Closing schools saved lives during the Spanish flu. Can this work for coronavirus?

As education and public health officials in the United States debate the pros and cons of closing schools to slow the spread of the novel coronavirus, the Italian government Wednesday joins the governments of Japan and Hong Kong to close schools in response to the spread of COVID-19.

Widespread school closures seem an unlikely scenario in the United States at this point, especially when decisions are left to local authorities and any decision to close schools for an extended period would result in high costs to communities.

But what can research on previous pandemics tell school leaders and health authorities about what to do when weighing the costs and benefits of school closures?

A report on the local government’s response to the 1918 Spanish flu contains valuable lessons, according to researchers from the Center for the History of Medicine at the University of Michigan Medical School.

Closing American schools earlier and longer lessened the impact of the Spanish flu in 1918, said J. Alexander Navarro, co-author of the 2007 study and deputy director of the center. During this global pandemic, at least 50 million people have died worldwide, including 675,000 in the United States, according to the Centers for Disease Control and Prevention.

Navarro and other researchers studied how 43 cities across the country responded to the Spanish flu from 1918 to 1919. They found that cities that adopted “non-pharmaceutical interventions,” or NPIs, early on, such as shutting down schools or banning public gatherings, had lower peak mortality and lower overall morbidity than cities that waited longer to do so.

Most cities have “layered” different interventions. For example, the first line of defense was often self-isolation for infected people or quarantine. Closing schools, Navarro said, generally only becomes necessary after it is impossible to track how each victim became infected. A total of 40 of 43 cities closed schools at some point during the outbreak.

School closures are “one of the most helpful NPIs” a city can adopt, he said. One of the reasons is that people are already used to schools closing periodically. “People are used to schools being closed on snow days for a few days,” he said. “Longer school closures can be problematic, but if you immediately opted for bans on public gatherings…I think that would be too socially upsetting.”

In China, where COVID-19 was first detected, the government has enforced strict “social distancing” policies, such as closing schools, closing businesses and ordering residents to stay at their home. These measures, while drastic, are helping to drive down the number of new cases in China, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told the Los Angeles Times. Wednesday.

The ‘delicate balance back’ of school closures

But deciding to close schools is a “tricky balancing act,” Navarro said, more so now than 100 years ago when, for example, it was far less common for mothers to work outside the home. home.

“A lot of students across the country get free or discounted lunches at school and so that’s a major source of nutrition, as well as daycare basically,” he said.

“If you take that away, how do you feed these kids?” Navarro added. “How do we give them somewhere safe and secure to be when public gatherings may not be safe from a public health perspective?”

Extended shutdowns would be a major disruptor to children’s learning, even in districts that may be equipped to roll out online or distance learning programs.

Ideally, schools could even close proactively, that is, before a case is even reported among the student body, according to Nicholas Christakis, a sociology professor at Yale University.

“Reactive school closure, while rational and helpful, is not enough,” Christakis wrote on Twitter. “In my opinion, schools should be closed *before* the first case in a school, when cases appear in the community or in neighboring areas. It is not free of charge. But waiting reduces the benefits of #schoolclosure.

Navarro agreed, but noted that closing a school proactively is a “hard thing to do.”

“It’s hard to tell a community that sees no cases or very few cases circulating in the wider community, maybe none in the schools, to say ‘yes, we need you to close, and we are going to close all these schools for a long time,” Navarro said. “It’s very upsetting for parents and children.”

Navarro noted some caveats about applying the lessons of 1918 directly to the present, including changes in American civic culture. Declining trust in government and a partisan political process could contribute to causing people to question the judgment of public health officials.

Historical context also played a role, according to Navarro.

“One of the things that’s important to remember when talking about 1918 is that the United States was in the middle of the Great War, World War I, and so there was a huge feeling of hyper-patriotism,” Navarro said. “There was this feeling of ‘do whatever you can for the war effort.’ And when the flu pandemic hit, that also turned into a pandemic effort.

Additionally, there are now legal concerns about who has the authority to close schools. James G. Hodge, Jr., a professor at Arizona State University, said that “legal authority at the state level to close schools is ambiguous”.

“I can’t stress enough that closing schools isn’t like turning a light switch on or off,” Hodge said in a previous interview with Education Week.

Still, Navarro pointed out that following other illnesses like the H1N1 flu in 2009, many school officials gave more thought to how to carry out a widespread school closure.

“It’s been done before,” Navarro said. “It’s more problematic if it’s done on a large scale for longer, but it’s something that officials have certainly thought about.”

Edward K. Thompson