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Did Closing Schools Actually Help? Did Closing Schools Actually Help?
(3 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.
“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.”
Updated June 2, 2020 Updated June 5, 2020
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.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
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.
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.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.)
More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
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.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
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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