Doctor would greenlight day school opening this fall, with conditions

Dr. David Rosen is an assistant professor of pediatrics and a pathobiology researcher at Washington University School of Medicine. 


A couple of weeks ago, I joined a Zoom call with parents at Saul Mirowitz Jewish Community School, which is hoping to be able to resume in-person classes this fall even though the pandemic is far from over. 

While most schools in St. Louis County aren’t expected to issue specific reopening plans until July 20, Mirowitz outlined its steps as Head of School Cheryl Maayan explained guidelines and procedures that will be in place if the school’s 170 students are allowed to come back Aug. 20. 

In addition to Maayan, a few physicians serving as consultants to the school, including Dr. David Rosen, a pediatric infectious disease specialist and Mirowitz parent, fielded a myriad of questions about health and welfare concerns.

A few days later, I spoke to Rosen about the particulars of figuring out how schools can reopen safely. His answers were detailed and thoughtful and often punctuated with this caveat: All of this is a work in progress and subject to change based on ongoing research.

Nevertheless, Rosen, 40, who belongs to Congregation B’nai Amoona, feels that based on findings in Australia, China and European countries where schools have reopened, as well as the fact that children are less likely to get the virus or transmit it, they can go back to their classrooms without much risk. In a wide-ranging interview, he explained why, how and more.

Mirowitz is a relatively small school so it makes sense that it would be better able than most to reopen safely. What about public schools that are much larger?

All the data coming out suggests that there’s low, not zero, but low transmission among children, especially prepubescent children. And so, even with rising numbers, there are things we can do in almost all school districts to allow younger children to return to school safely.

Even in midst of the worst area of the pandemic, in New York City, health care workers had their children in day cares at the YMCA and they had zero cases of transmission. Papers that I read out of China, including one I read this morning, also suggest almost no transmission in day cares and lower grade schools.

What about high schools, where the kids are older?

High schools and middle schools, to a degree, are more complicated. It’s a spectrum, so as you get older, the risk of transmission and the risk of having more severe illness increases. It’s still very low in middle school and high school children, but we’re seeing now, for example, in Texas and other places, young people are really spreading the virus in bars and other places. They are asymptomatic, they’re ignoring some guidelines and getting close to each other. They’re not social distancing, they’re not wearing masks, and I think that is perpetuating infection in those areas. So you could imagine that if high schools weren’t doing things properly that they could play a role in transmission. But I still think it’s unlikely.

When you’re talking kids at the bars, you’re talking age 21 and up. When you’re talking high school, it’s 18 and under. Does that age gap make a difference?

There’s nothing magic that changes when you’re 17 versus 21. It’s a spectrum. There are some people at 16 who are going to be more susceptible to the virus than others 24 years old, and a lot of this, we are learning, has to do with the expression of the receptor for the virus. 

Some studies have looked at biopsies of the nasopharynx, which is the area of the body where most people would acquire the virus. If you look at the amount of receptor there — ACE-2 (angiotensin converting enzyme 2) — it seems to be much less in younger children and much higher in older adults. That, likely, is playing some role in our susceptibility to the virus. I am sure there are other factors as well, including immune factors and exposure to other coronaviruses.

We know that transmission and contracting the disease is greater in adults. Do you feel teachers, faculty and staff have reason to worry about schools reopening?  

Teachers and staff are certainly at higher risk than their students, so we need to do everything possible to mitigate these risks and make them feel comfortable in the classroom. Universal masking, frequent hand-washing and distancing when possible are the most important factors for protecting our teachers.

I think we need to help educate teachers and quell their fears in order to give them a realistic expectation for the fall. We also have to remind teachers and staff that their highest-risk interactions will be with other adults, so we should try to minimize in-person staff interactions.

While the risks in the classroom will never be zero, I do not believe the daily classroom experience will be any more dangerous than a routine trip to the grocery store. Some teachers and staff, especially those in high-risk demographics, may still not feel comfortable accepting these risks, and we need to support them in those decisions. 

In addition to Mirowitz, you are consulting with other school districts. What seem to be the biggest concerns among those larger districts? 

There are a ton of different concerns. Let’s start with guidelines. Every school right now I’ve talked to, and I talked to a handful, are just aching for some guidance and advice on what to do and how to do it safely. All want help with this. I think it’s up to our government and national organizations to try to provide that help. The problem is that all schools are totally different, and so the rules you would make up for Mirowitz are totally different than the strategy you would have for an inner-city public school that has busing and other factors that you need to consider. So the guidelines we are coming up with are very general and very broad. One of the roles that people like me, who are infectious disease or public health personnel, can play, is helping each individual school fit the guidelines to them and to their specific circumstances.

Talk a little more about guidelines, like masks, for example. What are some of the questions and concerns regarding masks in schools?

A big one is, what age should mask? What ages can effectively mask, and if you’re masked and you’re in a classroom with other people who are masked, does that count as a contact? One of the big reasons we’re masking is to try to minimize the disruption of schooling of our children. So if you have a bunch of high school classes where everyone is wearing a mask and someone does get infected with coronavirus, it’s likely very few people would have been exposed because that person was wearing mask and so is everyone else.

But we don’t know how public health officials will approach that. Will they say the whole class has to be out? In which case masking isn’t quite as important because our whole classes will have to be out anyway. Or do they say no, that’s not a contact because you had the proper masking and there was no prolonged exposure without masking, in which case we don’t have to take everyone out. That’s really the goal. The goal, in addition to minimizing disease, is minimizing our children’s educational disruption.

You’ve said the chance of children getting coronavirus and transmitting the disease are low. Your bigger concern is their education being disrupted. What other big concerns do you have?

How are we going to deal with children who get fevers or get colds or other common childhood illnesses? That’s going to happen, we know that. So how do we get them back to school? That’s really the issue. 

Some people feel if you have an illness with fever and other (COVID-like) symptoms, you may have to be out for 10 to 14 days. That’s a huge disruption. The other possibility is maybe we can get these kids tested relatively quickly and get them back to school in a few days. And then, what symptoms do we need to test for? If they have an isolated headache or isolated diarrhea, does that necessitate a COVID test before they can come back to school? 

I would argue not. I think taking a very practical approach and saying we want to eliminate children in school at the highest risk for transmitting the disease to others. So for me, that would be kids with fever, cough and other respiratory symptoms. 

What about school sports?

I’m very much on the fence about sports, especially contact sports. A lot of my colleagues are on the other side and totally accepting of it. One thing we need to consider with sports, especially our sports in older children, what are the children doing if they are not in those sports? 

A lot of the arguments are if we have kids in sports where they are supervised and spaced out and wearing masks when they are not in play, with adult supervision, those participants might be healthier and less at risk than if they weren’t in sports and congregating with their friends in other ways. I think it’s likely that teenagers will be finding their friends once they are back in school and doing things together. So sports might actually be a safer avenue than private parties at people’s houses and get-togethers. 

We want to try to minimize risk in everything we do, but it’s not going to be a perfect system. But if we do have sports and we do have events, we want to minimize the spectators at those events. 

You feel confident that returning to school is the best thing all around. I think a lot of parents wouldn’t mind hearing you reiterate why you feel this way.

I think it’s important for our children for so many reasons — developmentally, psychologically, socially — to get back to school, and I think we can do so safely given the demographics of who this virus affects. There are going to be cases, and we will have to deal with those. And hopefully as we do, we will have more data to base decisions on. 

If this were an influenza pandemic where we know the kids are a large mode of transmission, that would be a totally different story. But I think with this virus and what we have seen out of Australia and other countries that have schools currently open, I think we can do it safely.