Department of Integrative Biology, The University of Texas at Austin, Austin, TX, United States of America.
Fractal Therapeutics, Cambridge, MA, United States of America.
PLoS One. 2021 Mar 25;16(3):e0248509. doi: 10.1371/journal.pone.0248509. eCollection 2021.
As the world grapples with the ongoing COVID-19 pandemic, a particularly thorny set of questions surrounds the reopening of primary and secondary (K-12) schools. 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 is now understood that children are as susceptible to infection as adults and have a similar viral load during infection, even if asymptomatic. Based on this updated understanding of the disease, we have used epidemiological modeling to explore the feasibility and consequences of school reopening in the face of differing rates of COVID-19 prevalence and transmission. We focused our analysis on the United States, but the results are applicable to other countries as well. We demonstrate the potential for a large discrepancy between detected cases and true infections in schools due to the combination of high asymptomatic rates in children coupled with delays in seeking testing and receiving results from diagnostic tests. Our findings indicate that, regardless of the initial prevalence of the disease, and in the absence of robust surveillance testing and contact-tracing, most schools in the United States can expect to remain open for 20-60 days without the emergence of sizeable disease clusters. At this point, even if schools choose to close after outbreaks occur, COVID-19 cases will be seeded from these school clusters and amplified into the community. Thus, our findings suggest that the debate between the risks to student safety and benefits of in-person learning frames a false dual choice. Reopening schools without surveillance testing and contact tracing measures in place will lead to spread within the schools and within the communities that eventually forces a return to remote learning and leaves a trail of infection in its wake.
随着全球应对持续的 COVID-19 大流行，围绕中小学（K-12）重新开放的问题特别棘手。从教育质量、心理健康、情感健康、公平以及获得食物和住所的角度来看，面对面学习的好处是多方面的。早期报告表明，儿童可能对 COVID-19 的易感性降低，而且与老年人相比，儿童的并发症较少。在过去的几个月里，我们对 COVID-19 的认识进一步受到新出现的数据的影响，现在人们知道儿童和成年人一样容易感染，并且在感染期间具有相似的病毒载量，即使无症状。基于对该疾病的最新认识，我们使用流行病学模型探讨了在不同 COVID-19 流行率和传播率的情况下重新开放学校的可行性和后果。我们的分析重点是美国，但结果也适用于其他国家。我们发现，由于儿童无症状率高，再加上检测和诊断测试结果的延迟，学校中检测到的病例和实际感染之间可能存在很大差异。我们的研究结果表明，无论疾病的初始流行率如何，并且在没有强大的监测检测和接触者追踪的情况下，美国大多数学校可以期望在没有出现大量疾病集群的情况下开放 20-60 天。在这一点上，即使学校在疫情爆发后选择关闭，COVID-19 病例也将从这些学校集群中产生，并传播到社区中。因此，我们的研究结果表明，学生安全风险与面对面学习收益之间的辩论构成了错误的二元选择。在没有监测检测和接触者追踪措施的情况下重新开放学校，将导致学校内部和最终迫使学校重新转向远程学习的社区内部传播，并留下感染的痕迹。
