chuka_lis (chuka_lis) wrote,

Непростые решения

"Проблемная" научная статья о том, какие факторы важно учитывать,  при оценивании перспектив возврата школьников к учебе на
кампусах, в контексте влияния на эпидемическую ситуацию в округе.
С точки зрения авторов, стоит учитывать, что открытие школ, даже частичное, и с соблюдением реально возможных противоэпидемичных мер,  приведет к увеличению случаев ковида. Что в школе, что в семьях школьников (и сотрудников школы) что в комьюнити.
Факторы, определяющие, на сколько мощным будет вклад возвращения студентов в школу в общую эпидемическую картину, это:
1) базовая распространенность вируса в обществе и местные особенности выполнения рекоемндуемых противоэпидемических мер,
2) наличие возможностей обширного и регулярного тестирования и отслеживания контактов (ну и изоляции),
3) популяционные особенности локальной комьюнити ( количество и плотность школьников в округе, возрастная структура комьюнити, плотность населения, "здоровость" населения, расово-этнический состав.

There is broad agreement that school closures involve heavy burdens on students, parents, and the economy, with profound equity implications, but also that the risk of outbreaks cannot be eliminated even in a partial reopening scenario with in-school precautions. Consensus largely ends there, however: the approaches states and localities have taken to integrating these concerns into school reopening plans are highly variable.

This variability is driven partly by differences in values and priorities. More concerning is that it may reflect inattention to or underweighting of key epidemiological considerations. In particular, the intense focus of school reopening discussions on in-school mitigation measures has tended to underplay relevant features of the surrounding community and the relationship between school and community transmission of COVID-19. To succeed, school reopening efforts must account for salient characteristics of the communities within which schools are embedded and engage with fundamental questions regarding intergenerational risk and benefit tradeoffs.

Three community considerations are especially important. First, school reopening increases the risk of transmission within schools but also within households, workplaces, and the community at large. Second, community disease prevalence affects in-school transmission risk, and third, other community characteristics drive the potential impact of increased spread. We elaborate on each of these considerations.

First, a recent modeling study1 from the United Kingdom suggests that school reopening increases out-of-school transmission because students and staff mix with others and because reopening increases parents’ mixing as they return to work and spend more time outside the home. Based on assumptions about the magnitude of these changes, the modelers estimated that unless accompanied by a community-wide test-and-trace strategy, school reopenings would contribute substantially to a large subsequent wave of COVID-19 cases. In parts of the United States where baseline prevalence is higher, such effects may be worse.

Second, a recent multicountry review2 concluded that the effects of school reopening on disease transmission depend heavily on prevalence in the surrounding community
Finally, research suggests that other community characteristics are pivotal to the health effects of school reopening. The array of community mitigation measures in place and the strength of adherence to those measures are critical. Foreign experience shows that successfully maintaining in-person schooling depends on the success of measures taken in the wider community, including masking and closure of certain work and recreational facilities.2 In our modeling of California counties that have experienced declining COVID-19 incidence, when both in-school and community mitigation measures are in place and largely followed, school reopenings still increase incidence in the community, but the increases are relatively small and do not spark widespread epidemic growth; by contrast, substantially wider community spread is estimated when reopening occurs amid relaxed mitigation measures.

A community’s age structure is another important factor. Transmission risks increase with the size and density of the school-aged population, and older individuals experience more severe disease when infected. This means that, other factors being equal, communities with relatively large school-aged population proportions, relatively large elderly population proportions, or both face higher risk from school reopening.
Other relevant characteristics that differ across communities include population density, race/ethnic composition, and the prevalence of comorbidities known to elevate the risk of severe disease. These factors appear to have had little or no prominence in local discussions about reopening schools.

In sum, a decision-making framework for in-person learning should start with a threshold requirement of strong in-school mitigation measures and then give closer consideration to several factors operating beyond the school gates—namely, looking for flat or declining community incidence over a defined period and demonstrated willingness to implement and enforce community mitigation measures (eg, social distancing, masking). Additionally, the framework should include consideration of distinctive local characteristics that influence community transmission and risk of severe disease.
Tags: коронавирус, статьи, эпидемия

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