EdCast Schools, Families, and the Coronavirus HGSE Professor Meira Levinson and epidemiologist Bill Hanage of the Harvard T.H. Chan School of Public Health provide guidance to schools on the best ways to prepare for and respond to COVID-19. Posted March 10, 2020 By Jill Anderson HGSE's Meira Levinson in discussion with Harvard Chan School's Bill Hanage on the Harvard EdCast. Photo: Elio Pajares Many school districts are facing challenging decisions about how to prepare and respond to the novel coronavirus including whether to close and try distance learning. Harvard epidemiologist Bill Hanage and education ethicist Meira Levinson explore the public health issue and its potential impact on schools and families. They also offer guidance for practitioners and parents.Read more in our ongoing series, Confronting the Coronavirus Outbreak, on how schools and communities can prepare and respond, support young people, build resilience, and keep the learning going.TRANSCRIPTJill Anderson: I'm Jill Anderson. This is the Harvard Ed Cast. This new Coronavirus outbreak has set off a wave of school closures and forced educators to figure out what to do. Harvard Epidemiologist, Bill Hanage, and Educational Ethicist Meira Levinson say it's important not to panic, but to prepare and take some necessary precautions. We talked about how schools can best prepare and make some of these challenging decisions as information about this new virus unfolds.Bill Hanage: I think there are things that schools should do in general to prevent the spread of any virus at all. I mean, the basic things that they should be invested in right now are things to do with hand hygiene, hand washing, that sort of thing. You want to be getting the kids to do this. You want to be building time into a day around recess so that they can maintain that. You want to be encouraging isolation of kids who are suffering from symptoms. Although it doesn't look as if children seem to have symptoms in the same way that adults do. So, these are all basic interventions, which pretty much every school should be doing right now.I should point out, I am not an expert in schools. I am abundantly not an expert. There are lots of difficult choices to be made around here. I know for instance, while I'm thinking about disease dynamics and stuff, schools have a lot of roles in this society. They're not just places for education. Kids going to school enable parents to work, kids going to school sometimes is where they get food, there's a lot of stuff going on here and there are lots of moving pieces and it's very hard to figure out how best to intervene in order to protect the health of our communities while at the same time fulfilling the important functions that schools perform.Meira Levinson: I think what Bill says is exactly right and there are two things. So there's this very short term question, should schools be changing their practices right now in order to address whether or not it's a unique threat, the current sort of crisis level of threat around coronavirus. And that is where certainly schools that do not normally have soap in their bathrooms, which was true for the school that I taught in for five years.Bill Hanage: That's crazy.Meira Levinson: I mean, we just didn't, we didn't have soap, the teachers, we bought our own soap for our bathrooms, but the kids didn't have soap. They didn't have toilet paper often and they didn't have paper towels. We released this press release yesterday or over the weekend that was joint among the Ed school, the Medical school, the School of Public Health, Boston Children's Hospital, the Center For The Developing Child that was about these low cost efficient and effective ways in which schools can help address Coronavirus by reducing transmission specifically through hand-washing. And interestingly, last night one person responded saying, okay, give it 20 seconds per kid. That's added on after recess, after lunch, before lunch. Multiply that by 27 kids. And if you're doing that three or four times a day, you have now eaten up large percentages of your instructional time.So I said, so what are we supposed to do about that? And I think part of it is in the short term, it may just be that you eat up that instructional time. You realize that it's much better to keep the public healthy and safe and in fact better if one could keep schools open because of these infection control measures that you're taking than to have public health really suffer. But then there's also this long term adjustment that needs to be made, which is it should not take minutes away from instructional time to have students washing their hands. Right?Bill Hanage: Right.Meira Levinson: Students washing their hands before and after going to the bathroom, before lunch, after lunch, at times during the day that should be seen as an essential non-negotiable part of what it means to have kids in schools. And so I think in the long term, part of what this means is not only do we need to have massive facilities upgrades and many districts that have not been investing in things like school bathrooms, but also we need to rethink our use of time in schools. We need to expand lunch periods, expand recess periods, expand time for kids to move among classes and not see that as a loss of learning time, but really see that as a gain of learning time, both because we are helping to educate kids how to keep themselves and others healthy and because by keeping them healthy we will enable them to stay in school more and learn more.Jill Anderson: Right. You've got all these kids, all these schools probably don't have warm water. They don't have the time. They don't have the soap. What is going on here that schools are even in this situation? Shouldn't they have been doing something for all the other viruses that are out there?Bill Hanage: Well, I think that schools in general and well I remember when my kids were in preschool, they were very, very keen to achieve good hand hygiene. They were very up on respiratory virus season, put it in that way. It's a lasting regret of mine that I wasn't able to do a study with them because I thought that they had some great ideas for studies of transmission within the preschool system.People are aware of it, but they also feel like they're used to it. And that is something which is very different from this. People think, "Oh, it's flu. Oh, it's this." You can hear folks saying, "It's not the flu. We have the flu every year and nothing goes wrong." This isn't like the flu. There is no immunity to this. The messaging that I keep trying to return to in terms of trying to encourage people to understand how serious it is, is that we know for a fact that this has caused huge outbreaks in Wuhan, Iran, Italy, and South Korea.And since we know that it is capable of that, we should be doing everything in our power to stop being next. That's it. And so I personally think schools have a huge part to play in that.Meira Levinson: And you think the schools need to prepare to be closed?Bill Hanage: Yes. You should not be thinking, "Oh, maybe we'll avoid it or it'll pass us by or it will be really bad in Baltimore, but not here." I think all schools should be prepared to be closed. They should expect it to happen at some point. They should have plans in place. I know it's going to be difficult and it's going to be more difficult than I can imagine, but you need to start thinking about it now, look at options for online learning and the like while at the same time at the minimum encouraging things like hand washing. And I'm wondering if there are other things that we can do which would be creative as well.I don't know if you've noticed, but I'm not touching my face. If I got an itch, I take my glasses off and I scratch it with my glasses because I know that touching the face is a means of transmission. If you can get into kids in school to have a competition, see who can touch their face least, get them little buddies, where one will say to the other, "Oh! You're touching your face!" or something like that. Anything. I think we're going to have to think pretty creatively in order to just flatten the curve, which is really the most important thing we can do right now.Meira Levinson: And given that children don't seem to get very sick, why is closing schools a reasonable or even necessary?Bill Hanage: You have with unerring instinct zeroed in on the crucial thing which we need to know and I'm going to be in one of those unfortunate situations where I say there is stuff here that we don't know and that's going to make it really hard to make decisions.Jill Anderson: So if you are a school or a district leader, we have suspected cases, it's a strange time of year where kids are sick anyways with other things. What kind of guidance can you perhaps offer for figuring this out? When do you close? When do you stay open?Bill Hanage: So I think the first thing to get into this is to just lay out a little bit on the science of exactly how transmission happens or at least how we think it happens in kids. So for a long period of time we thought that kids were not really affected because they weren't tallying up in case counts. And the reason for that is that kids ... it's pretty secure to say now really do not get severe disease. And quite reasonably the authorities in Wuhan were kind of thinking, "Oh, we should test the people who have severe disease. Then we'll focused on them," so we have sort of under counted the children until quite recently. And then about a week or so ago some data started to be published and get into the public domain which showed that children could indeed be infected, be positive for the virus and yet they had much less severe symptoms.Now that leads us to the million dollar question do they transmit? And the answer to that right now is we don't know. There are some places, I believe Hong Kong has closed at schools for long period of time until they can actually determine the role of children and transmission because if the children are transmitting then basically by keeping your schools open you are just producing this nice fountain of virus which is just going to spew forth into the community. I'll be technical here: We want to avoid that. So it is very difficult to decide. I don't want to be telling school districts what they should be doing, but there's only one really key message which I want to get across. Don't panic. Do prepare. And it's probably later than you think.Meira Levinson: The challenges facing school and district leaders as they're trying to decide whether to close, how long to close, how to prepare for closures are incredibly complex for many of the reasons that Bill had mentioned earlier about all of the different roles that schools play. Teachers declare all the time, we are not babysitters, but of course we are people who are responsible adults who keep children safe for learning and occupied while their parents and guardians are able then to go to work. And if we close schools, then we really stymie the productive economy in all sorts of ways. We provide nutritious school meals to millions of children each day. We provide in many cases, although again it depends on deferred maintenance buildings that are appropriately heated or cooled, and we provide stimulation. We know from many, many studies that when children stay at home because of snow days, rates of domestic violence go up, physical and emotional abuse go up, nutrition goes down, child wellbeing goes down.So it's incredibly important that we think about the whole package, not just infection control. And that we also really think about issues of equity because of course the children who are the most vulnerable when schools close, those who rely on nutritious lunches, those who rely on a stable, caring adult to take care of them during the day, are the ones who are then going to be most vulnerable when schools close. And who are the least likely to have things like reliable broadband access and a desktop computer rather than just a phone, and unlimited data plan as opposed to a say, monthly data plan, that is limiting in various ways. And so as we think about the impact on children's learning, that is also going to be very inequitably effected by what district children are in and they're closing.And so I think that as we think about the educational justice issues and the equity issues, it's this double bind, where those who serve the most vulnerable kids are likely going to want to stay open the most. Just like they wait the longest to call the snow day. And yet if they are serving as vectors of transmission and if they are putting whole communities at risk because they are healthy enough to go to school, they aren't going to stay home because they're not sick, they don't seem to be sick, and then they are transmitting to the other adults in the school to other children in the school who are then going home to family members who may be immunocompromised who may be-Bill Hanage: Exactly. Maybe the grandparents were caring for them because the parents have to work. We know that older adults are more likely to be severely affected. So, there are all kinds of knock on effects. I remember a guy who I was working with in 2009 during swine flu talk about closing schools and just saying, "Oh that's just going to shift the epidemiology from the schools to the shopping malls," because the kids don't just sort of evaporate and they have to go somewhere and they can transmit wherever they go.Meira, thinking specifically about that is anything you can think of that would help the sort of distance learning from home. Because if you're doing that, then you're not just saying, "Oh, school's out" and the kids don't go, "Yay" and go to the mall, instead they have to be at home doing something. And then that is a considerably better outcome from the point of view of disease transmission.Meira Levinson: Right. I mean I think that it's been really amazing to see the ways in which say China has very quickly mobilize to do online learning. So, I think some things that we can learn from this is that low tech is sometimes better than high technology. If you are thinking that many of the children will be accessing things on phones rather than on computers, so they're going to be using cell service rather than broadband, that things may load slowly, et cetera it may be that you don't want to do super fancy stuff, but you want to use apps that kids already have access to. Apps that are free, Quizlet or Google Classroom or Google Docs, other things, rather than anything that certainly cost money or takes much effort to get into. At the same time, another thing that we've seen China doing, which has been really interesting, is that they've centralized a lot of the instruction.So, they have central departments creating instructional videos that they then send out, so that individual teachers aren't all trying in real time to create daily instructional materials to send out to their kids. And then it means that the teacher's time is somewhat freed up to respond to the specific work that their children produce or to a smaller segment of the classroom day when they might do school specific kind of stuff. I mean, it'll be interesting as we think about the effect of having Common Core “light” or under other names in many districts and states across the country, to what extent actually will this be a move towards some forms of centralization of instruction, at least for some time.I think textbook companies are hopefully trying to get ahead of this and thinking about how can they create materials that can be accessed online by kids in districts that are using those textbooks. I think this is a time that nonprofit providers can also step up. I mean there is a wide ecosystem of materials on the web, what is hard is to curate that, to make it age appropriate, to make it accessible to English language learners, to students who have various kinds of language processing or visual processing or other needs.So, there's a lot of customization that may need to happen, but the more that we can say to teachers, you don't need to recreate materials online, instead you can play a bit of a curatorial role and be also just in text or email or discussion forum, contact with your kids to provide them feedback on their learning. I think that will be good. Also, kids don't need to learn in isolation. One of the nice things about digital technologies is that they can still be very much in community.Bill Hanage: Oh, absolutely. I'm working from home, by the way, everybody who can work from home should work from home. I've only come in here because Meira asked me. Just before I came in here, I was on a Zoom call with about 12 or so other people. And it went on for an hour and we had discussions about a whole bunch of interesting and sometimes sobering things, but it was a very effective way of working and so if ... the hopeful part of me is that this is going to provide an opportunity to move into the future and really make use of some of the tools that we have much more effectively. In much the same way as we've spent years trying to tell people to not fly because of the planet, and now suddenly there are all of these meetings which are going to be virtual and maybe we'll discover that actually we can do these things in a kind of effective fashion. So just possibly, you know, this might just save the world.Jill Anderson: And I just want to backtrack to the kind of contingency planning ... I think a lot of schools, I hope school leaders are in that mode right now working on this. So they need to be thinking about distance learning. They need to be working on that, too. People are panicked and trying to figure out whether to stay open or closed.Meira Levinson: Schools are closed across China, across Japan, across Hong Kong, which is part of China, across Italy now. Or at least parts of Italy.Bill Hanage: Yeah, Italy did it late. And it's worth noting, I don't want to say this as causal because there's lots of other stuff going on there, but Hong Kong has been keeping a remarkably tight lid on the spread of coronavirus. I mean it's done very well. This is partially because of the legacy of things like SARS. Places like Hong Kong and Singapore have extraordinarily good dedicated teams working this. Hong Kong has been doing well and they have shut schools early. Italy has been doing terribly and they have only just shut schools. They were driven to do it. If you're asking the question you really have to think is it necessary? Then, it's probably getting to the point where it's necessary. Everybody is talking about this in the wrong way. From the perspective of people like me, which is we kind of look at and go, "Oh look, there's a virus now."We don't want to go there because the virus is there. That's where the virus was last week because it takes a week or so for a person to show up and become infected. The virus it's moved on from there now, it's somewhere else. If there were more people there than you think this is ... who are infected. This is why things like the fact that the two first cases that were reported in Iran very rapidly turned into deaths was so worrying because it takes about two or three weeks, maybe a little more for people who are infected with this to die. So that means that for those two people, given our estimates of the fatalities rate, there were many more.Meira Levinson: Yes, clearly schools need to be planning for distance learning and I do think that this is a place in which we really can learn from colleagues around the world. Japan schools have been closed for weeks. China's schools have been closed for weeks. They have actually had some time to think and learn and innovate around how they are going to provide meaningful education to millions of children. And so we should ask them. I was listening to, I think it was the mayor of Seattle talk about how she was pulling together a handbook for mayors of other cities of, "These are the things that we've done and these are the things that we've learned to do and we've realized that we should be talking to these people and taking these actions and we're going to hand this off to you so that you can build on what we've learned and you don't have to reinvent it."And that's incredibly useful. And you know, district leaders, superintendents, school boards and so forth should be seeking the same kind of guidance from our colleagues around the globe because they can provide us a lot of insight that will help accelerate our own planning and delivery of learning and enrichment and opportunities to kids.Jill Anderson: As a parent, how do you recommend they think about, "Do I send my kid to school? Do I keep my kid at home?" How do you navigate that?Bill Hanage: My feelings about this kind of thing can flip very, very rapidly. I mean a couple of weeks ago I went to Israel and while I was there ... and I actually packed with the expectation that I might be quarantined at some point. So I took an extra two weeks worth of stuff. I wasn't, I spent a lot of interest in time round an isolation unit and found out a lot of interesting things, but I wasn't quarantined, fortunately. On the way back though, I was thinking would I make that trip now? Because the pace with which things are changing is what's hard to wrap your head around.I think we're really getting into this stage of mitigation. We should be utterly focused on preserving our healthcare system and stopping it from being overwhelmed. That is why everybody who can work from home should work from home. Reason being that if you're not out there, you are at least delaying yourself getting the virus and becoming infected. And the more that you can delay, the less likely there is to be a surge of cases and overwhelming health healthcare. Now that's me.As for the kids, I fully accept that I'm an incredibly privileged position. I can both work from home, my kids can come home and they are able to do some stuff with computers. We have broadband, we have all of the things that Meira was talking about and they are probably able to afford to miss a bit of school. And that's just not true for everyone. However, I think that it is important that everybody consider what they can do in order to help the community by just doing whatever you can to cut off the roots of transmission that this thing is going to take and it's going to be with us for a long time.I hope that we can learn from people in Japan and China, like Meira was saying this is not going to go away overnight. It's going to be here for months, if not potentially years.Meira Levinson: A couple things that I would say parent to parent are that we shouldn't be apologetic for wanting to protect our children, our families, and our communities. This is something that always as parents we deal with. Is that we feel both an emotional and an ethical obligation to care for our kids and our families. We want to keep them healthy, we don't want them to be infection vectors. We also want them to be happy, to be learning. We're thinking well, schools might close in two weeks. You care about kids' mental health, about their social wellbeing.So it's hard for us as parents to make good decisions for kids under any circumstances, especially under these circumstances. And trying to figure out how we care for ourselves and how we care for our community is really hard. And so I think that as we try to make the best decisions that we can make, if other people question those decisions, why did you keep your children home from school? Why are you insisting that they not come to the birthday party? Things like that. I think we can just be kind of firm and say, "I think this is what is best both for my family and for public health as a whole."And then if we also make different choices, I think we can say that we're staying attentive to the data. We're trying to pay attention to experts. And that we recognize that our choices may need to change rapidly and we can practice talking to our kids themselves about it in ways that are not scary, but are fact-driven and as informative as we can be.Jill Anderson: Meira Levinson is a professor at the Harvard graduate school of education. Bill Hanage is an associate professor of epidemiology at the Harvard Chan school of Public Health. I'm Jill Anderson. This is the Harvard Ed Cast, produced by the Harvard Graduate School of Education. Thanks for listening.About the Harvard EdCast In the complex world of education, we keep the focus simple: what makes a difference for learners, educators, parents, and our communities.The Harvard EdCast is a weekly podcast about the ideas that shape education, from early learning through college and career. 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