Why school quarantine is the wrong measure against coronavirus

2024 Author: Seth Attwood | [email protected]. Last modified: 2023-12-16 15:55

Renowned public health and medical sociologist Nicholas Christakis answers questions from Science magazine. The scientist explains whether schools should be closed preventively to prevent the spread of the coronavirus, and explains how social distancing works and why it is needed.

The social upheaval caused by the COVID-19 coronavirus is expanding and intensifying, which raises the question for many in the United States: what about schools? Schools in Japan, Italy, parts of China and elsewhere have closed. Their example was followed by a small number of educational institutions in the United States, the number of which is gradually increasing. Schools are closed for a day, a week or longer.

But does the closure of schools help society, especially when there are many uncertainties about the involvement of children in the spread of COVID-19? Nicholas Christakis, a sociologist and physician at Yale University, believes he is helping, but admits there are many tough issues surrounding school closures. Christakis is a social media researcher and develops software and statistical methods to predict the spread of an epidemic even before it starts.

He was interviewed, which has been abridged and edited for clarity.

Science: Schools act differently in this situation. What measures can schools take, and what measures have they taken in the past when epidemics occurred? And how can such measures help?

Nicholas Christakis: I would like to highlight the difference between proactive and retaliatory school closures. Closure as a response is when a school decides to close after a student, parent, or staff member becomes ill. Most people don't mind such a measure. If a pandemic has entered the school, it must be closed.

There is a lot of research on the topic of school closures as a response. Among them is a paper published in Nature in 2006 that applied mathematical models [on the influenza pandemic]. The authors of such studies generally find that school closures as a response reduce disease prevalence by about 25% for moderately transmitted pathogens and delay the peak [in their region] by about two weeks. If the peak is delayed, there are fewer and fewer cases of illness. There is a certain value in this. The incidence of the disease on any given day is less, and therefore we do not have to overload the healthcare system.

So, as a response, the school closes when a student, parent or staff is diagnosed with the COVID-19 virus. Should the entire school be closed if the case is an isolated one? And in general, does it depend on the circumstances?

- For example, if a person flew to your city from Italy and brought a virus with him, this is something else, but not a case of a local illness, when we do not know how the person got sick. An out-of-hospital case is like a canary in a coal mine. When you identify one case, there may be dozens or even hundreds of other infections.

So, an out-of-hospital case of a local illness requires the closure of the school?

- Yes. By this time, the disease can already be transmitted to other people. This is the tip of the iceberg. In one paper [on the influenza pandemic] I read about the closure of one or more classrooms. But this gives almost nothing.

And if the parent returns from a trip to Italy? Should the school be closed in that case?

- Maybe. It is possible to isolate people in close contact with an infected person. I would probably close the school, but I could well understand the decision not to close it.

What about early closure, that is, before a school-related infection emerges? It helps?

“Proactive closure, or school closure before a case of illness occurs, has been proven to be one of the most effective non-drug measures you can take. Preemptive closure works in the same way as closure as a response, but not because the small vector children are isolated and not involved in the spread of the infection. It's not just about the safety and health of children. We are talking about the safety of society, the whole area. When we close schools, adults are less likely to come into contact, because parents do not come there, teachers are not present in the classroom. By closing schools, we are essentially demanding that parents stay at home.

There was a wonderful publication analyzing Spanish flu data in 1918, comparing the two types of school closures. When did regional authorities close schools: before or after the outbreak? The study authors found that preemptive school closures saved many lives. In St. Louis, schools closed the day before the disease spike, and closed for 143 days. In Pittsburgh, they were closed seven days after the peak of the infection - just 53 days. The death toll from the epidemic in St. Louis was about three times less than in Pittsburgh. Such measures are effective.

How should the authorities decide when a proactive closure is necessary?

- How many cases are there in the region? And what is the epidemiological situation there in general? If we are talking about a medium-sized city, then, as soon as there is at least one out-of-hospital case of the disease, schools should be closed, regardless of whether this case occurred at the school or not.

“Let's look at a case of a community-acquired illness that happened to a priest in Washington. He was diagnosed with COVID-19 last weekend. Should schools in the entire region be closed due to such an isolated incident?

- If the priest was in an epidemiologically unfavorable area, and if we believe that the school should be closed as a response measure, when a case of illness is detected there, then such an out-of-hospital case will certainly appear [at the school]. So why not close it early enough to prevent the spread of infection and minimize the infection of staff and students?

“But this is causing a lot of confusion

- Not surprisingly, the costs are very significant - both for health and for the economy. Many children receive meals at school and their health could be affected by school closures. Health care workers will look after their children just when they are needed most in hospitals. Parents may lose their jobs. Therefore, in Japan, parents are provided with a basic income during school closings. The state should go on these expenses.

Are there any social distancing measures without closing schools, especially if there are no cases of the disease in the given school? For example, canceling large events in which many families are involved?

- Yes, I'm glad you mentioned that. There should not be an all-or-nothing policy. Some intermediate steps are possible. For example, if a family wants to keep their children at home, why not let them do it? And why not cancel all events like sports and musical performances that are attended by a lot of people?

When we do social distancing, it's not just that you yourself don't get infected. The main advantage is that, by self-isolation, you close all the paths through which the virus passes through you. You provide a service to society, you help people. Employees willing (and able) to work from home can work from home.

Many schools close for the day for sanitization. It helps?

- I do not know. It depends on the circumstances.

Another important question is about the timing. If a school closes, when can it be reopened?

- To be honest, I do not know what research has been carried out in this direction. The school needs to be closed for several weeks. The Chinese have closed their schools for six weeks. The Japanese are four. What is the rule for opening schools? I don’t know the answer.

The closure of schools is now causing a lot of controversy. The authors of some articles say that it gives almost nothing. And since this is a new virus, we need to draw on lessons learned from previous outbreaks of other infectious diseases to understand how school closures would benefit. What would you say to people who say there is little benefit from school closures, especially when there are relatively few infections in the area?

- Let's do a thought experiment. If a school has an outbreak, will you insist on closing it? If an epidemic occurs around a school, you know that the students will also be infected. But if you are ready to close a school after an infection appears there, then it is much more logical and wiser to do this when the virus has not yet entered the school.

The experience of past epidemics with different types of viruses indicates that school closures are working. We know that it interrupts adult-to-adult transmission, even if children are not carriers. In this case, children can be carriers, as evidenced by preliminary data from Chinese studies. I admit that it is very difficult to do any calculations here. But we are talking about a pandemic.