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Duke, UNC study suggests that schools can reopen safely but only if proper precautions are followed

Duke University
Dr. Kanecia Zimmerman is one of the authors of the study, "Incidence and Secondary Transmission of SARS-CoV-2 Infections in Schools'

  New research is suggesting that even if there’s high spread of the coronavirus in the community, that doesn’t translate into increased cases in schools. But the findings rest upon each school’s commitment to masking, handwashing, and distancing.

Dr. Kanecia Zimmerman is part of the Duke University/UNC-Chapel Hill research group that studied 11 school districts in the state. The data comes from schools in a hybrid model for the months of August through October. 

She says their study shows that schools can return to in-person learning safely if the 3W’s are followed.Critics of reopening have pointed to a lack of clarity on how, exactly, the school district will make sure students comply. They’ve also questioned whether the study’s findings hold up with the emergence of new Covid-19 variants. Dr. Zimmerman:

“I think the bottom line is that you should be okay, even if these start to circulate even more. There’s no evidence that a variant can penetrate a mask; there’s no evidence that handwashing and distancing and masking don’t work for the variants.”

She also says that vaccinations should cover most of the variants, but there might be a point when they don’t. That means adhering to masking is even more important.

The New Hanover County School Board is meeting Tuesday night to discuss how to move forward with reopening plans for pre-K-5 schools. 

Below is an extended conversation with Dr. Zimmerman. 

Dr. Kanecia Zimmerman is an associate professor of pediatrics in the Division of Pediatric Critical Care Medicine at Duke University.  

Rachel Keith: What would you like for the public to understand about this recent study that you co-authored? What are the big takeaways?

Dr. Kanecia Zimmerman: The big takeaways are that success in schools, defined as safe schools, are actually possible with implementing mitigation strategies of washing hands distancing, and strict adherence to masking.

RK: So about a month ago, the New Hanover County School Board voted not to go back to full time for elementary students, even though that they had planned to because essentially, they were nervous that they couldn't keep to the six feet of social distancing on the bus or in the classrooms. So what does this study say about this point, should kids return to school, even if the school can't promise this six feet of social distancing?

KZ: So the evidence that we generated was really in the hybrid settings where they were adhering to six feet during that time period. So half the school was coming half the time, so that's the data that was generated. That being said, those counties that were in the study have continued to go to school and opened up the school for even more of their students, and have been successful in doing so largely because they had already mastered how to move through the process with fewer students in the building. So they had protocols in place, and they were successful in executing those protocols.

As they move to Plan A, which would be more aligned with what New Hanover was thinking about, the bottom line is that people certainly have been successful in moving towards Plan A, once they have kind of mastered Plan B. The data that we specifically generated was on Plan B. But those people have since then have blossomed out and continued to be very successful.

RK:Even if they say, okay, we can probably do three feet, but not six feet all the time?

KZ: That's correct. 

RK: And also during this last meeting, I saw your colleague Dr. Akinboyo present these findings, and some of the members of the board were concerned about the data set of only 11 school districts. So I'd like to take that apart for the public as to why this data set is valid. And how we can make some conclusions from it?

KZ: To me, I think the benefit of our data set is that it's a breadth of data. I mean, 11 school districts encompassing almost 100,000 people. So that's students and staff members that are across the state of North Carolina with some representative districts. But I think people should just realize that one study should not ever be the end all be all. But increasingly, we're getting additional data, there was just recently information from Wisconsin, where they looked at fewer schools, but still found the same thing. I think when we look at studies, in Mississippi, for example, there was a case-control study that evaluated whether or not kids who go to school have a higher risk of infection compared to those who were not going to school, and certainly, school was not a risk factor in that setting. There are studies from Europe that have suggested that even when people haven't been totally perfect with mitigation strategies, that transmission from one person to another within the school building was actually really low. So we think at this point, we are gathering increasing evidence that in different settings, different populations, different time periods, different levels of community spread, that success is possible if you have the mitigation strategies in place.

RK: Could you go through the difference between elementary and middle and high school students when it comes to transmitting the virus?

KZ: There are potentially some data suggesting that kids in elementary schools below the age of 10 are maybe less efficient at spreading the virus. It probably has something to do with the way the virus attaches to them, and whether or not they had the appropriate receptors and things of that nature. And some of that still needs to be fleshed out. That being said, we know that those kids can spread disease. We know that those kids can spread infection with what we have seen not only with adults, with kids, no matter how old they are, that your behavior and how you're acting, and whether or not you're actually following the rules makes a big difference. 

So I think the key message here is, we do all these mitigation strategies outside of the school building, we know that they work when we go to Target or when we go to the hospital. The CDC has recommended washing your hands, distancing, and wearing masks, and we know that those things work, there's no reason to think that they wouldn't work inside the school building. And there's no reason to think that they wouldn't work whether you're an adult, a high schooler, or elementary school student.  

RK: I know that the big question on everyone's mind right now is the emerging variants. Should school members pump the brakes on a full return because of these? Or do you feel like the findings of your study still hold true?

KZ: I think the bottom line is that you should be okay. Even if these start to circulate even more. And I think that it's a really important point, that there's no evidence that a variant can penetrate a mask, there's no evidence that handwashing, distancing, and masking don't work for the variants. What we have seen is that even with vaccinations, we expect that the vaccinations are going to cover these variants. However, there may be a point at which vaccinations won't necessarily cover these variants. And so that's why we need to even be more adherent to these mitigation strategies.  

RK:And is there anything else that you'd like the media or political leaders to know? What are they missing about the science of this virus or your study that you'd like to clear up?

KZ: I think early on there were definitely signs that said, we, theABC Science Collaborative, said go back to school, which is not what we said. I think the key message here is more of the message that's been said lately, the mitigation strategies are so very important. If you have a commitment to doing those, you can be successful, if you do not have a commitment to doing those, failure is also possible. So I think that is the key message that people need to take home, we can be successful. This is no longer a question of, can this be done? We can be successful if we have the mitigation strategies in place.

RK: I don't know if you could weigh in on this, but there are mainly two sides to this conversation. One side says we need to stay in Plan B because we’re less likely to get our students and staff sick with the coronavirus. The other side says, hey, kids are losing their social, emotional learning; this isn’t helping their mental health or their academics. They need to go back to recoup these losses.

KZ:It is a bit disheartening that much of the conversation has not actually been about kids. I am also a mother. And I also have two kids, and I watch them every single day as we're going through this process. And my kids are savvy enough to even recognize that the conversation isn't about them. And as a mother, that's fairly heartbreaking. Because as the science comes out, and as we learn more, that schools aren't the reason that the community is out of control. At Christmas schools were closed, and we had this gigantic surge. I think the fact that now the science is continuing to show that this is possible. The more and more we decide not to go back to school -- and there are many reasons not to do so -- but not to open school doors makes it less and less about children. And more and more about other things.

RK: One of the reasons the School Board decided not to return was the lack of concrete plans laying out how exactly we would return full-time to classrooms. Is that what you're hoping, that school districts really have a clear plan when they're ready to go back full-time?

KZ: Absolutely. With the ABC Collaborative, for example, when a school did have a secondary transmission we had a conversation with them about it, so what happened? And how can we make that better? So I think from the beginning, there needs to be very clear communication of plans and protocols. And if something doesn't go necessarily according to plan, how do you fix that? How do you make it better? What are the things that you are going to have in place within the school buildings to ensure that people are actually masking to make sure that teachers are feeling comfortable? Does that administration have their back? 

I think what we've learned is that there are issues of trust, there are issues of fear, all of these things are playing into what we're seeing. And why the conversation isn't necessarily about children. It's because there are deep-seated issues, not only in public education in general but within school buildings about whether or not we can trust the people who are around us, whether or not we can trust our leaders. So communicating to people about having a plan, how you're going to fix things and make them better if something doesn't go according to plan is so very, very important.

RK: Yes, it’s been hard for our community to make these decisions. And like you said, it's just this fear that can we do this right? 

KZ:Fear is, unfortunately, very powerful. But I think the other thing just for us, the data is suggestive that you may be more protected in the school field. And that's probably because people are compliant. Like when you go to Target, you see all kinds of people with the mask below their noses. Like, no one tells you to pull that up. When you go to Target, no one tells you to step away. When you go to school, teachers, administrators, they're used to putting policies and plans in place, they're used to having roles. It's a highly compliant environment. That is why people are successful because they are dedicated.

RK:The North Carolina Association of Educators, they are concerned that around nine teachers in the state have died of the virus. Those news stories can be scary for them; I mean it can be a life and death situation.

KZ: Unfortunately, the stories that have come out around teachers dying here in North Carolina and elsewhere failed to have those details put into the media, whether or not that they had someone at home who was infected or something else. Certainly, we know that teachers are getting infected, even when they're in a hybrid model. 

We know that there are teachers in buildings without students in them who are getting infected. So I certainly understand the fear, and we know that teachers are going to be more vulnerable to infection than kids. I think the fortunate thing is, it's not usually the kids giving the infection to the teachers. So that's the thing that I think people have a really hard time wrapping their heads around. And that's been shown in situations where there hasn't been masking like in Europe, like the UK and Norway, where they didn't mask, they did some other things. And when they measured, when they tested all the people who had been in contact with anyone else, most of the time, more than half of the time, it was teachers giving it to teachers. It was students sometimes giving it to students, and very rarely students giving it to teachers. So that kind of evidence, it's really hard for people to kind of take that in. But it should be reassuring, even though I understand that people have a hard time looking at evidence when they're afraid. 

I think the other piece of evidence that we have is that of health care workers. Health care workers are infected at two times the rate of the community. So there was a study that was done at the end of last year on this rate, but when you look at where they got infected, only 11% of those infections came from the hospital. And only about 30% of the infections that came from the hospital actually came from Covid-19 positive patients. Like these are patients you're taking care of that are actually Covid positive, the rest came because health care workers were sitting in the break room, kind of hanging out with their girlfriends or whomever, and didn't have their mask on. So that I think is like a very telling statement about human behavior. Just because health care workers are getting infected at a rate twice that of the community doesn't seem to have anything to do with the fact that they are actually health care workers. But everything to do with the fact that they are people, and that they have activities they do, they travel to weddings, they do all of these other things that could put them at risk for infection. 

RK: Dr. Zimmerman, thanks for your time.

KZ: Thank you.

Editor's Note: At the time of this interview, we had the tally of educators who have died of the virus at around nine. On February 3rd, the New Hanover County Association of Educators have this number at 15.