they transmit them to each other and their families with considerable speed. Many drew parallels to the 100-year-old influenza epidemic, in which it was true that children played a central role in transmission. But in the 6 to 8 weeks since most schools in the US have closed, we have gathered new evidence about both children’s risks from the virus and their likelihood of transmitting it, as noted by Esposito and Principi2 in this issue of JAMA Pediatrics. We know only what we know today about the benefits and harms associated with school closure.
However imperfect these data are, they must inform a critical decision that many states and school districts will be making in the very near future. Notably, even as states provisionally plan on opening workplaces, most are giving no consideration to opening schools. Many have already canceled the rest of the year, and all are now considering what to do in the fall. The risks posed by delaying school openings are real and sizeable, particularly for students from low-income families.1,2 The phenomenon of summer learning loss has been well established, with children losing a mean of 1 to 3 months in varying subjects. Some estimate that there will be a 9-month to 12-month loss when children return to school in the fall, and this will only be compounded if distance learning continues. No credible scientist, learning expert, teacher, or parent believes that children aged 5 to 10 years can meaningfully engage in online learning without considerable parental involvement, which many families with low incomes are unable to provide because parents must work outside the home.
The daily coronavirus task force briefing makes no regular mention of the school situations as they discuss bringing the US back to work. To help inform states and counties that are struggling to make this enormously consequential and urgent decision regarding the fall semester, an expert task force focusing exclusively on school closure should be convened immediately. This panel should include epidemiologists, infectious disease experts, educational scientists, and child psychologists, among others. They should review the state of the evidence regarding horizontal transmission among children and their families, as well as what is known about the feasibility of distance learning and the psychological implications of children continuing to stay at home. Their recommendations should be developmentally framed, taking into account children’s varying needs and cognitive abilities; kindergarten is not the same as high school or college. Using all existing and emerging data—however incomplete—they should make their best-informed recommendations to help states make this crucial decision, based on science and not politics, as soon as possible. We owe this to our children. Years from now, when they reflect on the pandemic, they will hold us accountable.
Corresponding Author: Dimitri A. Christakis, MD, MPH, Seattle Children's Research Institute, Center for Child Health, Behavior, and Development, 2001 Eighth Ave, Ste 400, Seattle, WA 98121 (firstname.lastname@example.org).
Published Online: May 13, 2020. doi:10.1001/jamapediatrics.2020.2068
Funding/Support: None reported.
N. School closure during the coronavirus disease 2019 (COVID-19) pandemic: an effective intervention at the global level? JAMA Pediatr
. Published online May 13, 2020. doi:10.1001/jamapediatrics.2020.1892Google Scholar