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COVID clusters and in-person learning; as cases rise can we keep our kids in school?

Read more at www.masslive.com

In Framingham, Superintendent Robert Tremblay said he has noticed something alarming: cases of coronavirus were starting to spread among students.

This fall, Massachusetts education officials have said schools are not leading to significant spread of the virus among children. But some districts, like Framingham and Billerica, have reported transmission they believe occurred in buildings.

“So for whatever the CDC might be saying or whatever the governor or the commissioner of education may be saying, that it’s safe to come back to school and schools are not the nexus of where spread is happening, we have evidence to the contrary in our community. And maybe we’re an anomaly, but it’s a concern and it’s one we have to be paying close attention to,” Tremblay said last week during a school committee meeting.

Cases and hospitalizations are rising across Massachusetts following Thanksgiving. With more holidays on the horizon, there is the potential for further spread of COVID if groups gather to celebrate. While one study from the UK indicated an apparent rise in coronavirus cases among school-aged children during England’s second lockdown, when schools remained open and most other places were closed, local health and education officials report that schools are not leading to large amounts of transmission.

“I feel pretty confident that the school setting, because of the precautions that are taken, is one of the safest places for kids compared to any other place they can be outside of their home,” said Christina Hermos, a pediatric infectious disease specialist at UMass Memorial Health Care. Schools in Massachusetts require students and staff to wear masks and keep a distance of at least 3 feet, though some schools are sticking to a standard of 6 feet touted by the CDC this year.

With all the precautions in place, students have been asked to stay home if they feel ill. In Framingham, there may be some parents sending children to school with symptoms or even known cases, the superintendent said.

“It’s alarming because I’ve become aware of situations where families are sending children to school potentially with known cases or known symptoms. That can’t happen,” Tremblay told school committee members.

The district has now switched to remote education through the start of January.

In Billerica, Superintendent Timothy Piwowar last month reported suspected in-school transmission at Billerica Memorial High School. There were two cases as of Nov. 16 and then two more the next day, to be followed by another seven cases. The school was shut down and a mobile testing unit was deployed.

After 221 tests were administered to students and staff on Nov. 24, there were zero positive results for the virus and the school was slated to reopen. The district is providing regular updates. Between Dec. 4 and Dec. 6, Piwowar announced 10 more positive cases but no evidence of in-school transmission.

Mobile testing and K-12 clusters of COVID

There are 76 active clusters of coronavirus identified among K-12 schools, according to a weekly report from the Massachusetts Department of Public Health. Those clusters included 145 confirmed cases.

Of the clusters, 29 were identified from Nov. 8 to Dec. 5. The other 47 were identified before Nov. 8 but have not yet met the criteria for closing. A cluster is considered closed after 28 days have passed since the last confirmed case.

School clusters include cases associated with a school where in-school transmission cannot be completely ruled out, officials said, although other transmission settings are considered more likely. While school-aged children have been infected with COVID-19, health officials say the bulk of those infections are not coming from spread in a school setting. Epidemiologic data points to more kids becoming infected outside of classrooms.

DPH assesses whether an in-school cluster has occurred based on information from the school and public health investigators, like the board of health or the Community Tracing Collaborative. Evidence of possible in-school transmission includes two or more cases that share a classroom or other school setting; timing between cases, as the average time between exposure and development of disease for COVID-19 is 5 days; and ruling out of other exposure settings, officials said.

Education officials have said through the fall that there is minimal evidence of in-school clusters. Local school districts can request mobile testing when they believe there is a COVID cluster within a school.

Education officials said the mobile response unit has been sent out to, or is heading to, more than a dozen communities for testing: Milton on Oct. 8; Lawrence on Oct. 11 and 12; Malden on Oct. 23; Acton Boxboro on Oct. 23; Braintree on Oct. 24; Rockland on Oct. 27; St. Columbkille in Brighton on Oct. 29; CATS Academy in Braintree on Nov. 9; Southwick on Nov. 13; Haverhill on Nov. 13; Worcester on Nov. 13; Winchester on Nov. 18; Billerica on Nov. 24; Marshfield on Dec. 1; Lynnfield on Dec. 7; Hudson on Dec. 10; and to Hingham and the Ivy School in Brookline at dates not determined as of Tuesday.

In September, when schools were getting back into session, young people ages 0 to 19 accounted for 16% or 17% of COVID cases, according to DPH data. That figure rose to 20% in late September and one week in October, but was back at 16% as of the week of Nov. 22 and is at 17% for the week of Nov. 29.

In Massachusetts, roughly 450,000 students and 75,000 staff members are currently in public school buildings during the pandemic. Officials said last month that 77% of districts have some form of in-person learning while 23% are remote as the pandemic continues.

Of those students and staff members who have recently been in school buildings, weekly reports of coronavirus cases have remained somewhat steady until this week. On Thursday, the Department of Elementary and Secondary Education announced positive cases among 503 students and 420 staffers from Dec. 3 to 9, a significant increase compared to previous weeks.

From Nov. 26 to Dec. 2, there were cases among 276 students and 251 staffers. From Nov. 19 to 25, there were positives among 276 students and 206 staffers. That was a dip compared to Nov. 12 to 18, when 398 students and 254 staffers were reported to have tested positive.

Though DESE is not reporting the number of coronavirus cases among remote learners, some districts are collecting that information. In Worcester, Superintendent Maureen Binienda told school committee members on Dec. 3 that from Sept. 10 to Dec. 2, there have been 103 students and 72 staff members with COVID.

However, that number of student cases may not be accurate. The student cases are self-reported, Binienda noted, and it’s possible that some students have tested positive and have not informed the district.

With a disease that can be asymptomatic, it’s possible that some children have been positive and have not known.

“That’s what the precautions are really in place to prevent,” Hermos, the UMass Memorial pediatric infectious disease specialist, said. “An asymptomatic child with a mask, with appropriate distancing and those other mitigation strategies should be at extremely low risk of transmitting. We’ve had multiple classes quarantine because of close contacts and the transmission, even in those close contacts, is extremely low in that school setting, even with symptomatic kids, so it’s likely even lower with asymptomatic kids.”

Hermos said her feeling is that in-school spread is very low, particularly with students in kindergarten through fifth grade. Percentages of positive tests among children from infancy to 19 years old can be skewed by the behaviors of high school-aged kids, who are more likely to play high-risk sports and engage in social activities than their younger peers, she said.

With cases rising across the state, Hermos said it is more likely that students are getting sick from a family member rather than from each other.

“If you have very low rates in the community and you have two [positive] children in the same classroom, then the chances that those are linked is much higher,” she said. “But when you have very high rates in the community, it becomes unlikely that those two cases are linked. In addition, we need to follow whether you can identify who that child got it from.”

With cases surging in Massachusetts, contact tracers are overwhelmed.

Other states, countries report in-school spread

While other parts of the nation and world are seeing spread in schools, most say that transmission in classrooms is less significant than other areas of spread.

Other states have also reported clusters of cases connected to schools. In New Jersey, 285 students, teachers and school staff had contracted or spread the virus at school since late August, according to NJ.com.

New York Gov. Andrew Cuomo in an opinion article for Newsday wrote that after hundreds of thousands of COVID-19 tests in the state’s schools, infection rates in schools are less than 3% on average. Even in areas where community spread is more than 5.3%, school infection rates are lower. Cuomo said that in Massapequa Park, there is a community infection rate of 6.6%, but a school rate of 3.5%.

A recent study from the Imperial College in London indicated that during England’s second national lockdown in response to the pandemic, there was a roughly 30% reduction in virus prevalence overall. Despite downward trends for most age groups, the study showed apparent increased rates among school-aged children.

“We note that, in contrast with the first national lockdown in England, schools remained open during this period,” the study reads.

A study from The Lancet, published Tuesday, showed outbreaks were uncommon in educational settings during the summer half-term, from June to July, in England.

Hermos said there’s much more data about coronavirus spread now compared to earlier this spring, and that schools not only are safe for children but also more beneficial for kids’ mental health.

“It was the right thing to do to shut the schools back in March,” Hermos said. ”But we have examples all around the world where if adults can behave and not congregate, then the children can safely be in school with the mitigation strategies.”

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