Study of COVID-19 hospitalization rates may be best evidence yet for reopening schools, say researchers

Rachel Grumman Bender
·7 min read

A new study found that hospitalization rates of people diagnosed with COVID-19 did not go up in most — but not all — U.S. counties when schools reopened, suggesting it may be safe for more K-12 schools to return to in-person learning.

For the study, the researchers focused on hospitalization rates from January through the end of October 2020 (before the new, more contagious COVID-19 strain was identified in the U.S.) rather than positivity rates, deeming it a more reliable indicator of negative health outcomes. In counties where the total number of new COVID-19 hospitalization rates was below about 36 to 44 hospitalizations per 100,000 people per week before schools reopened, the study authors wrote that they found “no effect of in-person school reopening on COVID-19 hospitalization rates.”

Students attend school, with safety precautions, in Pennsylvania. A new study of hospitalization rates in counties where schools have reopened suggests in-person learning might be safer than previously thought.
A new study of hospitalization rates in counties where schools have reopened suggests in-person learning might be safer than previously thought. Here, students attend school, with safety precautions, in Pennsylvania. (Photo: Ben Hasty/MediaNews Group/Reading Eagle via Getty Images)

In counties with higher rates of COVID-19 hospitalizations (more than 36 to 44 hospitalizations per 100,000 people per week) before schools reopened, the researchers found inconsistencies — some data showed higher rates of COVD-19 hospitalizations after schools reopened, while other data found the opposite — and deemed it “inconclusive.”

The study authors wrote that there’s a trade-off to opening schools in these high-COVID-19 areas — namely, doing so might spread the virus, but they note that “school-age children seem less likely to transmit” or “suffer mortality” from the virus.

COVID-19 spread among college students poses a higher risk than those in K-12, the study points out, which could be an argument for keeping college campuses empty.
COVID-19 spread among college students poses a higher risk than those in K-12, the study points out, which could be an argument for keeping college campuses empty. (Photo: Al Seib / Los Angeles Times)

They also emphasize that returning to in-person school may “improve other health outcomes for students and their families in other ways,” including mental health and physical abuse (teachers are more likely to be the ones who report child abuse).

While the study authors called closing physical schools a “reasonable reaction to an uncertain and fluid pandemic,” they wrote that the decision compounds the “social and economic crisis in the short-term and the long-term.” They point out that remote learning has “forced many parents to leave the workforce or work from home while also supporting their children’s learning.”

“There are academic consequences that we're now well aware of, but also health consequences,” Douglas Harris, lead author of the study and professor and chair of the department of economics at Tulane University, tells Yahoo Life. “Children are more likely to suffer from mental illness, abuse and malnutrition. These health consequences from keeping schools closed need to be weighed against the consequences of possible COVID spread when schools are open in person.”

The study authors also draw a distinction between K-12 schools and colleges. They state that colleges are “apt to spread viruses, especially in residential colleges where students come from a distance and live in dormitories or other group housing.”

They add that “students are likely to bring the virus to campus with them, to spread the virus in dorms and social settings, and then to bring the virus back home during breaks and vacations. Multiple studies have shown increased COVID-19 positivity of college-age adults and in the general population living near colleges.”

Remote learning has “forced many parents to leave the workforce or work from home while also supporting their children’s learning." Here, 11-year-old twins are seen participating in remote learning in Boston.
Remote learning has “forced many parents to leave the workforce or work from home while also supporting their children’s learning." Here, 11-year-old twins are seen participating in remote learning in Boston. (Photo: Suzanne Kreiter/The Boston Globe via Getty Images)

Harris tells Yahoo Life that it’s “very likely safer” to reopen in-person K-12 schools “compared with residential colleges where students live on campus.”

“Young people in schools seem less susceptible to the virus, and they go home at the end of the day to their individual homes and apartments,” Harris adds. “But college students live in dorms, where the spread of viruses is hard to stop. Also, the indirect effects of keeping schools closed are worse — young adults in college can learn more remotely than young children can, and learning remotely doesn't require parents to cut their work hours the way it does with K-12 schools.”

Dr. Ashish K. Jha, dean of Brown University’s School of Public Health and former director of the Harvard Global Health Institute, told EdWeek in November 2020 that some school districts are being “too cautious” with school closures. “There’s no doubt in my mind that schools need to be bolder than they’re being. There is a large mental health cost to children. And we know this is going to very substantially widen the achievement gap between wealthier/white students and poorer/students of color. The effect is going to be felt for a very long time.”

Jha adds: “You always have to weigh those very large costs against the cost of going back to in-person education. Obviously, if going back to in-person education was going to lead to a lot of infections and deaths, you’d say, OK, that’s a cost we can’t bear. But districts that are being too cautious are doing enormous harm to children and families in their communities.”

However, Joshua Salomon, PhD, professor of medicine and director of the Prevention Policy Modeling Lab at Stanford University, says the decision to reopen schools is a complicated one. “I don’t think we can make blanket statements about whether it is safe or unsafe to open schools,” Salomon tells Yahoo Life. “There are risks to every activity that puts people in contact with others, and schools are no exception. There are also harms associated with keeping kids out of school for extended periods. So, decisions around school reopening require weighing of complicated tradeoffs.”

Salomon says there are some factors that affect the safety of schools reopening “that are beyond the control of school administrations, notably the level of infection risk in the community.” But Salomon adds there are steps schools can take to reduce the risks of transmission, including “mask requirements, classroom distancing and other infection control measures, schedule modifications and cohorting, vaccination, and frequent widespread testing.”

“With resources and planning, these mitigation measures can reduce risks of transmission within schools to levels that may be acceptable when weighed against the costs of keeping them closed,” Salomon says. “Without these mitigation measures, it is hard to imagine that schools can reopen safely in the context of the present surge.”

Dr. Grace Lee, professor of pediatrics specializing in infectious diseases at Stanford Medicine, agrees, telling Yahoo Life: “It’s all about risk mitigation." She adds, “We need multiple layers of protection. None are perfect, but if we stack them up, we can ensure the safety of kids and teachers. That means vaccines, masking, social distancing, cohorting/bubbles, environmental/engineering controls, hand hygiene, testing, contact tracing, etc. The difficulty is that most of these interventions rely on behaviors and require high adherence all of the time, which is hard to do. The nice thing about vaccines is that it’s two doses and 95 percent protection. So, it’s a layer of protection that is easier to achieve.”

Harris tells Yahoo Life the study provides “important new evidence about the public health consequences” of schools reopening, “showing that it's still safe in most counties, but not in others.” Harris hopes the report “helps our leaders see the trade-offs more clearly,” adding, “There are no ‘risk-free’ or perfect options, and we have to do the best we can in these difficult circumstances.”

For the latest coronavirus news and updates, follow along at https://news.yahoo.com/coronavirus. According to experts, people over 60 and those who are immunocompromised continue to be the most at risk. If you have questions, please reference the CDC’s and WHO’s resource guides.

Read more from Yahoo Life:

Want lifestyle and wellness news delivered to your inbox? Sign up here for Yahoo Life’s newsletter.