Sunday, January 31, 2021

I was very much disappointed in the Atlantic

"I was very much disappointed in the Atlantic Ocean."
Oscar Wilde, interviewed while in quarantine in New York harbor, 1882
That's not the Atlantic: that's the Clinton Reservoir! 
Consider it a metaphor.

Sometimes I put off writing something, because it so clearly needs to be done that surely someone, somewhere, will do it first?
And sometimes I wait and I can't find anyone who did. Oh, well...

So it is this week with a piece by staff writer Derek Thompson that The Atlantic first called "Just Open the Schools Already" (check the http address),  and then retitled "The Truth about Kids, Schools, and COVID." The author himself called it: 

The first title at least had the benefit of not being deceptive, as it would more clearly frame it as an opinion piece. What it certainly is not is the whole truth about kids, schools, and COVID.
(In fact, it is so much not as framed that I went looking on The Atlantic's website for an editor's address, to as a subscriber implore them to hire a fact checker. If you find such an address, let me know.)

This starts from the very first line of the piece: Thompson says "Federal health officials at the CDC this week called for children to return to American classrooms as soon as possible." He then cites an opinion piece published in the Journal of the American Medical Association entitled "Data and policy to guide opening schools safely to limit the spread of SARS-CoV-2 infection." 
Here is the disclaimer from the authors of the piece: 

Thus we are into words being tricky things: are the three "federal health officials at the CDC"? Yes. Does this represent anything other than the opinion of three officials at the CDC? By the disclaimer, no. I'd also note that this was a common framing, with many going much farther, framing the essay as coming from the CDC. 

More concerningly, what the essay does not at all do is "[call] for children to return to American classrooms as soon as possible." The conclusion of the JAMA piece, in fact, is this: 
Decisions made today can help ensure safe operation of schools and provide critical services to children and adolescents in the US. Some of these decisions may be difficult. They include a commitment to implement community-based policies that reduce transmission when SARS-CoV-2 incidence is high (eg, by restricting indoor dining at restaurants), and school-based policies to postpone school-related activities that can increase risk of in-school transmission (eg, indoor sports practice or competition). With 2 vaccines now being distributed under Emergency Use Authorizations and more vaccine options anticipated to be available in the coming months, there is much hope on the horizon for a safer environment for schools and school-related athletic activities during the 2021/22 school year. Committing today to policies that prevent SARS-CoV-2 transmission in communities and in schools will help ensure the future social and academic welfare of all students and their education.

That is not calling for a return as soon as possible, nor is that anywhere in the essay. The essay by contrast lays out a cautious array of policies and actions necessary to make safe operation possible.

Thompson next notes "adequate masking, distancing, and ventilation" as necessary, but he does not speak of the "community-based policies that reduce transmission" that the authors lead with in their conclusion, and speak of at greater length earlier in their piece: 

Preventing transmission in school settings will require addressing and reducing levels of transmission in the surrounding communities through policies to interrupt transmission (eg, restrictions on indoor dining at restaurants).

Thompson's third sentence is "The CDC’s judgment comes at a particularly fraught moment in the debate about kids, schools, and COVID-19." As above, the essay quite explicitly is not the CDC's judgment. 

So why, in Thompson's view, is it a particularly "fraught moment"? 

Parents are exhausted. Student suicides are surging. Teachers’ unions are facing national opprobrium for their reluctance to return to in-person instruction. And schools are already making noise about staying closed until 2022.

And each of those has a hyperlink. His evidence?

  • "Parents are exhausted" cites this December 8th Vox piece that talks about parents being exhausted (no argument), working long hours (that's from the Wall Street Journal), and leaving the workforce. Several times the statistic of 865,000 women leaving the workforce between August and September is noted. Not noted in any of those places is that job losses, per the National Women's Law Center,  disportionately hit Black women,  Latina women, and women with disabilities. 

    I wouldn't dispute that the parents are exhausted. I do find it very revealing when that argument is made during a pandemic, and the death of family members, the illness of family members, the cost of medical bills, concerns over residential extended family, the long-term health impacts of COVID on children (that's hearts; there are others), and, while yes, rare, the death of children are not anywhere noted. That speaks to the writer's place within the pandemic.

  • "Student suicides are surging" cites, as many of us feared last week, Erica Green's piece about Las Vegas schools in The New York Times. The headline of the piece aside, note that Green very specifically wrote: 
    Adolescent suicide during the pandemic cannot conclusively be linked to school closures; national data on suicides in 2020 have yet to be compiled. 

    As it happens, teen suicides in Clark County haven't surged this year; as Dr. Tyler Black, who studies this, noted on Twitter:  

    Simply put: is mental health suffering during the pandemic? Yes, internationally. But to speak of a "suicide surge" based on incomplete data from a single American county is irresponsible.

  • "Teachers’ unions are facing national opprobrium for their reluctance to return to in-person instruction." This is one really demonstrates the sloppiness of the piece: the EdWeek piece itself to which Thompson links says this: 

    National polling data show that overall support for teachers and their unions has remained steady...a nationally representative Education Next survey, conducted from Nov. 10 to Dec. 3, found that just 30 percent of parents said teachers' unions have a negative effect on schools--about the same as survey results from May 2019 and 2020. Forty-six percent of parents said unions have a positive effect on schools, up from 40 percent last spring..."In plenty of places where unions have opposed reopening, they have the support of many parents who are concerned for their own children's safety," [editor-in-chief of Education Next Professor Martin] West said. "I think it is always risky to reach conclusions based on what you hear from the loudest voices."

    Yes, the piece to which Thompson links says precisely the opposite of what he is arguing. 

  • The final sentence here is: "And schools are already making noise about staying closed until 2022." That links to this Washington Post op-ed from June--yes, this past June--about school buildings not reopening this past fall. 
    The smart districts are for certain going to be having conversations about this coming fall--the actual fall of 2022--but I have yet to see much coverage of that as yet.
    And it again is not what the piece to which Thompson links says...again.

And then Thompson says:
Into this maelstrom, the CDC seems to be shouting: Enough! To which, I would add: What took you so long?

And of course, the CDC isn't shouting any such thing. 

So on to the evidence: Thompson writes:

 ...people under 18, and especially younger kids, are less susceptible to infection, less likely to experience severe symptoms, and far less likely to be hospitalized or die

And links as follows: 

  • For "less susceptible to infection," Thompson links to this "COVID-19 in children and young people" piece from Science in October. Regarding infection, the piece says this: 
    Evidence from contact-tracing studies suggest that children and teenagers are less susceptible to SARS-CoV-2 infection than adults; however, community swabbing and seroprevalence studies conducted outside of outbreak settings suggest that infection rates are similar to those in older age groups

    Did you catch it? While the contract tracings suggest Thompson's conclusion, community swabbing and seroprevalence rates suggest infection rates are similar to other groups. This has been found, for example, in studies done in Austria and evidence from the U.K. during their fall lockdown when schools were open; that's from this very thorough der Spiegel piece
    What the CDC itself says is:

    The true incidence of SARS-CoV-2 infection in children is not known due to lack of widespread testing and the prioritization of testing for adults and those with severe illness.

    Absence of evidence is not evidence of absence.
    And again, Thompson has linked to a piece that says the opposite of what he is arguing. 

  • For "less likely to experience severe symptoms," Thompson the same piece again. There are not two pieces of evidence here.
    Nonetheless, this is something on which there appears to wide agreement; to go back to the CDC

    A recent systematic review estimated that 16% of children with SARS-CoV-2 infection are asymptomatic, but evidence suggests that as many as half of pediatric infections may be asymptomatic.

    Note, of course, that it is this very absence of symptoms in junction, as cited above, with lack of widespread asymptomatic testing, that has led to the idea that children don't get or don't have coronavirus as often. It is instead that we have a great lack of information. 
    There are, of course, rare but very significant symptoms possible for children with COVID; there has been concern around multisystem inflammatory syndrome, as well as, as noted above, long-term heart damage and other effects

  • For "far less likely to be hospitalized or die," Thompson links to the CDC statistics (from August). No argument. I think they now only update that information through the dashboards.

Thompson notes that in August and September, we didn't have a lot of data for making recommendations around schools. Noting the time since then, he says: 
Meanwhile, anybody paying attention has long figured out that children are probably less likely to transmit the disease to teachers and peers. This is no longer a statistical secret lurking in the appendix of one esoteric paper. It has been the repeatedly replicated conclusion of a waterfall of research, from around the world, over the past six months.

That first sentence is just plain wrong. 
To support his claim, Thompson links to "Don't Forget the Bubbles," which is a website that collects research, rather than any particular research; I guess it's his "waterfall"?
A check through the links at hand right now don't make blanket claims about children spreading to peers and teachers. This December study discusses low spread in southwest Germany during the initial phase of the pandemic, and that children under ten were not "particular drivers" of the illness.
 This piece on Italy finds that cases among children were lower than the general population in all but two regions of Italy. 
Thompson--while still only linking to that general page--specifically cites a study from Ireland from May in which 1000 contacts from school cases were interviewed; I think that's this study. The kicker?

 Only symptomatic contacts were tested, and so asymptomatic secondary cases were not captured.

And cases after that would be characterized further as not stemming from the schools, of course.
He also cites a Singapore study--still linking only to that general page--that he says children are not primary drivers. My best guess is that's this study from March (!), as it's the only one I can dig up that has three clusters coming out of Singapore, though I can't find anything there about children. That isn't about schools or about children at all, so I am confused there. 

He then cites this Washington Post piece that, as of the end of September, "explosive" growth had yet to happen; the same piece says this: 

Poor and inconsistent reporting in many parts of the country means that experts do not yet have a full view of the situation, and most schools have been open for only a few weeks. 

Here's how things looked across the country since September: 

We of course are not going to escape a piece such as this without a citation of Emily Oster of Brown University, who is, let's remember, an economist who is doing a voluntary collection of data from schools across the country, which have widely varying systems of being in school and no widespread asymptomatic testing. 

He then notes this piece from Norway which systematically traced and tested contacts of students up to age 14. What Thompson fails to note is that the sample size here is of only 13 cases:

A total of 13 index cases and 292 school contacts participated in the study

They did systematically test all contacts; they did find no secondary cases. That is a very, very small sample size, though.  

And then he notes this piece in Pediatrics is of eleven school districts in North Carolina, which he says "found no cases of child-to-adult spread in schools." In fact, what the conclusion reads (scroll to the end) is the researchers were "not able to analyze incidence of child-to-child or adult-to-child transmission" due to privacy reasons. They did, to be clear, find low rates overall.

Thompson then refers to the large study of Korea from July, looking at data from the spring; that's the study that said: 

We showed that household transmission of SARS-CoV-2 was high if the index patient was 10–19 years of age. 

Thompson argues that this was followed up by this piece by some of the same authors, of which he says:

...the same Korean research team caveated those conclusions, saying it couldn’t prove whether the children in the study were infecting their parents, or whether those parents were infecting their kids, or whether entire households were being exposed by a third party.

If you read the study, however, it doesn't reference the earlier study, and it doesn't say what Thompson asserts in the above paragraph. What it did find, in contrast to the earlier study, was lower rates of pediatric transmission in the household with social distancing (yes, in a home).

Thompson then speaks of Israel, which made headlines due to outbreaks as schools reopened in the fall. A study that followed up, he argues, reverses that argument; he says “No increase was observed in COVID-19 … following school reopening" is what the authors conclude.

It's a lot more complicated than that, if you read the discussion (starting on page 10); for one thing, Israel has higher rates of positivity among children, which the researchers may be due to higher rates of testing. Here's what the piece actually concludes:

In conclusion, our findings suggest that school reopening did not have a substantial effect on the SARS-CoV-2 infection rate in the general population and suggest a major effect of ease of social restrictions on the COVID-19 resurgence in Israel. Though complete reopening of schools may have contributed to the spread of infection, it does not seem to have played a primary role per se, in the June-July 2020 resurgence. 

And lest we think we can determine too much on cause and effect, earlier, the researchers say this:

The main limitation of our study is its ecological design and the possibility that some findings presented here may have been related to other concurrent interventions. Due to the observational design, this study cannot inform causal relationships. Since the demographic, cultural, and socioeconomic features of Israel evidently affect our results, particular attention should be given to such factors in assessing reopening in specific geographic areas.

Now let me note that all of the above is in contrast to, for example, the large study in India, that found children drive spread; the round up of recent research of COVID-19, children, and schools by Dr. Zoe Hyde from early December; this discussion of children and COVID;  this piece on why the debate is so fraught; everything I cited in this earlier post; not to mention that as cases are shooting back up due to new variants, schools in Europe and elsewhere are closing.
That last is due to schools being among interventions that have been shown, more than once, in reviews of multiple studies across many countries, to lower the contagion rate; see this thread for an explanation of that. 
(And I could cite much more here; I really recommend that people interested start listening to epidemiologists, who frequently are discussing this on Twitter.)

Thompson then turns to other arguments: high income parents are leaving! That isn't exactly what this Axios piece he links to says, but it's effectively boils the argument down to the same "consumer demand" arguments. That much of the demands of schools is tied to privilege isn't surprising. That privilege should drive public health decision making is a terrible argument.
Calls, he says, to mental health lines have increased; that links to this Washington Post opinion piece which cites no source for this assertion. That piece in turn links to this piece on stress, but that is pandemic stress overall. As I noted earlier, there is much, much more going on than school buildings being opened or closed.
And then he talks about Las Vegas and suicides again. 

And yes, agreed, that immunizing kids is more difficult, as is feeding them. We should be wondering, though, why those have fallen to the schools to do?

And, no, schools being closed do not "make impossible the edifying effects of play.'
A pandemic, which requires social distancing and masking, however, does make it more difficult.
It is interesting, isn't it, that he only gets to play this far into his argument? 

 His proposals?

  1. open the the lower schools
  2. enforce COVID-19 protocols, which he speaks of as mask wearing, social distancing, and whispering. He doesn't mention restaurants, gyms, or other large gathering spaces being open; he doesn't mention community rates of transmission; he doesn't mention hospitalization rates; he doesn't mention demographic disparities. 
  3. accelerate vaccination and procurement. Sure, no argument
  4. "Distribute high-quality scientific information. Most important, educate teachers about the lower transmission risk of young students—and the ongoing necessity of COVID-19 protocols—to get their enthusiastic buy-in, which will naturally be contingent on our success at reducing community spread and accelerating vaccination."
 I darkly laughed at this last one. Every educator has solidly in their minds the 72 educators of the New York City public schools that had died of COVID by May. Most can cite many, many other cases of teachers who have sickened, and some who have died. That is the place where this work on "buy-in" needs to begin. There are districts that have done so successfully, but they have done so from a place of local community trust, which is the work of years.
And this piece does not mention anywhere else the reduction of community spread. It is difficult to take seriously his argument that this is a key point when it nowhere prior is noted. 

Moreover, if this piece is supposed to be the "high-quality scientific information" Thompson thinks is necessary, no wonder teachers don't trust it!

In his closing, Thompson says, "I don’t blame teachers for keeping schools closed yet."
How generous of him! Teachers, of course, are not the only ones who are in some cases advocating for school buildings being closed; schools of course are not. As noted over and again during the pandemic, there are major demographic differences in who wants their children back in buildings. That is not accidental. 
Thus his conclusion:
Americans have to learn, and accept, that the preponderance of evidence simply doesn’t support the fears that govern school policy today. not only wrong, as demonstrated above: it reveals a vast lack of understanding about school policy and the history of many groups--including teachers and families of color.

As author Noliwe Rooks noted earlier today:

 This piece is poorly sourced, badly edited, condescending in its conclusion, and marked in its privilege. It is not a piece that should drive any school policy.

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