In the long shadow of our best intentions: model-based assessment of the consequences of school reopening during the COVID-19 pandemic

As the United States grapples with the ongoing COVID-19 pandemic, a particularly thorny set of questions surrounds the reopening of K-12 schools and universities. The benefits of in-person learning are numerous, in terms of education quality, mental health, emotional well-being, equity and access to food and shelter. Early reports suggested that children might have reduced susceptibility to COVID-19, and children have been shown to experience fewer complications than older adults. Over the past few months, our understanding of COVID-19 has been further shaped by emerging data, and it looks increasingly likely that children are as susceptible to infection as adults and have a similar viral load during infection. While the higher prevalence of asymptomatic disease among children makes symptom-based isolation strategies ineffective, asymptomatic patients do not in fact carry a reduced viral load. Using assumptions consistent with the emerging understanding of the disease, we conducted epidemiological modeling to explore the feasibility and consequences of school reopening in the face of differing rates of COVID-19 prevalence and transmission. Our findings indicate that, regardless of the initial prevalence of the disease, and in the absence of systematic surveillance testing, most schools in the United States can expect 20-60 days without a major cluster emerging. Without testing or contact tracing, the true extent of these disease clusters may not be apparent, and our research suggests that the case count will underestimate the true size of the clusters by a large margin. These disease clusters, in turn, can be expected to propagate silently through the community, with potentially hundreds to thousands of additional cases resulting from each individual school cluster. Thus, our findings suggest that the debate between the risks to student safety and benefits of in-person learning frames a false dual choice. Given the current circumstances in the United States, the most likely outcome in the late fall is that students will be deprived of the benefits of in-person learning while having incurred a significant risk to themselves and their communities.