Matt Strauss: We can't protect the elderly by closing schools

We need to protect the most vulnerable instead of placating the most anxious.

By: Matt Strauss

Critics of my last piece on the nominal risk to children posed by COVID-19 were pointed; as sophisticated news readers, they know full well that COVID-19 poses almost no risk whatsoever to elementary-aged schoolchildren.

I’m glad we agree.

The droves of anxious parents who have asked me about their children’s safety are evidently not subscribed to The Line. My critics have noted, correctly, that the real risk of school re-opening is the danger posed to the lives of elderly and immuno-compromised members in their families and communities. 

As an ICU doctor, it has been my life’s work to save the lives of sick elders. But I must say that this particular objection about school reopening fails to consider the values of the elders involved. It also fails as a matter of public health practicality.

Even if it were possible to fully stop transmission of COVID-19 by keeping children out of physical classrooms for as many years that it will take to discover, validate, license, produce, and distribute an effective vaccine — how much health, education and development would we be willing to deprive them of while we wait? (By way of benchmark, four years passed between the discovery of the Ebola vaccine and its widespread deployment.)

This is not a question that infectious disease epidemiologists or vaccine biologists can answer. Scientists answer questions about facts. This is a question of values.

I have a hard time finding grandparents who think it's reasonable or fair to demand their young grandchildren remain sequestered in their homes — or forced to make do with half-assed virtual education — for the foreseeable future. But even if we did live in a society in which elders prioritized their own longevity ahead of their grandchildren’s well-being, disrupting schooling would still be an inefficient way to protect them.

It is an edict of Public Health 101 to direct most health resources to the places where they can help the most people. We prescribe HIV-prevention drugs to people who engage in high risk behaviours like IV drug use — not to high school seniors on their first date. We screen every pregnant woman for syphilis because the consequences of an untreated infection can be devastating to a fetus in utero. We don't do the same for elders. 

Matt Gurney of the National Post rebutted my earlier column by criticizing the provincial government's handling of school re-openings. And on some specific points, I agree with him. But he also called for mask-mandates, smaller cohorts and aggressive retrofitting to prevent spread of COVID-10 in schools. In an ideal world, these would be good recommendations, and I agree with every single one — to be applied in nursing homes and hospitals, where the truly vulnerable are congregated. 

Remember, that we do not enjoy limitless resources. We have to allocate our time, energy, and money in a way that will most effectively protect those who are most at risk. Every dollar spent retrofitting a classroom is a dollar not being spent retrofitting a long-term care home. Right now, if your elderly mother is admitted to almost any hospital in Canada with a hip fracture, she is likely to be housed in a four-bed room with three strangers who could be asymptomatic carriers of COVID-19. That is where we need to focus our efforts — not on placating anxious and vocal parents by installing expensive and questionably useful infrastructure in schools.

Gurney further lays out his concerns with the state of school re-openings, thusly:

"The choice is this: I can send my children to school, which they will benefit immensely from, or I can maintain a somewhat normal life with my extended family with reasonable confidence that I am not putting them in danger. I can't do both of these things at once." 

Well, yeah. 

If you're sending your children to school, you may have to reduce or restrict access to other vulnerable members of your family. For many people, that will be a tough call. But it's a difficult call that families can only make if the schools remain open in the first place. 

While the decisions might be difficult at the individual level, from the perspective of our society as a whole, they're really not. The risk to children's mental health, their long-term educational prospects, and the consequences for class mobility and female equality, all will be severely impaired if we allow schools to close — or even to be significantly disrupted — for long periods of time. 

Of course, it is sad to imagine your children not being able to kiss their grandmother’s cheek on their biweekly visit. But is this more or less sad than your child not being able to play hide-and-go-seek or softball with their classmates for years on end?

The literature to date on how COVID-19 is spread in children is mixed. Some studies suggest that children over the age of 10 spread the virus effectively — which increases the justification for more remote learning for older children who can stay at home. On the other hand, children under the age of 10 do not appear to spread the virus as well. This rapid review of the limited evidence so far compiled by McMaster University’s School of Nursing noted two key findings; first that young children were not a major source of transmission within the community. Further, that children who did test positive from COVID-19 were more likely to have become infected in the community or in their homes, rather than via schools or daycare. In short, elementary schools and daycares seem to reflect the state of community spread more than they contribute to it.

But all of these analyses are preliminary. We can’t know for certain how the next few months are going to go. We’re all making best guesses based on limited data and shifting assessments of relative risk.

In the meantime, I would be delighted if those claiming to have vulnerable elders' interest at heart focused their efforts where it was most likely to matter.

Matt Strauss is a critical care and internal medicine specialist who practices in Ontario.

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