School Zone: Approach COVID Outbreak Narrative With Caution

Recently, the story of SARS-CoV-2 spreading in an elementary school in Marin County, California went viral (pardon the pun). An unvaccinated teacher developed COVID-19. Initially thinking it was allergies, the teacher attended class, and continued to do so even after symptoms worsened — including cough, headache, and fever. All students wore masks, and the teacher was masked for most of the day except when reading a story to the class.

Twelve students out of 22 (55%) ended up testing positive, and eight (36%) had symptoms. Four of their parents — one unvaccinated — and several siblings also subsequently became sick. Another class (3 years apart in age) had cases of SARS-CoV-2 and these were thought to be from in-school interactions.

Across social media and national news media, there have been many interpretations of the data. Some alleged that the teacher spread the virus while reading without a mask. That’s possible, but it is also possible that the teacher spread the virus during the many other hours spent in the classroom while sick, despite wearing a mask. The children who tested positive became infected despite wearing masks all day in a school with high adherence — and despite the classroom being equipped with particulate air filters and having open doors and windows. Most tweets we saw focused on masking, but the most important issue to note is that during a global pandemic, it is probably not a good idea to go to work when you feel ill.

Many assumed that the root of this problem (index patient) was the teacher, and whole genome sequencing was applied. Sequencing was able to link the cases among the kids — i.e., they appeared to share the same virus. However, whole genome sequencing was unavailable for the teacher, which is a key limitation. Moreover, not all interactions between students were confined to school. Several students had a sleepover together. So while the popular narrative — the teacher brought this virus into the school and it spread inside — is entirely compatible with the data, there remains some uncertainty as to how many cases arose through in-school versus out-of-school spread.

What are we to do with this anecdote? Surely, it may scare parents whose kids are just beginning the school year — after all, despite masks, ventilation, distancing, and open windows, some kids developed COVID-19. That brings us here: the report highlights the importance of being careful when it comes to covering anecdotes about COVID-19 from schools. The media should absolutely continue to cover the science of COVID-19 in schools, but — like everything else during the pandemic — it needs to be backed with scientific evidence and data and put into the proper context. Otherwise, mania and panic may ensue.

Contrast schools with vaccines. The media is rightly cautious when it comes to covering adverse events after vaccination, usually emphasizing the rarity of these events. Of course, vaccine induced thrombocytopenia and thrombosis (VITT) and myocarditis are two important safety signals that have emerged, after adenoviral and mRNA vaccines respectively, but we rarely hear detailed first-person narratives of complications after vaccination on the news for one simple reason: These anecdotes may be misunderstood, and result in people making unwise choices to defer vaccination.

Sending kids in person to public school is equally important and equally delicate. The net societal benefit exceeds the downsides in all but the worst situations. Anecdotes about school that are misconstrued or misused have potential to raise parent anxiety, reduce confidence in in-person schooling, and deter parents from sending their children to get the education they need.

We saw the danger of irresponsible rhetoric play out last fall. While many districts reopened schools, implemented masking and other mitigation strategies in many cases, and successfully offered fully in-person learning with few outbreaks, others turned to virtual instruction. Some local teachers unions, with their members preferring to work from home and hoping to delay the restart of in-person learning, organized well-covered publicity stunts with mock body bags and child-sized coffins. School board members irresponsibly claimed parents had to choose: “Do you want your child to be alive or to be educated?”

Such inflammatory messaging clearly had an effect. By late fall, a significant number of families — including more than 50% of Black and Latino parents — did not feel comfortable sending their kids back to school. Despite a concerted campaign by President Biden and his Education Secretary Miguel Cardona stressing the importance of in-person learning, many kept their kids home this spring even as their districts reopened their doors. Academic achievement suffered and achievement gaps grew.

Fortunately, efforts to overcome “school hesitancy” and communicate the importance of in-person learning seem to have worked. By late spring, most families reported planning to send their children back for the 2021-2022 school year. As local districts restarted in-person learning and made efforts to persuade parents that in-person school was safe for their kids, comfort levels improved dramatically across the board. As the school year began this month, the vast majority of kids returned, even in districts where virtual options remained available. Yet, anxiety over the Delta variant remains high, headlines now emphasize rising childhood infections (weekly cases among U.S. kids just topped 200,000 for the second time in the pandemic) and pediatric hospital capacity shortages, and some parents may be having second thoughts. Once again, media coverage is likely to be pivotal for many families.

The Marin story is a powerful anecdote, and that’s why it captured widespread attention. But what does it mean for policy, and for the individual risk-benefit calculations individual families must make? Does it mean that with Delta, school should not be in-person? It’s important to think through the counterfactual world. Without school, what would happen to these kids? Some would learn virtually in households with unvaccinated parents; many would play together indoors anyway; some may have grandparents come in to help with childcare and others would be placed in childcare centers. In other words, in a world without school, we have no idea if more, fewer, or the same number of kids or parents would get sick.

Without knowing what happens in a world without school, or a world where the teacher never took the mask off, or a world where the teacher did not come to work sick, or a world without that sleepover, the Marin anecdote is not very useful for policy. Instead, it may be misunderstood by the public, and wrongly induce parent panic that unnecessarily keeps kids home and disrupts their learning.

The media should absolutely cover the science of COVID-19 in schools, but that means more data and context, and less anecdote.

Vladimir Kogan, PhD, is an associate professor in the Department of Political Science at The Ohio State University. Vinay Prasad, MD, MPH, is a hematologist-oncologist and associate professor of medicine at the University of California San Francisco, and author of Malignant: How Bad Policy and Bad Evidence Harm People With Cancer.

Last Updated August 31, 2021