Reactive or Proactive: Fairfax County Schools' Decision-Making

The novel coronavirus is truly new in so many aspects. Data currently available indicate that children do get infected, but exhibit only mild symptoms. Data from China suggest that children can be transmitters of the virus. Infections of the virus among children, however, remain low. Thus, COVID-19, the disease caused by the novel coronavirus, is markedly different from influenza. Yet, how effective nonpharmaceutical interventions such as school closure are to delaying and minimizing an epidemic is based on what we know regarding influenza. Thus, a proactive measure at this point truly requires guidance from health officials. Fairfax county, in its update late yesterday afternoon, noted that schools would be closed on Monday to give teachers the opportunity to prepare for distance learning in case schools are closed. They did not announce that schools were closing today. Late in the evening, the superintendent decided to close schools. The decision was visibly influenced by parents and teachers asking for a more proactive approach to curbing the spread of COVID-19 in the county. A proactive approach requires a clear implementation, not a day-to-day or wait-and-see process. The main disadvantage of a proactive approach is the disruption it causes while having no clear guarantee of being effective or necessary. A better proactive approach at this point, for example, is a decision to close schools starting next Monday, and keeping schools closed for two weeks. It offers clarity. We already have enough uncertainties to worry at this point. The lack of certainty does not provide enough room or time for parents to prepare for the disruption. This is one great advantage of a proactive approach over a reactive one.

When schools should close is an important question. Unfortunately, the data we currently have are on influenza so it would take a leap of faith to assume that it likewise applies to the coronavirus. The most familiar figure we have seen these days regarding epidemics is the following graph:

Copied from CDC

It is a figure that tells us how nonpharmaceutical interventions like washing one's hands regularly, keeping social distance, can squeeze the pandemic curve, resulting in a lower peak and a slower rate of infection, which avoids overrunning a community's health infrastructure. The graph does relay an important message, but it is not a quantitative graph. The figure is not even based on an actual study. Here is what we know in the case of influenza, and specifically, how school closures affect the epidemic:

Above copied from
https://doi.org/10.1016/j.jiph.2018.01.003

With influenza, the mean reduction of the peak than can be attributed to school closure is 29.65%. School closures both reduce and delay the epidemic peak for influenza. The longer the duration of the closure the greater the reduction in the epidemic. "Implementing school closure before or after the epidemic reaches its peak reduced the overall influenza epidemic."

Combined with what local health officials tell us, these are the grounds upon which decisions should be made. These decisions cannot be made based on the likes or dislikes one receives on social media.


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