5 Key Questions to Consider Before Sending Your Child Back to School
[Editor's Note: This essay is in response to our current Big Question, which we posed to several experts: "Under what circumstances would you send a child back to school, given that the virus is not going away anytime soon?"]
It is August. The start date of school is quickly approaching. Decisions must be made about whether to send our children back. As a physician, a public health researcher, and the mother of two school-aged children, I have few clear answers.
To add insult to injury, a spate of recent new data suggests that - as many of us suspected all along - kids are susceptible to COVID-19, they transmit COVID-19, and they can get really sick from COVID-19.
Let me start with the obvious. My kids, and all kids, deserve a safe, in-person school year. We know the data on the adverse effects of school closure on kids, particularly for those who are already vulnerable. I also know, on a personal level, that distance learning is no substitute for in-person schooling. Homeschooling may be great for those with the privilege to do it, but I - like many Americans - am unable to quit my job, and children need more than a screen to learn.
Moreover, safe school reopening should not be an impossible dream. I and many other physicians, teachers, and scientists have described the bare minimum that we need to safely reopen schools: a stable, low rate of COVID-19 in the community; funding and mandates for basic public health precautions (like universal masking and small, stable classes) in the schools; and easy access to testing for kids and teachers. This has been achieved, successfully, in other countries.
Unfortunately, the United States has squandered its opportunity to do right by families. Across our country, rates of COVID-19 are rising. Few states have been able to sustain a test positivity rate of less than 5 percent - the maximum that most of us, in the public health world, would tolerate. Delays in testing are rampant. Systemic under-funding of public schools means that many schools simply can't afford to put basic public health measures in place. Worst, science denialism (and the spread of quack conspiracy theories online) means that many communities are fighting even the most basic of safety precautions.
To add insult to injury, a spate of recent new data suggests that - as many of us suspected all along - kids are susceptible to COVID-19, they transmit COVID-19, and they can get really sick from COVID-19. This data increases the risk calculus. Our kids are not immune, and neither are we.
Given that the necessary societal interventions simply have not happened, most American families are therefore left making an individual choice: do I send my kid to school? Or not? There are five key questions for parents to ponder when making the difficult choice about what to do.
First, we must look at our community. Knowing that testing is difficult to obtain, a true estimate of community prevalence of COVID-19 is nearly impossible. But with a test positivity rate of more than 5 percent, it's safe to assume that in a school of 500 people, at least 1 will be positive for COVID-19. That is too high for safety. Whether or not the local government does the right thing, I would not send my child to in-person school if my community had these high rates of test positivity.
Second, we must look at our school district's policies. Will the school mandate masks? Are they cohorting students and teachers in small, stable groups? Do they have contact tracing and isolation policies in place for when a student or teacher inevitably tests positive? Do they have procedures to protect vulnerable teachers and staff? If not, I would not send my child to school. If the district is doing all of the above, I would consider it.
Third, we must look at the health profile of our own kids and families. If my child had chronic medical issues, or if I lived with my elderly parents or were myself at high risk of severe disease, I would not send my child to in-person school.
It is therefore unlikely that schools anywhere in the U.S. will be open by October.
Fourth, we must do the difficult, ethical weighing of the non-zero risk of infection (even in the safest communities) with the needs of our children. Even in low-prevalence states, there will be infections in the school setting. That said, the small risk of a severe infection may be outweighed by the social, emotional, and financial risk of keeping a child home. This decision must be made on a family-by-family basis. I know my answer; but I cannot provide this answer for others.
Finally, we must call attention to the fact that many kids and families have no options. There are far too many American children who literally depend on their school system for physical, nutritional, emotional, and academic safety. There are too many parents who have no way to earn an income and keep their kids safe without in-person learning. If anyone deserves to be prioritized for in-person schooling, it should be them. (And yes, we should also work to fix the social safety net that leaves these children high and dry.)
As I write this on August 2nd, 2020, I am planning to send my two children back to our public schools for in-person education. We have low rates of infection in our community, we have masking and stable cohorts in place, and my family is relatively healthy. We also depend on the schools to keep my children safe and engaged while I'm working in the ER! I will not hesitate, however, to pull my children out of school should any of these considerations change, if local test positivity rates go up, or if my children report that masking is not the norm in the classroom.
And sadly, I expect that this discussion will soon be a moot point. We continue to fail as a nation at basic public health policies. It is therefore unlikely that schools anywhere in the U.S. will be open by October. Our country has not shown the willpower to control the virus, leaving us all with, literally, no choice to make.
[Editor's Note: Here's the other essay in the Back to School series: Masks and Distancing Won't Be Enough to Prevent School Outbreaks, Latest Science Suggests.]
Story by Big Think
Our gut microbiome plays a substantial role in our health and well-being. Most research, however, focuses on bacteria, rather than the viruses that hide within them. Now, research from the University of Copenhagen, newly published in Nature Microbiology, found that people who live past age 100 have a greater diversity of bacteria-infecting viruses in their intestines than younger people. Furthermore, they found that the viruses are linked to changes in bacterial metabolism that may support mucosal integrity and resistance to pathogens.
The microbiota and aging
In the early 1970s, scientists discovered that the composition of our gut microbiota changes as we age. Recent studies have found that the changes are remarkably predictable and follow a pattern: The microbiota undergoes rapid, dramatic changes as toddlers transition to solid foods; further changes become less dramatic during childhood as the microbiota strikes a balance between the host and the environment; and as that balance is achieved, the microbiota remains mostly stable during our adult years (ages 18-60). However, that stability is lost as we enter our elderly years, and the microbiome undergoes dramatic reorganization. This discovery led scientists to question what causes this change and what effect it has on health.
Centenarians have a distinct gut community enriched in microorganisms that synthesize potent antimicrobial molecules that can kill multidrug-resistant pathogens.
“We are always eager to find out why some people live extremely long lives. Previous research has shown that the intestinal bacteria of old Japanese citizens produce brand-new molecules that make them resistant to pathogenic — that is, disease-promoting — microorganisms. And if their intestines are better protected against infection, well, then that is probably one of the things that cause them to live longer than others,” said Joachim Johansen, a researcher at the University of Copenhagen.
In 2021, a team of Japanese scientists set out to characterize the effect of this change on older people’s health. They specifically wanted to determine if people who lived to be over 100 years old — that is, centenarians — underwent changes that provided them with unique benefits. They discovered centenarians have a distinct gut community enriched in microorganisms that synthesize potent antimicrobial molecules that can kill multidrug-resistant pathogens, including Clostridioides difficile and Enterococcus faecium. In other words, the late-life shift in microbiota reduces an older person’s susceptibility to common gut pathogens.
Viruses can change alter the genes of bacteria
Although the late-in-life microbiota change could be beneficial to health, it remained unclear what facilitated this shift. To solve this mystery, Johansen and his colleagues turned their attention to an often overlooked member of the microbiome: viruses. “Our intestines contain billions of viruses living inside bacteria, and they could not care less about human cells; instead, they infect the bacterial cells. And seeing as there are hundreds of different types of bacteria in our intestines, there are also lots of bacterial viruses,” said Simon Rasmussen, Johansen’s research advisor.
Centenarians had a more diverse virome, including previously undescribed viral genera.
For decades, scientists have explored the possibility of phage therapy — that is, using viruses that infect bacteria (called bacteriophages or simply phages) to kill pathogens. However, bacteriophages can also enhance the bacteria they infect. For example, they can provide genes that help their bacterial host attack other bacteria or provide new metabolic capabilities. Both of these can change which bacteria colonize the gut and, in turn, protect against certain disease states.
Intestinal viruses give bacteria new abilities
Johansen and his colleagues were interested in what types of viruses centenarians had in their gut and whether those viruses carried genes that altered metabolism. They compared fecal samples of healthy centenarians (100+ year-olds) with samples from younger patients (18-100 year-olds). They found that the centenarians had a more diverse virome, including previously undescribed viral genera.
They also revealed an enrichment of genes supporting key steps in the sulfate metabolic pathway. The authors speculate that this translates to increased levels of microbially derived sulfide, which may lead to health-promoting outcomes, such as supporting mucosal integrity and resistance to potential pathogens.
“We have learned that if a virus pays a bacterium a visit, it may actually strengthen the bacterium. The viruses we found in the healthy Japanese centenarians contained extra genes that could boost the bacteria,” said Johansen.
Simon Rasmussen added, “If you discover bacteria and viruses that have a positive effect on the human intestinal flora, the obvious next step is to find out whether only some or all of us have them. If we are able to get these bacteria and their viruses to move in with the people who do not have them, more people could benefit from them.”
This article originally appeared on Big Think, home of the brightest minds and biggest ideas of all time.
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Embrace the mess: how to choose which scientists to trust
It’s no easy task these days for people to pick the scientists they should follow. According to a recent poll by NORC at the University of Chicago, only 39 percent of Americans have a "great deal" of confidence in the scientific community. The finding is similar to Pew research last year showing that 29 percent of Americans have this level of confidence in medical scientists.
Not helping: All the money in science. Just 20 percent of Pew’s survey respondents think scientists are transparent about conflicts of interest with industry. While this issue is common to many fields, the recent gold rush to foot the bill for research on therapies for healthy aging may be contributing to the overall sense of distrust. “There’s a feeling that at some point, the FDA may actually designate aging as a disease,” said Pam Maher, a neuroscientist who studies aging at Salk Institute. “That may be another impetus for a lot of these companies to start up.”
But partnering with companies is an important incentive for researchers across biomedical fields. Many scientists – with and without financial ties and incentives – are honest, transparent and doing important, inspiring work. I asked more than a dozen bioethicists and researchers in aging how to spot the scientists who are searching for the truth more than money, ego or fame.
Avoid Scientists Who Sound Overly Confident in messaging to the public. Some multi-talented scientists are adept at publishing in both top journals and media outlets. They’re great at dropping science without the confusing jargon, in ways the public can enjoy and learn from.
But do they talk in simple soundbites, painting scientific debates in pastels or black and white when colleagues use shades of gray? Maybe they crave your attention more than knowledge seeking. “When scientists speak in a very unnuanced way, that can be irresponsible,” said Josephine Johnston, a bioethicist at the Hastings Center.
Scientists should avoid exaggerations like “without a doubt” and even “we know” – unless they absolutely do. “I feel like there’s more and more hyperbole and attention seeking…[In aging research,] the loudest voices in the room are the fringe people,” said the biogenerontologist Matt Kaeberlein.
Separate Hype from Passion. Scientists should be, need to be passionate, Johnston explained. In the realm of aging, for example, Leonard Guarente, an MIT biologist and pioneer in the field of aging, told me about his belief that longer lifespans would make for a better world.
Instead of expecting scientists to be lab-dwelling robots, we should welcome their passion. It fuels scientific dedication and creativity. Fields like aging, AI and gene editing inspire the imaginations of the public and scientists alike. That’s not a bad thing.
But it does lay fertile ground for overstatements, such as claims by some that the first 1,000-year-old has already been born. If it sounds like sci-fi, it’s probably sci-fi.
Watch Out for Cult Behavior, some experts told me. Follow scientists who mix it up and engage in debates, said NYU bioethicist Arthur Caplan, not those who hang out only with researchers in the same ideological camp.
Look for whether they’re open to working with colleagues who don’t share their views. Through collaboration, they can resolve conflicting study results and data, said Danica Chen, a biologist at UC Berkeley. We should trust science as long as it doesn’t trust itself.
Messiness is Good. You want to find and follow scientists who’ve published research over the years that does not tell a clean story. “Our goal is to disprove our models,” Kaeberlein said. Scientific findings and views should zig and zag as their careers – and science – progress.
Follow scientists who write and talk publicly about new evidence that’s convinced them to reevaluate their own positions. Who embrace the inherent messiness of science – that’s the hallmark of an honest researcher.
The flipside is a very linear publishing history. Some scientists have a pet theory they’ve managed to support with more and more evidence over time, like a bricklayer gradually, flawlessly building the prettiest house in the neighborhood. Too pretty.
There’s a dark side to this charming simplicity: scientists sometimes try and succeed at engineering the very findings they’re hoping to get, said Charles Brenner, a biochemist at City of Hope National Medical Center.
These scientists “try to prove their model and ignore data that doesn’t fit their model because everybody likes a clean story,” Kaeberlein said. “People want to become famous,” said Samuel Klein, a biologist at Washington University. “So there’s always that bias to try to get positive results.”
Don’t Overvalue Credentials. Just because a scientist works at a top university doesn’t mean they’re completely trustworthy. “The institution means almost nothing,” Kaeberlein said.
Same goes for publishing in top journals, Kaeberlein added. “There’s an incentive structure that favors poor quality science and irreproducible results in high profile journals.”
Traditional proxies for credibility aren’t quite as reliable these days. Shortcuts don’t cut it anymore; you’ve got to scrutinize the actual research the scientist is producing. “You have to look at the literature and try to interpret it for yourself,” said Rafael de Cabo, a scientist at the National Institute on Aging, run by the U.S. National Institutes of Health. Or find journalists you trust to distill this information for you, Klein suggested.
Consider Company Ties. Companies can help scientists bring their research to the public more directly and efficiently than the slower grind of academia, where “the opportunities and challenges weren’t big enough for me,” said Kaeberlein, who left the University of Washington earlier this year.
"It’s generally not universities that can take technology through what we call the valley of death,” Brenner said. “There are rewards associated with taking risks.”
Many scientists are upfront about their financial conflicts of interest – sometimes out of necessity. “At a place like Duke, our conflicts of interest are very closely managed, said Matthew Hirschey, who researchers metabolism at Duke’s Molecular Physiology Institute. “We have to be incredibly explicit about our partnerships.”
But the willingness to disclose conflicts doesn’t necessarily mean the scientist is any less biased. Those conflicts can still affect their views and outcomes of their research, said Johnston, the Hastings bioethicist.
“The proof is in the pudding, and it’s got to be done by people who are not vested in making money off the results,” Klein said. Worth noting: even if scientists eschew companies, they’re almost always financially motivated to get grants for their research.
Bottom line: lots of scientists work for and with companies, and many are highly trustworthy leaders in their fields. But if a scientist is in thick with companies and checks some of the other boxes on this list, their views and research may be compromised.