New York City public schools, the largest public school system in the country, closed this week, under orders by Mayor Bill de Blasio. As the early stages of the winter coronavirus surge begin to hit New York, rising from 1% to 3% test positivity rate, more than 700,000 of the over 1 million students who had been attending school are being sent home for remote learning for the foreseeable future. The mayor’s initial decree to open schools just weeks ago was considered a bold one, as New York had been last spring’s national epicenter of coronavirus infections, combined with the challenge of managing ongoing smaller outbreaks in a wide range of New York City neighborhoods. The second largest school system, in Los Angeles, never fully opened, but has and continues to have limited students with high needs attending school in-person throughout the city.
Parents in New York are outraged. While the city’s coronavirus test positivity rate has tripled in recent weeks, students, teachers, and staff have remained remarkably safe. Since October, there have been 140,000 coronavirus tests issued to students and staff. There have been 308 positive, with a test positivity rate of 0.23%. Indeed, schools may be safer spaces, not only with respect to academic learning, socialization, food provision, and reduced domestic abuse, but also as spaces to reduce the spread of Covid-19 infections. Rule-following is always prioritized in the classroom. Masks, physical distance, and hygiene practices have been ramped up, and students and teachers alike are more apt to abide by these while at school than while out and about.
While we have yet to know the long term impact of students being sent home just weeks after being back at school, investigators based at The University of Washington and UCLA published some concerning data about last spring’s school closures in this month’s JAMA. Much of our knowledge regarding Covid-19 will be based on hindsight assessments, as we are continuing to make best-guess decisions without having the luxury of known implications for outcomes. This group evaluated the potential impact on life expectancy of the precipitous nation-wide school closures in the spring of 2020. No, this was not measuring pediatric deaths in the spring. On the contrary, it was a modeling study predicting earlier mortality as adults based on educational time lost as children.
The effect of educational attainment on adult mortality was previously evaluated in 2013, where annual mortality rates were at record lows in the U.S. At that time, average life expectancy for women was 81 years, and 76 years for men (compared to 73 years and 66 years in 1960, respectively). The authors of the 2013 study found that there could be as much as a ten-year discrepancy in life expectancy based on educational background. The mortality of an individual who had not finished high school was four times higher by age 64 compared to a person who had a college education.
The playing field during the coronavirus pandemic has been anything but level, especially when it comes to education. Those with means have created learning pods, hired virtual tutors, had the means to have one parent not needing to work provide educational support at home, or had private school support with much more individualized attention. Some had the luxury to move out of state, or to other counties, in search of an open school system. But over 24 million elementary school children were at home last spring, with an average of 54 missed school days. Disruption in a child’s education, at any point, can lead to eventual reduction in educational attainment: averaging 3 to 4 months overall. While a few months of educational loss in the scheme of 16+ years of education may not seem like much, when scaled to an entire country’s population of children, it becomes significant.
According to the study’s model, using life expectancy and educational attainment data from the CDC, US Census Bureau, and the Social Security Administration, there will be 5.53 million years of life lost in our nation’s children as they enter middle and late adulthood. The mortality of coronavirus cases by the end of May 2020 was 88,241, which translates to 1.5 million years of life lost. Had schools remained open, with likely resultant increased spread of infections based on this study’s model, an additional 1.47 years of life lost may have occurred. While no life years should ever be unnecessarily lost, 5.53 million versus 2.97 million will be the difference we may see as our children become adults. While the authors of the JAMA study acknowledge significant limitations in such population-based modeling estimates, prior data supports the fact that higher educational attainment reduces mortality rates.
While millions of years lost to our future adults may be another nail in the worldwide coffin of coronavirus death news, the modeling methods are subject to speculation, not necessarily real outcomes. Only time (decades) will tell whether or not these projections carry any validity.
As we are now seeing that masks, social distance, hygiene, as well as reduced risk of transmission from children has substantially lowered risks of outbreaks in schools, gaining better understanding of the implications of school openings remains paramount. Not just to students, parents, and educators, but also to our nation’s potential for healthy adults in the future.