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Did Closing Schools Actually Help? Did Closing Schools Actually Help?
(7 days later)
As different countries and states tentatively start reopening their economies, there seems to be no clear plan, and no clear way to figure out which of the lockdown measures made a difference in slowing the spread of Covid-19.As different countries and states tentatively start reopening their economies, there seems to be no clear plan, and no clear way to figure out which of the lockdown measures made a difference in slowing the spread of Covid-19.
Was it necessary to shut down schools? Did it matter if state parks and playgrounds in New Jersey were closed? Did an 8 p.m.-to-5 a.m. curfew make a difference? When can we go back to normal?Was it necessary to shut down schools? Did it matter if state parks and playgrounds in New Jersey were closed? Did an 8 p.m.-to-5 a.m. curfew make a difference? When can we go back to normal?
With so many restrictions in place in different regions and countries, and with so many different ways of lifting them, it can seem impossible to draw conclusions.With so many restrictions in place in different regions and countries, and with so many different ways of lifting them, it can seem impossible to draw conclusions.
Now, two Norwegian medical researchers, experienced in evaluating cancer data, suggest a way to get reliable information. Their answer: a randomized clinical trial of reopenings.Now, two Norwegian medical researchers, experienced in evaluating cancer data, suggest a way to get reliable information. Their answer: a randomized clinical trial of reopenings.
Its design could be analogous to some studies asking, for example, if cancer screening lowered death rates. The results, they add, should be generally applicable. If such a study is done in Norway, its findings should apply to the United States, too.Its design could be analogous to some studies asking, for example, if cancer screening lowered death rates. The results, they add, should be generally applicable. If such a study is done in Norway, its findings should apply to the United States, too.
The researchers, Dr. Mette Kalager and Dr. Michael Bretthauer, a husband-and-wife team at the University of Oslo, do not suggest randomizing individuals, as is done in studies of experimental drugs, but rather randomizing regions like similar school districts in adjacent towns.The researchers, Dr. Mette Kalager and Dr. Michael Bretthauer, a husband-and-wife team at the University of Oslo, do not suggest randomizing individuals, as is done in studies of experimental drugs, but rather randomizing regions like similar school districts in adjacent towns.
To test whether it was safe to open schools, they envision what is called rapid-cycle randomization, in which measures are quickly evaluated and adjusted as data emerge.To test whether it was safe to open schools, they envision what is called rapid-cycle randomization, in which measures are quickly evaluated and adjusted as data emerge.
In the first cycle, schools in one district would remain closed while those in another would reopen carefully with, for example, half the usual number of students and with six-foot social distancing in place. Students and teachers in both districts would be tested for the coronavirus at the start and end of the cycle. Each cycle could last between 10 days and two weeks, accounting for a viral incubation period of four to five days.In the first cycle, schools in one district would remain closed while those in another would reopen carefully with, for example, half the usual number of students and with six-foot social distancing in place. Students and teachers in both districts would be tested for the coronavirus at the start and end of the cycle. Each cycle could last between 10 days and two weeks, accounting for a viral incubation period of four to five days.
If the careful reopening did not result in increased transmission of the virus, the study would advance to the second stage: Schools in one district would open with half the normal number of students and six-foot social distancing while those in the other would have three-quarters of the normal number of students and maintain just three feet of social distancing.If the careful reopening did not result in increased transmission of the virus, the study would advance to the second stage: Schools in one district would open with half the normal number of students and six-foot social distancing while those in the other would have three-quarters of the normal number of students and maintain just three feet of social distancing.
If there were no increased transmission, the third phase would compare that less restrictive setting with a full, unrestricted reopening.If there were no increased transmission, the third phase would compare that less restrictive setting with a full, unrestricted reopening.
In the best-case scenario — no increased transmission — all schools could open after three to six weeks.In the best-case scenario — no increased transmission — all schools could open after three to six weeks.
Dr. Kalager and Dr. Bretthauer add that the study would minimize harm because only those randomized to the increasingly lax restrictions and those they came in contact with would be at risk.Dr. Kalager and Dr. Bretthauer add that the study would minimize harm because only those randomized to the increasingly lax restrictions and those they came in contact with would be at risk.
The same trial design could, in theory, be applied to places like gyms and office buildings.The same trial design could, in theory, be applied to places like gyms and office buildings.
Epidemiologists and medical researchers in the United States say the idea is worth considering, although it is not clear how practical it would be to carry out.Epidemiologists and medical researchers in the United States say the idea is worth considering, although it is not clear how practical it would be to carry out.
Updated June 24, 2020 Updated June 30, 2020
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles.Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles.
A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
“The general idea is a good one,” said Jon Zelner, an epidemiologist at the University of Michigan. The data that will emerge from the reopenings that are starting now will be analyzed, he said, but it’s not clear how useful that data will be because the reopenings are being done “in a very ad hoc, not rigorous way.” Although he questions the details of how a randomized study could be designed, or whether a randomized trial is the best way of answering these questions, he said, “just the contribution of the idea to the discussion is valuable.”“The general idea is a good one,” said Jon Zelner, an epidemiologist at the University of Michigan. The data that will emerge from the reopenings that are starting now will be analyzed, he said, but it’s not clear how useful that data will be because the reopenings are being done “in a very ad hoc, not rigorous way.” Although he questions the details of how a randomized study could be designed, or whether a randomized trial is the best way of answering these questions, he said, “just the contribution of the idea to the discussion is valuable.”
Dr. Robert Aronowitz, a professor of the history and sociology of science at the University of Pennsylvania, added that a rigorous study might be more convincing to a skittish public than data from observations of a variety of reopenings.Dr. Robert Aronowitz, a professor of the history and sociology of science at the University of Pennsylvania, added that a rigorous study might be more convincing to a skittish public than data from observations of a variety of reopenings.
But, Dr. Kalager and Dr. Bretthauer said in a Zoom interview, it is not always in politicians’ interest to get data from randomized controlled studies. Those who called for quickly shutting schools down would face blowback if it turned out that the closings had virtually no effect on the spread of the epidemic.But, Dr. Kalager and Dr. Bretthauer said in a Zoom interview, it is not always in politicians’ interest to get data from randomized controlled studies. Those who called for quickly shutting schools down would face blowback if it turned out that the closings had virtually no effect on the spread of the epidemic.
So far, a study like the one they propose is just a thought experiment. No schools in Norway are planning to randomly test reopenings. Gyms are interested — they have everything to gain if they can prove it was safe to open up — but Dr. Kalager and Dr. Bretthauer said they were still studying how to best design a gym experiment.So far, a study like the one they propose is just a thought experiment. No schools in Norway are planning to randomly test reopenings. Gyms are interested — they have everything to gain if they can prove it was safe to open up — but Dr. Kalager and Dr. Bretthauer said they were still studying how to best design a gym experiment.
But, Dr. Kalager said, “we are really pushing this, talking to local and national politicians.”But, Dr. Kalager said, “we are really pushing this, talking to local and national politicians.”
“If it takes one and a half years to develop a vaccine,” she added, “we can’t close down the schools for one and a half years.”“If it takes one and a half years to develop a vaccine,” she added, “we can’t close down the schools for one and a half years.”
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