Schools &

COVID-19 Risk
November 17, 2020
Presentation Prepared for:
Kelseyville School District
Presenter:
Dr. Gary Pace, Public Health Officer,
Lake County Health Services
The US has tended to prioritize Is there evidence
opening restaurants more than
supporting on-site learning at to support safe
schools. Europe has taken the opening of
opposite approach.
schools?
California Case Epi-Curve
Lake County Case Epi-Curve
Lake County, under 18 44% were 13-18 years old
100 total COVID cases in Lake County (age 0-18) 35% were 5-12 years old
13% of Total Cases 22% were 0-4 years old
 Kelseyville School District Area Case Epi-Curve

There are approximately 12,500 people residing in the Kelseyville Unified School District.
20% of this district are children under 18 years old (+/- 2.6%).
Children under 18 make up approximately 7% of cases within the district.
Overview of Questions
Disclaimer: Data is

We Will Look At inconclusive, and the thinking

is always changing.

1) We are in the Red Tier-- schools can open. What if we move

to Purple?
2) Do kids get COVID?
3) Do they transmit?
4) What is happening in schools that open?
5) What are the downsides of not having onsite learning?
6) How to keep school safe?
7) What would be useful current recommendations?
The Tier System
 In the US:

● 277,285 COVID-19 cases in children have

been reported.
● COVID-19 incidence among adolescents aged
12–17 years was approximately twice that in
children aged 5–11 years.
● Approximately 100 deaths

In California:

● 104K (965K total) of cases are 0-17 yo.

Rates of ● Approx 10% of total cases

COVID-19 in kids: In Lake County:

● Age 0-12: 54 or 7%
● Age 13-24: 126 or 17%
● 1 has been hospitalized
Can Kids Spread South Korea study in July--Overall message:
“Children under age 10 do not spread the

COVID? virus as much as adults do, and the ability

to transmit seems to increase with age.”

Latest data:
1. The rate of transmission in schools is
relatively low, especially in younger kids.
“Schoolchildren Seem Unlikely to Fuel
Coronavirus Surges, Scientists Say.”
NYT, 10/22/20
2. Overall it has seems that younger kids
It looks like children are less spread the virus about ⅓-½ as much
as adults.
susceptible to getting it, and less
likely to spread than adults.
What is the Likelihood of Transmission?
Current Thoughts….

a) To Other kids?
i) Appears to be limited transmission from kids to each other, especially in younger
children.
ii) Middle school and HS kids, probably more transmission. Older kids may
transmit as frequently as adults. “Older Children and the Coronavirus: A New
Wrinkle in the Debate.” NYT, 10/7/20.
b) To Family?
i) In England, random testing in schools there showed sharp increases in
infections among kids older than 11, but they did not lead to increase in adult
cases.
c) To Teachers?
i) Pediatrics, “COVID-19 Transmission in US Child Care Programs” surveyed
57,000 childcare providers in US. No more likely to get the virus than similarly
matched adults.
ii) The experience from Australia and Europe is that adult staff are more likely to
introduce the virus into the schools than the kids, especially younger kids.
Disparities
Cases:
● Of school-aged children with COVID-19 and
complete information on race/ethnicity,
○ 42% were Hispanic/Latino (Hispanic),
○ 32% were non-Hispanic White (White)
○ 17% were non-Hispanic Black (Black).
○ Hispanic children accounted for
■ 46% of cases among younger
children
■ 39% among adolescents;
Complications:
● Acute COVID-19 and multisystem
inflammatory syndrome in children (MIS-C)
have been reported to disproportionately
affect Hispanic and Black children (approx
75% of cases)
● Admissions to ICU more likely in Hispanic and
Black children
When schools Open: Global Experience:
Schools in Europe
Germany, France, Ireland:
Schools generally open, even
when they close the bars and
restaurants. “Europe’s
Locked Down, but Schools
are Open,”, NYT, 10/30/20.
“The continent’s leaders have
largely adopted the advice of
experts who contend that the
public health risks of keeping
children in school are
outweighed by educational
and social benefits…”
In Germany, if cases go
above 50/100K, then they
move to distance learning.
Schools in Israel Schools in Sweden
“When Covid subsided, Israel Reopened its Schools. Has kept schools open
It didn’t go Well.” NYT 8/4/2020. Resumed classes with few restrictions.
in late May. Huge outbreak within days at a Generally have smaller
Jerusalem High School. “The lesson, experts say, is class sizes. Few
that even communities that have gotten the spread significant problems,
of the virus under control need to take strict but teachers of older
precautions when reopening schools. Smaller kids have had 2X the
classes, mask wearing, keeping desks 6 feet apart, level of infection as
and providing adequate ventilation, they say, are similar adults.
likely to be crucial until a vaccine is available.” The
problem appears to be that they opened too quickly--
and there was a period of a heat wave where masks
were not required and windows were closed so air
conditioners could run at maximum. About 1000
students ended up testing positive, and a whole new
wave of infections spread throughout the country.
When Schools Open: US Experience
1) Very patchwork approach without clear national
guidelines. Does give us the chance to evaluate
different strategies.
2) Not much evidence of severe outbreaks where
they have opened, especially in elementary
schools.
3) NY has had strict masking and social distancing
in place. Reopened in september. Only 26% of
kids returned to onsite learning. Very low
incidence of outbreaks. Requiring 10-20% of
kids to be tested monthly.
a) 16,000 kids randomly tested 3 weeks in-- 28
were positive.
b) 37,000 staff tested, 180 were positive.
c) Despite minimal outbreaks, considering
reclosing due to high community spread.
4) Some superspreader events in high schools-- one in
Georgia, one in Utah. Often the spreading seems to be
from activities outside of the school-- carpool, sports,
etc.
5) California
a) 2 outbreaks so far
b) New reporting platform that will allow better
monitoring.
c) LA looking at January as earliest possible opening
date.
6) Lake
a) Two districts have completed 3 months of on-site
learning without an outbreak.
b) Kelseyville, Lakeport considering opening by Nov 30.
c) All districts have opened with some remote learning.
Downside of Not Having
Onsite Learning
1. Grades decline:
a. “Coronavirus: Failing grades spike in
Bay Area schools with distance
learning,” Mercury News, 11/3/20.
Some reported a 50% rise in failing
grades. Especially in poorer
communities.
b. 4/10 of Sonoma County HS students
have one or more failing grades. “Alarm
Raised over Anxiety” PD 11/6. “
c. Brown University found a loss of ⅓ in
reading, ⅔ in math with remote
learning. Top ⅓ of students had far less
of a drop.
2. Poor wifi in county: challenges for already
under-resourced families.
3. Disparities:
a. 25% of 1.1 million NYC public school kids have
returned for onsite learning. Almost all private
school kids have some onsite classroom time.
b. Similar findings in SF. NYT 11/6: “Are We
losing a Generation of Children to Remote
Learning?”
c. HIghest number of Fs in English language
learners: 67%falling behind in at least 1 class.
Up about 50% from last year.
d. Deficits even worse in kids with disabilities.
Continued - Downside of Not Having Onsite Learning
4. Mental health:
a. “Its not just adults who are
stressed. Kids are too.” NYT,
11/3/20. In a recent american
Psychological Assoc survey, 43%
of adolescents said their stress
levels had increased in the last
year.
b. 70% of students expressing
significant anxiety re: their future.
Suffering from ongoing trauma,
especially locally with recent fires.
c. HIgh parental stress, especially in
families with young kids. Notable
in households with financial
stressors.
5. Trauma/domestic violence:
Some evidence that violence
against women and children has
increased dramatically during the
pandemic. Sheriff reported in June
that he hadn’t found that in a
survey.
6. Substance use: Approximately
a 30% increase in overdose
deaths nationwide during COVID.
7. Sports: missing out on this
activity.
8. Socialization: Severe loss at
developmentally significant times.
How to keep
Schools Safe?
(Clearly, opening schools is not risk-free)

1) Social distancing/plexiglass dividers-- challenges to implement

2) Limiting congregate activities/Pods-- limiting number of contacts
3) Masks-- overall generally positive response
4) Screening-- temperature checks/screening questions
5) Testing-- data unclear on this, state currently recommending it
6) Active response to positive cases. Contact tracing, closure of
classroom, closure of school.
Current “Recommendations:”
1) As a society, and as educators,
we must weigh the risks of only
distance learning with the risk of
illness from onsite learning.
2) Overall, a cutoff point of about
5th grade seems to be where
the risk level increases for
transmission in older grades.
Concurrently, learning deficits
from distance learning are likely
greater in the younger grades.
3) Having children going to onsite
school is not risk-free. In the
current climate, almost certainly
there will be cases in the school.
4) Opening should depend on
community transmission rates. Tier
system in California is important
here. We can open now, in the
Red Tier. Schools that do not open
before we end up in Purple will not
be able to open.
5) When local infection trends go up,
we should consider keeping
schools open and closing bars,
restaurants, movie theatres.
6) Need a strong safety plan for
reopening.
7) Many families will opt not to return
to on-site learning until the
pandemic is under better control.
Thank you.
Gary Pace MD, MPH
gary.pace@lakecountyca.gov