Editor's Note: Martin Kulldorff is a professor at Harvard Medical School. Study infectious disease outbreaks and vaccine safety. He can be followed on Twitter at @MartinKulldorff. The opinions expressed in this column are those of the author. See more opinions at cnne.com/opinion.
(CNN Spanish) - There are passionate and heated discussions about the wisdom of opening schools this fall. And, as I have mentioned in other articles, the politicization of positions on how to react to this pandemic does not help at all. The next fundamental question for the US is: Is it safe to open schools in the middle of a pandemic? To contribute to this discussion, I wanted to write this article with the Swedish professor Martin Kulldorff, who is also a professor of Medicine at Harvard University, to describe the experience of that country at the beginning of classes.
Covid-19 is an extremely dangerous disease for the elderly, but the risks for children are less than the annual flu. Most agree that the decision should be based on science. Rather than anecdotes or hypothetical scenarios, we must examine scientific data from Sweden, the only Western country that kept schools open during the height of the pandemic. This is a basic principle of science. If we want to know the health effects of any exposure, we must study those who were exposed.
So in Sweden, were children at risk? Teachers? Parents, grandparents, and other family members? What happened to the community?
Children: Sweden has 1.8 million children between the ages of 1 and 15 who attended kindergarten or school during the pandemic. None of them died of covid-19. Since the majority of those infected are asymptomatic or mildly symptomatic, the total number of infected is unknown, but the known number was 468, that is, one in every 4,000 children. Of them, eight were hospitalized in an intensive care unit. This means that whether schools are open or not, children are at much less risk from COVID-19 than they are from the annual flu, which in the US has killed between 100 and 200 children a year since 2016.
Teachers: The risk of dying from COVID-19 increases with age, so teachers are at higher risk than children, but are they at high risk compared to other working adults? The answer is no. Swedish teachers had the same risk of contracting COVID-19 as the average in other professions, a much lower risk than, for example, restaurant workers, taxi drivers and bus drivers.
Family: Most grandparents are in the highest risk category, but are they in greater danger if they live with a grandchild who attends school? Those over 70 are at higher risk of infection if they live with an adult of working age than with someone their own age, but with Swedish schools open in Sweden, figures show that the risk did not increase any more if they also lived with a child under 16 years old.
Community: If schools were to promote the transmission of COVID-19, we would expect teachers to be at greater risk than other adults, and the elderly to be at greater risk if they live with children. There is no evidence of that in Sweden.
In scientific studies, we need a control group to compare. In the above examples, teachers were compared to other professions, while the elderly who lived with children were compared to those who did not. Don't we need a comparison for children too? Of course. So we can compare Sweden with countries that closed their schools. Not even one of them had a lower mortality from covid-19 among school-age children.
The data from Sweden is great news for children in the US and other countries, as they could safely return to school to get the education they need. This is especially important for working-class children, who suffered the most with schools closed. However, not everything should return to normal.
While keeping its schools open, Sweden instituted several infection control measures that other places can follow. Children with any respiratory symptoms had to stay home and, if symptoms appeared at school, they were immediately sent home. This is in stark contrast to Israel, which accepted sick students when its schools reopened in May. Swedish schools also increased surface cleaning, hand washing and outdoor teaching, while banning gatherings of more than 50 children. On the positive side, neither the children nor the teachers wore masks.
Does this mean that there will be no infections in schools? No. When schools reopen, based on the Swedish experience, some children will get sick and, with many tests, many asymptomatic cases will also be found. The point is not that we can prevent children from becoming infected. The fact is that the consequences are minor compared to influenza and other diseases.
People over 60 are at high risk, whether they work in a school or not, and it is vitally important that they are protected. Rather than depriving children of their education, it is better to let older teachers work from home, helping their young colleagues grade tests and essays, or providing online tutoring for sick students at home. This is the most important precautionary measure that schools can take.
Some have proposed a hybrid school model, with a mix of in-school and distance learning. Some teaching in school is better than nothing, but it is a worse option in terms of infection control. With hybrid schooling, many children will not only have two potential transmission sites - their home and their school, - but also a third with grandparents, neighbors, daycare, babysitters in charge of homework or whoever is babysitting on the days that they do not go to school.
For children, schools are not only important for the education they receive. Good education is also essential for physical and mental health. Keeping schools closed will have major detrimental effects on short- and long-term well-being among the most valued members of our society. The Swedish experience is clearly in favor of the reopening of schools. Now, we just have to help politicians and school officials see the light.
covid-19 Sweden
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