As summer winds down, parents and students are facing another school year. This brings many questions about what education will look like in the fall. Will it be safe for kids to go back to school? Are schools better prepared for remote learning? What might be the social and educational impacts of another period of homebound education? To find out more, GLG spoke with Dr. Leana Wen and Dr. Tommy Chang.

Dr. Wen is an emergency physician and public health professor at George Washington University. She is a contributing columnist for the Washington Post and a frequent commentator on the COVID-19 pandemic for CNN, MSNBC, ABC, and National Public Radio. Previously, she served as Baltimore’s Health Commissioner.

Dr. Chang is currently Senior Advisor for Strategy and Program for Great Public Schools Now, a nonprofit organization in Los Angeles that invests in schools, organizations, and initiatives that catalyze excellence in public education. Prior to this role, Dr. Chang served as the Superintendent of Boston Public Schools.

Below are a few select excerpts from our broader discussion.

Let’s start by talking about the transmission of this virus between children. How transmissible is it? What is our current understanding of this? And how is it playing out currently within schools that are open and encamped?

Dr. Wen: This is a critical topic, as we are now considering and facing a situation where kids are going to be coming back to schools in some way already, and soon. There is also a lot of misinformation that’s circulating around this issue.

The good news is that we do know that children tend to get much less sick. But that is not to say that children are immune. Nor does it mean that this disease is harmless in children. We now know that in the U.S. alone we have approximately 350,000 children who have become infected with COVID-19. It’s true that, when compared with adults, a much smaller percentage of children than adults become hospitalized. But some children have been hospitalized, and a minority have needed intensive care, and some — sadly — have died. So, it’s not something to take lightly.

When it comes to COVID-19 transmission in children, we must remember, kids don’t live in a bubble. Even if they don’t get sick, they can transmit it to others. A very well-run recent study in South Korea looked at nearly 60,000 contacts, and they found that children 10 and older have the same likelihood of transmitting COVID-19 as adults. Children younger than 10 are about half as likely.

The authors postulated a few reasons as to why. It may be that children under 10 are literally smaller, so maybe they carry less virus. It could also be that they’re shorter, so they’re not face-to-face with older individuals, and so maybe that could be one reason as well. But there are limitations to this study. It was conducted only with symptomatic people. Meanwhile, a separate study found that 30% of people never develop symptoms at all. This means we have no idea how asymptomatic kids might transmit it. What’s more, even if it’s true that children younger than 10 transmit half as much as older kids or adults, half of a lot is still a lot.

Finally, there was another study that looked at a camp in Georgia where a counselor who had symptoms got tested and was found positive. After everyone else in that camp was tested — approximately 600 people — nearly half were found positive. This is to say we don’t know for certain exactly how infectious kids are, but the evidence seems to be pointing that they are infectious and will transmit the disease to one another and to adults, whether it’s parents and caregivers or whether it’s teachers and staff.

Having kids back in school will change the dynamics of the disease for the community. The question is how much. If there’s anything that I want to impart on everyone, it’s that the level of infection in the community is the single most important determinant to whether schools are safe to reopen. If you have a community that’s a hotbed of infection, you simply cannot have schools safely reopen. It just does not make sense.

Dr. Chang, can you talk about the decision-making process that superintendents and school systems must make when thinking about the entire school systems?

Dr. Chang: Schools and school districts are complex systems, and school reform is challenging even in the most ideal situations. Here, school systems had to shift on a dime, literally within days. In a normal world, schools are typically safe places, even in emergency situations. But in March, suddenly…boom, that wasn’t the case this time. We needed to close schools.

So, it’s really no surprise that the implementation of distance learning didn’t go well. School districts shifted to focus on issues around operational aspects rather than instructional aspects. This was probably the right move, but it is unfortunate that we didn’t see a lot of improvement on the execution of instruction between March and the summer.

There’s a report from the Center for Reinventing Public Education where they surveyed 82 districts across the country, serving over 9 million students. They found only 20% of districts were providing real-time live instruction, and only 9 of those districts provided live instruction to all their students. In most cases, that live instruction was for middle and high school students, but our youngest kids are the ones who are being most affected.

I’m concerned that young people, especially in grades K-2, have fallen behind. This is when they’re learning how to read, fundamental learning for the rest of their lives. In a typical school year, roughly 70% of learning gains in reading would have been seen this fall. But with schools as they are, we expect to see just 50% of the learning gains of a typical school year. This has to do with a lack of instructional programming and incoherency in terms of things like tracking attendance and grading.

This is going to have a huge impact. One last data point to share on this is the World Bank reported they’re estimating a $10 trillion earning loss over time for this generation of students.

Dr. Chang, how important are the social aspects of school for a child just entering kindergarten if this school year is virtual?

 Dr. Chang: I think number one, young people do develop in social situations. I have a younger brother who has kids in the same age group. And he is already seeing that his two twin sons are regressing because they haven’t had a chance to interact with other young people their age. One of the challenges for teachers of young children is creating structures in the classroom setting where they are learning from each other and building from each other. That’s an even more difficult challenge in a virtual environment. I think there are going to be impacts that are not quite understood yet.

Another thing, kindergarten to second-grade teachers are trained to teach reading. In this environment, kids are not getting the group instruction they need in a very effective way, nor are they getting the one-on-one instruction that they need. When you go into a highly effective classroom in normal situations, you see kids broken up into ability groups and teachers and paraprofessionals working with them in small groups. That’s not happening right now.

Dr. Wen, as a physician and public health expert, what are your biggest non-COVID-related health worries as we head into fall and flu season?

Dr. Wen: When you look at the symptoms for COVID-19, the three most common are fever, cough, and shortness of breath. But then you get to congestion and sneezing. You get to sore throat and headache. This is a normal November when you have a class of eight-year-olds. There’s at least somebody in the class who has a runny nose or a sore throat. So how on earth, come November and December, are we going to distinguish among a person who has COVID versus the flu versus a run-of-the-mill cold?

But outside of the flu, there are many things to be concerned about if kids are not in school. When I served as the Health Commissioner in Baltimore, I served a very vulnerable community. Eighty percent of our children depended on the school for free or reduced-fee lunch.

So, I worry about the basics of food security and safety. For many of the children whom I served, school was also the only place they felt safe. COVID has the potential to exacerbate existing disparities. How are kids going to be fed? Are they going to have a place to sleep? We know that teachers and school systems identify a great number of cases of child abuse and neglect, and if that isn’t available, what’s going to happen to those extremely vulnerable kids?

I oversaw health services for over 180-plus schools, and in many instances the schools helped identify the problems, so we could provide health care for children who needed asthma treatment, or dental and vision care. We even provided immunizations. Where are they going to get those immunizations now? Are they going to?

Sometimes there is this tendency to pit public health versus education or public health versus the economy, because we in public health are saying, “Whoa, there’s a risk here.” But we’re not saying, “Don’t do these things.”

Of course, people should go back to work. Of course, students should go back to school. But it’s only saying that we just need to be really aware of the risks of what we’re entering. How can we reduce those risks as much as possible, and at what point can we say those risks just outweigh the benefits of those actions?

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This article is adapted from the August 6, 2020, GLG teleconference “K-12 School Reopening: COVID-19 Health Concerns vs. In-Person Learning Benefits.” If you would like access to this teleconference or would like to speak with Dr Wen, Dr. Chang, or any of our more than 700,000 experts, contact us.