On #stopthespread and school closures

On the decision to keep schools open in Australia yesterday:

• According to the Australian Chief Medical Officer, schools are under represented in global data as hotspots of community spread.

• This is especially clear compared to clusters that have come from the 20-45 age range, and the visible critical caseload that has been coming from nursing homes.

• Anyone with kids knows that schools are an automatic suspect for community spread, so i think it’s safe to say that folks have been looking for this in the data.

So, why isn’t school-based community spread common?

• We don’t know yet.

• At it's peak COVID sheds at ~1,000x the peak rate of Influenza-A, and this is usually during initial symptom onset. For some reason kids experience it more mildly then adults, so maybe they just shed less because they are coughing less. This is one theory.

• Absence of proof isn’t proof of absence, and it’s possible that school-based community spread is happening and we simply haven’t seen it.

• The tendency for child cases to be milder overall probably contributes to lower testing rates in children, but social tracing for critical cases would still eventually finger a school as the culprit for community spread. This hasn’t happened much.

• A lot of effort and diligence has gone into social tracing in Israel, some Asian countries (especially the ones that got hit hard by SARS-1), and some European counties, and many have made their data available to the WHO and various governments, including the Australian government.

• Again, schools get a lot of attention in outbreak epidemiology, and the absence of evidence that school-based community spread is happening doesn’t seem to be for a lack of trying.

Ok, what do we know?

• Kids who are uncontained are more likely to transit BETWEEN the populations who ARE confirmed to spread aggressively AND be more critically impacted.

• Kids tend to spend more time in closer proximity to extended family and friends, increasing the risk of transmission.

• Grandparents aren’t naturally great at social distancing with their grandkids, nor do they tend to be naturally great at grandchild containment.

• Households with school aged kids where both parents work are common in Australia.

• Proper work from home and lockdown is still a work in progress, so if we shut schools tomorrow there’d be a non-trivial number of households where there is no-one home but the kids, and maybe the grandparents if they need something.

• There are ~2,200 Intensive Care Unit beds in Australia

…and that’s why.

I said this yesterday but will repeat: Aside from age, covid mortality rates are most consistently correlated with the availability of critical care. Australian schools, rather than being closed, were today turned into optional TEMPORARY CONTAINMENT facilities to avoid a sudden influx of critical cases, and to attempt to avert overheating our response systems in the early stages of our collective battle with covid.

What about the teachers though?

• It’s not good for teachers, especially those who are at higher risk

• Changes in law making schooling optional will cause a quick reduction in attendance, because at this point parents are definitely aware, concerned, and making preparations

• This will in turn quickly allow teachers who consider themselves at higher risk to commence bugging out.

So, tldr:

Instead of going “Full China Protocol” the Australian State and Federal governments are attempting a graceful shutdown, with the goal of mitigating the kinds of chaos that would increase the rate of spread into critical-risk communities. It’s a counter-intuitive “best bad idea” in a situation where all solutions are bad, and i don’t like it – but i don’t think liking it is the point.

1. Decide whether or not you can contain your kids, then

2. Decide whether or not you want to send them to school tomorrow.

…For my family, we are very fortunate to be able to contain our kids, and we won’t be sending them to school even though we could.

…For a very large number of folks at least one of these things will be difficult to decide on.

Stay safe.